Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me including basic session notes, contact logs, treatment plans and intake information. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice.

This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private and secure.

  • Give you this notice of my legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • I can change the terms of this notice, and such changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment, Payment, or Health Care Operations

Federal privacy rules and regulations allow health care providers who have a direct treatment relationship with the client to use or disclose the client’s personal health information without the client’s written authorization to carry out treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This can be done without your written authorization. For the majority of these purposes, my clients sign a written consent form that can be revoked at any time. 

Example: If a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information in order to assist the clinician in diagnosis and treatment.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Therapists and other health care providers need access to full information to provide quality care. “treatment” includes coordination and management of care, consultations, and referrals.

Lawsuits and Disputes

If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or lawful process by someone involved in the dispute — but only if efforts have been made to notify you or obtain a protective order.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

1. Psychotherapy Notes

I keep “psychotherapy notes” as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your authorization unless the disclosure is:

a. For my use in treating you.
b. For my use in training or supervising mental health practitioners.
c. For my use in defending myself in legal proceedings initiated by you.
d. For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.
e. Required by law, limited to legal requirements.
f. Required by law for certain health oversight activities.
g. Required by a coroner performing authorized duties.
h. Necessary to help avert a serious threat to health and safety.

2. Marketing Purposes

I will not use or disclose your PHI for marketing purposes.

3. Sale of PHI

I will not sell your PHI in the course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

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

  1. When required by state or federal law.

  2. For public health activities, including reporting abuse or preventing threats to safety.

  3. For health oversight activities such as audits or investigations.

  4. For judicial and administrative proceedings (preferably with your authorization).

  5. For law enforcement purposes, including reporting crimes on my premises.

  6. To coroners or medical examiners performing authorized duties.

  7. For research purposes, such as comparing therapeutic outcomes.

  8. For specialized government functions (military, presidential protection, intelligence, correctional safety).

  9. For workers’ compensation purposes.

  10. For appointment reminders and information about health-related services.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

1. Disclosures to Family, Friends, or Others

I may provide your PHI to a person involved in your care or payment for care unless you object. Consent may be obtained retroactively in emergencies. In the majority of cases this PHI exchange happens with your authorization. 

VI. YOUR RIGHTS WITH RESPECT TO YOUR PHI

1. Right to Request Limits

You may ask me not to use or disclose certain PHI. I am not required to agree if it may affect your care.

2. Right to Request Restrictions for Fully Paid Out-of-Pocket Expenses

You may request restrictions on disclosures to health plans if you paid for a service out of pocket in full.

3. Right to Choose How I Contact You

You may request specific communication methods or addresses, and I will agree to reasonable requests.

4. Right to See and Get Copies of Your PHI

You may request electronic or paper copies of your record (excluding psychotherapy notes). I will provide these within 30 days and may charge a reasonable fee.

5. Right to a List of Disclosures

You may request an accounting of disclosures made in the last six years (excluding those for treatment, payment, or operations). The first list is free; additional requests may incur a fee.

6. Right to Correct or Update Your PHI

You may request corrections or additions to your PHI. I may deny your request but will explain why in writing within 60 days.

7. Right to a Copy of This Notice

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