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Notice of Privacy

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

 

This notice outlines my, the therapist's, responsibilities and your (the client's) rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which are a set of requirements enforced by law in order to protect clients' private, personal health information (PHI). For more information see 45 CFR 164.520.

 

I. MY (THE THERAPIST'S) PLEDGE REGARDING HEALTH INFORMATION:

** Please note: I will NOT sell your personal health information (PHI) AND I will NOT use or disclose your PHI for marketing purposes without written consent from you. **

                                  

I, the therapist, 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. 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, the therapist, Am Required By Law To:

 

1. Make sure that your protected health information (“PHI”) is kept private as defined in this notice.

 

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

 

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

 

4. Update the privacy notice as laws and requirements change and make updated copies available upon request, in my office, and on my website.

 

5. Make reasonable efforts to keep your physical record private, including but not limited to: using locked file cabinets, securely disposing of records, removing identifying information on documents given to third parties, and providing the minimum necessary information required to complete tasks.

 

6. Make reasonable efforts to keep your electronic record private, including but not limited to: creating strong passwords and two step authentication policies, investing in firewalls and advanced security, utilizing secure messaging, refraining from sending information via unsecure networks such as email, and providing the minimum necessary information required to complete tasks.

 

7. Make reasonable efforts to prevent verbal privacy breaches, including but not limited to: using false names while consulting with professionals, refraining from telling personal friends or acquaintances about your case, preventing interruptions to sessions, allowing the client to greet me first if in public, and providing the minimum necessary information required to complete tasks.

 

8. Make reasonable efforts to tell you about any information request(s) from the court and/or government agency with regards to your Personal Health Information (PHI) and when necessary obtain an order protecting the information requested.

 

9. Make reasonable efforts to promptly inform you of any significant breaches to security that result in the unintentional sharing and/or distribution of your personal health information (PHI).

 

10. Adhere to your, the client's, written wishes and consents whenever possible as long as the wishes/consents are reasonable, applicable, and comply with current federal and state laws. I must also adhere to 42 CFR part 2 with regards to privacy for substance use disorder records.

 

11. Keep your health record for 6 years from the time it was created, so that you can have the ability to request records for legal and/or personal purposes long after service has ended. This law is also in place to create opportunity for future research into the field of health sciences. In addition, it is my responsibility to keep a record of all uses and disclosures of your PHI for 6 years leading up to present day

 

12. Respond to your record requests within a reasonable timeframe. In addition, I shall take all reasonable efforts to respond promptly to client concerns regarding this notice.

 

 

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: DOES NOT REQUIRE YOUR AUTHORIZATION

 

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose your PHI without consent will fall within one of the categories.

 

 

For Treatment Payment, Health Care Operations, & Billing:

 

In order to conduct treatment for your health care, I may disclose your PHI without your consent. Examples include but are not limited to:

 

  • Federal privacy rules and regulations allow health care providers who have direct treatment relationship with the client to use or disclose the client’s personal health information without the client’s written authorization in order to carry out the health care provider’s own treatment, payment, billing, or health care operations.

 

  • I may also disclose your protected health information for the treatment activities of any health care provider. This too, can be done without your written authorization.

 

  • For example, if a clinician were to consult with me about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. Disclosures for treatment purposes are not limited to the minimum necessary standard.

 

  • The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

 

 

To Comply with Lawsuits and Disputes

 

In order to comply with the state or federal laws, I may disclose your PHI without your consent. Examples include but are not limited to:

 

  • Certain health oversight activities and court orders signed by a judge and other judicial and administrative proceedings, including responding to a court or administrative order. My preference is to receive your authorization, but this is not always possible under the law. The use or disclosure is limited to the requirements of such law.

  • 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 other lawful process by someone else involved in the dispute.

  • This will take place after efforts have been made to tell you about the request or to obtain an order protecting the information requested.

  • If I have substance use disorder records about you, subject to 42 CFR part 2, I cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

  • If you institute legal proceedings against me or my place of work, I can disclose your records for my use in defending myself in legal proceedings; I do not need your consent to disclose PHI

 

 

I may disclose your PHI to certain legal professions without your consent. Examples include but are not limited to:

 

  • law enforcement officers for the purpose of reporting a crime that occurred (on my premises, involving myself or my clients),

  • coroners or medical examiners (when such individuals are performing duties authorized by law),

  • and government/military agents for the purpose of conducting intelligence or counterintelligence operations or helping to ensure the safety of those working within or housed in correctional institutions. (This refers specifically to threats of national security and safety within government agencies and correctional institutions.)

 

 

To Comply with Industry Standards

 

I may disclose your PHI without your consent in order to comply with the mental health industry standards in the USA. Examples include but are not limited to:

 

  • To investigate my compliance with HIPAA by the Secretary of Health and Human Services, other audits and investigations, research, training or supervising mental health practitioners, and assisting with public health and safety issues

 

  • This includes the "Tarasoff rule" which is better known as "duty to warn and protect." In these cases, I am required to help avert a serious threat to the health and safety of others

 

  • Reporting suspected child, elder, or dependent adult abuse, or preventing and/or reducing a serious threat to anyone’s health or safety. I do not need your consent in these cases. It is an industry standard to take reasonable steps to remind clients of appointments and communicate regularly with clients.

 

  • Therefore, I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

 

 

III. CERTAIN USES AND DISCLOSURES REQUIRES YOUR AUTHORIZATION

 

  1. Psychotherapy Notes:

  • I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure falls with Section II in this notice.

  • Please note that psychotherapy notes are held in the highest confidence as they have the most PHI information in one place. I will make every reasonable effort to protect this information possible under the law.

 

 

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 family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

 

  1. Public Research Based Disclosures

  • I may provide your PHI in research, in which your PHI will become public knowledge due to publication or distribution of knowledge, unless you object in whole or in part.

 

  1. Fundraising or Marketing Efforts

  • I may provide your PHI on behalf of myself or my place of work for purposes of fundraising or marketing, unless you object in whole or in part.

 

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

** Please note that if you have authorized someone to operate on your behalf such as but not limited to a power of attorney, they have the same rights as defined below. **

 

  1. The Right to Request Limits on Uses and Disclosures of Your PHI.

  • You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.

 

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full

  • You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

 

3. The Right to Choose How I Send PHI to You.

  • You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address. I will agree to all reasonable requests.

 

4. The Right to See and Get Copies of Your PHI.

  • Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it (if you agree to receive a summary) within 30 days of receiving your written request. I may charge a reasonable, cost-based fee for doing so.

 

5. The Right to Get a List of the Disclosures I Have Made

  • You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last 6 years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.

 

6. The Right to Correct or Update Your PHI

  • If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

 

 7. The Right to Get a Paper or Electronic Copy of this Notice.

  • You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

 

 

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

 

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. This document is a copy of HIPAA Notice of Privacy Practices.

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If you believe that your therapist has not followed this notice or violated your rights please file a complaint in writing at the following email address:

 

privacyofficer@therapyquarter.com

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