THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT OUR PATIENTS AND CLIENTS MAY BE USED AND DISCLOSED AND HOW PATIENTS CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives the Patient rights to understand and control how their health information is used. We are required to abide by the terms of this notice. HIPAA provides penalties for misuse of personal health information. (Throughout this website, the terms “Patient” and “Client” are used interchangeably.)

HIPAA COMPLIANT USES AND DISCLOSURES:

• Providing, Coordinating, or Managing Your Treatment: For example, details of Patient treatment may be shared with another mental health professional during state-mandated case review.
• Billing for Services and Collecting Payments: For example, personal health information may be shared with Patient’s insurance company when attempting to collect payment for services that have been rendered.
• Health Care Operations: Patient’s information may be shared with other professionals involved in running our practices, for example, partners and staff members.
• Other Allowable Disclosures Not Requiring Your Consent: Reporting suspected child or elder abuse or neglect; complying with a court order or judge’s subpoena; state-mandated disclosure of deceased patients; medical emergencies that may necessitate disclosure to prevent serious harm; disclosure to legally authorized overseeing agencies for audits, investigations, or inspections; disclosure to authorized officials in government for national security and intelligence reasons; any threat of harm to self or others to the person or persons; disclosure to legally authorized public health and safety officials for the purpose of preventing and controlling disease or to prevent a serious imminent threat to the health or safety of a person or the public.

Any other disclosures will be made only with patient’s written authorization via our Release of Information form. Patient may revoke such authorizations in writing and we are required to honor and abide by that written request. If a breach of privacy occurs, Patient will be notified in writing.

WE MAY CONTACT PATIENTS TO:

• Provide appointment information or information about treatment.
• Provide information about treatment alternatives or services that may be of interest to patients.
• Provide fundraising information (of which patients have the right to opt-out of receiving).
• Collect payment for services that were provided.

PATIENTS HAVE THE FOLLOWING INDIVIDUAL RIGHTS:

• To request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by the patient. If we agree to a restriction, we must abide by it unless Patient submits a written request to remove it.
• To have disclosures of psychotherapy notes as well as sale of Patient information or marketing disclosures only on the basis of an authorization signed by Patient.
• To reasonably request to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• To inspect a copy of protected health information.
• To request that Patient’s file be amended if Patient believes information is incorrect or missing. This request must be made in writing.
• To receive an accounting of Patient’s disclosed protected health information.
• To restrict disclosures of Patient information for services of which Patient has self-paid.
• To obtain an additional copy of this notice upon request.