NOTICE OF PRIVACY PRACTICES

This Notice describes how your protected health information (“PHI”) may be used and disclosed, and how you can access this information. Please review it carefully.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

Your privacy is important. I create and maintain records about the mental health services you receive, and I am committed to keeping your information confidential. This Notice explains how I may use and disclose your PHI and describes your rights and my legal obligations.

I am required by law to:

·         Keep your PHI private.

·         Provide you with this Notice of my legal duties and privacy practices.

·         Follow the terms of this Notice.

·         Inform you if there is a breach of unsecured PHI.

·         Notify you if I change these practices (any updated Notice will be available upon request or posted on my website).

II. HOW I MAY USE AND DISCLOSE YOUR INFORMATION:

I may use or disclose your PHI for the following purposes without your written authorization:

1. Treatment, Payment, and Health Care Operations

·         I may use your PHI to provide your mental health treatment.

·         I may consult with other licensed health professionals involved in your care.

·         I may use PHI for billing, scheduling, practice management, or quality improvement.

2. Disclosures for Treatment

Sometimes I may need to coordinate care with other professionals. These disclosures are not limited by the “minimum necessary” rule because full information may be needed to provide quality care.

3. Lawsuits and Disputes

If a court orders me to release your PHI, I may be required to comply. I will only disclose the minimum necessary information.

4. Certain Legal or Regulatory Purposes

I may disclose PHI without authorization when required by law, including:

·         Abuse or neglect reporting (child, elder, or dependent adult).

·         Serious threats to your safety or someone else’s.

·         Health oversight activities, such as audits or investigations.

·         Judicial or administrative proceedings with proper legal documentation.

·         Law enforcement, when legally required.

·         Coroners or medical examiners, where required.

·         Specialized government functions, such as national security requirements.

·         Workers’ compensation, as required by law.

·         Appointment reminders and information about treatment alternatives.

III. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION:

1. Psychotherapy Notes

I keep psychotherapy notes as defined by HIPAA. These notes have special protection and cannot be shared without your written authorization except in the following situations:

a)       For my own use in treating you.

b)       For supervision or training.

c)       To defend myself in a legal action brought by you.

d)       For oversight by the Secretary of Health and Human Services.

e)       When required by law.

f)        For health oversight regarding the originator of the notes.

g)       For coroner’s investigations.

h)       To prevent or lessen a serious threat to health or safety.

Psychotherapy notes do not include diagnosis, treatment plans, times of sessions, medications, or clinical summaries.

2. Marketing

I will not use your PHI for marketing without your written authorization.

3. Sale of PHI

I will not sell your PHI.

For any other purposes not listed in this Notice, I will obtain your written authorization. You may revoke that authorization at any time in writing.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION:

I may use or disclose PHI without your written authorization for:

1.       Required reporting (state or federal law).

2.       Public health activities.

3.       Health oversight activities.

4.       Judicial or administrative orders.

5.       Certain law enforcement purposes.

6.       Coroners or medical examiners.

7.       Research approved by law.

8.       Government functions (national security, protection of officials).

9.       Workers’ compensation claims.

10.    Appointment reminders or information about services I provide.

V. USES AND DISCLOSURES REQUIRING OPPORTUNITY TO OBJECT

I may share PHI with a family member, friend, or other person involved in your care only if you do not object. If you are unable to agree or object (e.g., due to an emergency), I may use my professional judgment.

VI. YOUR RIGHTS REGARDING YOUR PHI:

You have the following rights:

1. The Right to Request Limits

You may ask me not to use or disclose certain PHI. I may deny requests if it would affect your care.

2. The Right to Restrict Disclosures to Health Plans

If you pay out-of-pocket in full for a service, you may request that I not disclose that information to your health plan.

3. The Right to Choose How I Contact You

You can request that I contact you by phone, email, or mail, and at preferred addresses/numbers.

4. The Right to See and Get Copies

You may request to see or receive a copy of your PHI (paper or electronic). I may charge a reasonable, cost-based fee for copying, mailing, or preparing summaries.

5. The Right to an Accounting of Disclosures

You may request a list of times I disclosed your PHI for reasons other than treatment, payment, or healthcare operations.

6. The Right to Correct Your PHI

If information is inaccurate or incomplete, you may request a correction. If I deny the request, I will explain why in writing.

7. The Right to a Copy of This Notice

You may request a paper or electronic copy of this Notice at any time.