Privacy Policy
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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 of mental health or condition and related health care services.
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 your health care bills, to support the operation of the therapy practice and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your mental health care and any related services. This includes the coordination or management of your mental health care with a third party. For example, we would disclose your protected health information to a psychiatrist for treatment or to your primary care physician for coordination of care.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of this practice. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, medical billing, and conducting or arranging for other business activities. For example I might use or disclose your protected health information, as necessary, to call to speak to you about a missed appointment. I could also provide your PHI to your insurance company or health plan to get payment for the mental health services rendered or to such associates as billing companies, claims processing companies and others that process health care claims for this office.
Other Disclosures: We may use or disclose your protected health information in the following situations without your authorization: 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: Worker’s 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.
Other permitted required uses and disclosures will be made only with your consent, authorization and opportunity to object as required by law. You may revoke this authorization, at any time, in writing, except to the extent that your therapist or the therapist’s practice has taken an action in reliance on the use or disclosure indicated in this authorization.
Your Rights
The following is a statement of your rights with respect to your protected health information.
You have the Right of Inspection. Under federal law you have the right to inspect and copy your protected health information. Under the 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. Copies of your PHI will be given for a nominal photo-copy charge of .25 per page. If you elect for a summary report or an explanation of your PHI, an additional charge may be assesses with your prior approval. If it is in your best interest to deny your request, the denial will be sent in writing within thirty days indicating the reasons for the denial and indicating your rights and procedures for having the denial reviewed.
You have the Right to Restricting your 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 be in writing and must state the specific restrictions requested and to whom you want the restriction to apply. Your therapist is not required to agree to a restriction that you may request. If the therapist believes it 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 use another mental health professional.
You have the Right to Request Alternatives: You have the right to request confidential communications form this office by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice, even if you have agreed to accept this notice alternatively (i.e. electronically).
You have the Right of Amendment: You have the right to amend your public health information, if you believe the information is in error or is incomplete. Your request and the reason for your request must be made in writing. If we deny your request for amendment, you have the right to file a statement of disagreement and we may prepare a rebuttal to your statement, providing you with a copy of the rebuttal.
You have the Right to a List of Disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This list will not include uses or disclosures to which you have already consented, i.e., those for treatment, payment or health care operations.
Complaints: You may complain to us or to the Secretary of Health and Human Services if your believe your privacy rights have been violated. There will be no retaliation against you for filing a complaint. If you have any questions about this notice or you have any complaints contact me.
Effective Date of this Notice: APRIL 14, 2003b
