HIPAA Notice: Southwest EAP



This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Note: The EAP does not release information to insurance companies, nor do we collect medical information on you; we are a separate individual service provided to you by your company. All information obtained by the EAP remains in our offices.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your therapist, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay for your EAP sessions, to support the operation of the EAP, and any other use required by law.

Treatment:  We will use and disclose your protected health information to provide, coordinate, or manage your counseling and any related services. This includes the coordination or management of your health care with a third party. For example, we may disclose information about your current therapy to a drug and alcohol treatment center if you are referred to them for more extended care under the case management of the EAP.

Payment: Your protected health information will be used, as needed, to obtain payment for your EAP sessions. For example, your demographics information may be released to the EAP by your therapist to prove use of the EAP.

EAP Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your EAP. These activities include, but are not limited to, quality assessment activities, EAP review activities, training of staff, and conducting or arranging for other business activities. For example, your protected health information may be disclosed to the EAP by the EAP therapist in order to receive payment. We may use or disclose your protected health information, as necessary, to contact the therapist to confirm the EAP referral and to receive your appointment dates.

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500. (Note that some of the above do not apply to EAP services).

Other Permitted and Required Uses and Disclosures Will Be Made Only with Your Consent, Authorization or Opportunity to Object unless required by law. For example, in the case of a supervisor referral we will ask that you sign an authorization form that will allow the therapist to disclose recommendations, progress in treatment and attendance to the EAP; this release will then allow the EAP to report attendance and compliance with recommendations to your supervisor.

You may revoke this authorization, at any time, in writing, except to the extent that your EAP or therapist has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights

Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Under normal practice of the EAP we only discuss protected health information with the therapist and you, the client, unless an authorization has been signed.

Your EAP is not required to agree to a restriction that you may request. If the EAP believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to not use the EAP.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You may have the right to have your EAP amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.


You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before September 14, 2003.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our Main Phone Number.