Notice of Privacy Practices

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. I need this record to provide you with quality care and to comply with certain legal requirements.

This notice applies to all records of your care generated by this mental health care practice. It explains the ways in which I may use and disclose health information about you. It also describes your rights regarding the health information I keep about you and my obligations regarding its use and disclosure.

I am required by law to:

• Make sure that protected health information, also called PHI, that identifies you is kept private.
• 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 this website.

How I may use and disclose health information about you

The following categories describe different ways that I use and disclose health information. Not every use or disclosure in a category will be listed. However, all permitted uses and disclosures will fall within one of these categories.

Treatment, payment, or health care operations

Federal privacy rules allow health care providers who have a direct treatment relationship with a patient or client to use or disclose personal health information without written authorization in order to carry out the provider’s own treatment, payment, or health care operations. I may also disclose your protected health information for the treatment activities of another health care provider without your written authorization.

For example, if a clinician consults with another licensed health care provider about your condition, personal health information may be used and disclosed to assist in the diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard because therapists and other health care providers need access to complete information in order to provide quality care. Treatment includes the coordination and management of health care providers with a third party, consultations between health care providers, and referrals from one health care provider to another.

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 other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or obtain an order protecting the requested information.

Uses and disclosures that require your authorization

Psychotherapy notes

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

1. For my use in treating you.
2. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
3. For my use in defending myself in legal proceedings instituted by you.
4. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
5. Required by law and limited to the requirements of that law.
6. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
7. Required by a coroner performing duties authorized by law.
8. Required to help avert a serious threat to the health and safety of others.

Marketing purposes

As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI

As a psychotherapist, I will not sell your PHI in the regular course of my business.

Uses and disclosures that do not require your authorization

Subject to limitations in the law, I can use and disclose your PHI without your authorization for the following reasons:

1. When disclosure is required by state or federal law and is limited to the relevant requirements of that law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain your authorization first.
5. For law enforcement purposes, including reporting crimes occurring on my premises.
6. To coroners or medical examiners performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy with those who received another form of therapy for the same condition.
8. For specialized government functions, including ensuring the proper execution of military missions, protecting the President of the United States, conducting intelligence or counterintelligence operations, or helping ensure the safety of those working within or housed in correctional institutions.
9. For workers compensation purposes. Although my preference is to obtain your authorization, I may provide your PHI to comply with workers compensation laws.
10. For appointment reminders and health related benefits or services. I may use and disclose your PHI to remind you of an appointment or tell you about treatment alternatives or other health care services or benefits that I offer.

Uses and disclosures that require an opportunity to object

Disclosures to family, friends, or others

I may provide your PHI to a family member, friend, or other person 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.

Your rights with respect to your PHI

1. The right to request limits on uses and disclosures. You may ask me not to use or disclose certain PHI for treatment, payment, or health care operations. I am not required to agree and may decline if I believe it would affect your health care.
2. The right to request restrictions for expenses paid in full. You may request restrictions on disclosures of your PHI to health plans for payment or health care operations if the PHI relates solely to a health care item or service you paid for in full.
3. The right to choose how I send PHI to you. You may ask me to contact you in a specific way or send mail to a different address. I will agree to reasonable requests.
4. The right to see and receive copies of your PHI. Other than psychotherapy notes, you have the right to receive an electronic or paper copy of your medical record and other information I have about you. I will provide a copy or an agreed upon summary within 30 days of receiving your written request and may charge a reasonable fee based on the cost of providing it.
5. The right to receive a list of disclosures. You may request a list of instances in which I disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided authorization. I will respond within 60 days. The list will include disclosures made within the previous six years unless you request a shorter period. The first list in a year is provided at no charge. I may charge a reasonable fee for additional requests within the same year.
6. The right to correct or update your PHI. If you believe there is a mistake in your PHI or important information is missing, you may ask me to correct the information or add what is missing. I may decline your request but will tell you why in writing within 60 days.
7. The right to receive a paper or electronic copy of this notice. You may request a paper copy or an electronic copy of this notice, even if you previously agreed to receive it electronically.