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NOTICES OF PRIVACY PRACTICES AND AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION - River City Church Biblical Counseling.

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.
While River City Church (RCC) Biblical Counseling is not directly responsible for maintaining or providing access to your health information, we are providing this Notice of Privacy Practices to explain how we may use or share your information from your Designated Record Set. This notice also explains some of the responsibilities of our Biblical Counselors as they relate to your health information.

The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please contact River City Church at 2102 8th Street, Lewiston, ID 83501.

UNDERSTANDING YOUR MENTAL HEALTH SERVICES RECORD AND INFORMATION
When you complete an intake form on our website, personal health information (PHI) is collected, and when you schedule an appointment, the PHI is shared with a Biblical Counselor within our ministry. RCC Biblical Counseling may use and/or disclose your PHI collected to:

• provide information for medical research
• provide information to public health officials
• comply with legal requirements to release your mental health services record
  Understanding what is in your record and how your health information is used helps you to:
• ensure it is accurate
• better understand who may access your health information
• make more informed decisions when authorizing disclosure to others

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.

• Reminders. We may contact you to provide appointment reminders.
• As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
• Reporting. Federal and state laws may require or permit RCC’s Biblical Counseling Ministry to disclose certain health information related to the following:
• Public Health Risks: We may disclose health information about you for public health purposes, including:
• Prevention or control of disease, injury or disability
• Reporting births and deaths;
• Reporting child abuse or neglect;
• Reporting reactions to medications or problems with products;
• Notifying people of recalls of products;
• Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease;
• Notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
• Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
• Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
• Reporting Abuse, Neglect or Domestic Violence: Notifying the appropriate government agency if we believe a patient has been the victim of abuse, neglect or domestic violence.
• Law Enforcement. We may disclose health information when requested by a law enforcement official:
• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at RCC’s Biblical Counseling Ministry; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
• National Security and Intelligence Activities. We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.  To obtain a paper copy of this Notice, contact River City Church at 2102 8th Street, Lewiston, ID 83501.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our website. The Notice will specify the effective date on the first page. In addition, if material changes are made to this Notice, the Notice will contain an effective date for the revisions and copies can be obtained by contacting River City Church at 2102 8th Street, Lewiston, ID 83501.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with RCC Biblical Counseling with the Secretary of the Department of Health and Human Services. To file a complaint with RCC Biblical Counseling, contact River City Church at 2102 8th Street, Lewiston, ID 83501. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

BIBLICAL COUNSELING INTAKE FORM