NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal in
formation about you and your health. This information about you
that may identify you and that relates to your past, present or future physical or mental health or condition
and related health care services is referred to as Protected Health Information (“
PHI”). This Notice of
Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law
including the Health Insurance Portability and Accountab
lity Act (“HIPAA”), regulations promulgated
under HIPAA including the HIPAA P
rivacy and Security Rules,
agency code of ethics
. It also
describes your rights regarding how you may gain access to and control your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties
d privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy
Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any
new Notice of Privacy Practices will be effecti
ve for all PHI that we maintain at that time. We will
provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website,
sending a copy to you in the mail upon request or providing one to you at your next appointment.
Your PHI may be used and disclosed by those who are involved in your care for the
purpose of providing, coordinating, or managing your health care treatment and related services. This
ncludes consultation with clinical supervisors or other treatment team members.
We may disclose PHI to
any other consultant only with your authorization.
We may use and disclose PHI so that we can receive payment for the treatment services
provided to you.
This will only be done with your authorization.
Examples of payment
are: making a determination of eligibility or coverage for insurance benefits, processing claims with your
insurance company, reviewing services provide
d to you to determine medical necessity, or undertaking
utilization review activities. If it becomes necessary to use collection processes due to lack of payment for
services, we will only disclose the minimum amount of PHI necessary for purposes of collec
For Health Care Operations:
We may use or disclose, as needed, your PHI in order to support our
business activities including, but not limited to, quality assessment activities, employee review
activities, licensing, and conducting or arranging fo
r other business activities. For example, we may
share your PHI with third parties that perform various business activities (e.g., billing or typing
services) provided we have a written contract with the business that requires it to safeguard the privacy
f your PHI.
For training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law:
Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Departmentof Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization.
Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations.
It is our practice to adhere to more stringent privacy requirements for disclosures without an authorization.
The following language addresses these categories to the extent consistent with agency policies HIPAA
Child Abuse or Neglect:We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.
Judicial and Administrative Proceedings:We may disclose your PHI pursuant to a subpoena (with your written consent), court order,administrative orderor similar process.
Deceased Patients:We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estateor the person identified as next-of-kin.PHI of persons that
have been deceased for more than fifty (50) years is not protected under HIPAA.
We may use or disclose your PHI in a medical emergency situation to medical personnel only
in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Family Involvement in Care: We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
Health OversightIf required,we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.
Law EnforcementWe may disclose PHI to a law enforcement officiala’s required by law, in compliance with a subpoena (with your written consent), court order
,administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
Specialized Government FunctionsWe may review requests from U.S. military command authorities if
you have served as a member of the armed forces, authorized officials for national security and
intelligence reasons and to the Department of State for medical suitability determinations, and disclose
your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
Public Health:If required, we may use or disclose your PHI for mandatory public health activities to a p
ublic health authority authorized by law to collect or receive such information for the purpose of
preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
Public SafetyWe may disclose your PHI if necessary to prevent or lessen a serious and imminent threat
to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Verbal Permission: We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization:(i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices.