Notice of Privacy Policies
This notice describes how medical information about you may be used and disclosed. It also describes how you can get access to this information. Please review it carefully.
Your health record contains personal details about your health and well-being. This information, which may identify you and pertains to your past, present, or future physical or mental health, as well as related healthcare services, is known as Protected Health Information (PHI). This Privacy Practices Notice outlines how your PHI may be used and disclosed, in accordance with applicable laws, the NASW Code of Ethics, and the American Psychological Association Code of Ethics. Additionally, it explains your rights regarding how you can access and control your PHI.
As required by law, I must ensure the confidentiality of your PHI and provide you with this notice outlining my legal obligations and privacy practices concerning PHI. I am committed to following the terms outlined in this Privacy Practices Notice. Please note that I may update this notice as needed. Any revised notice will apply to all PHI I hold at the time of the update. You will receive a copy of the updated notice either by mail upon request or during your next appointment.
HOW YOUR HEALTH INFORMATION MAY BE USED AND SHARED
For Treatment: Your PHI may be used and shared by those involved in your care to provide, coordinate, or manage your healthcare treatment and related services. This may involve consulting with clinical supervisors or other members of your treatment team. I will only share PHI with other consultants with your explicit authorization.
For Payment: I may use and disclose your PHI to provide necessary information to your insurance company regarding the treatment services you received, but only with your authorization. Examples of payment-related activities include determining your eligibility or coverage for insurance benefits, processing insurance claims, reviewing services provided to assess medical necessity, or conducting utilization review activities.
For Communication with You: I may contact you by telephone using the phone numbers you provided to reach you when necessary.
When Required by Law: I am legally obligated to disclose your PHI to you upon your request and to the Secretary of the Department of Health and Human Services for purposes of investigating or determining my compliance with privacy regulations.
Without Authorization: Applicable laws and ethical standards allow me to disclose information about you without your authorization in a limited number of situations, such as:
When legally mandated, like in cases of mandatory reporting of child abuse or neglect, or during government agency audits or investigations (e.g., social work or psychology licensing boards or the health department).
When required by a court order.
When necessary to prevent or reduce a serious and imminent threat to the health or safety of an individual or the public. If information is disclosed to prevent such a threat, it will be shared with a person or persons reasonably able to prevent or mitigate the threat, including the target of the threat.
With Verbal Permission: With your verbal permission, I may share your information with family members directly involved in your treatment.
With Written Authorization: Any use or disclosure of your information not covered by applicable law will only be made with your written consent, which you may revoke at any time. Your treatment will not be affected if you choose not to sign an authorization.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights concerning your PHI:
Right to Access and Copy: You have the right to inspect and copy your PHI, which may be used to make decisions about your care, except in exceptional cases where access may cause serious harm.
Right to Amend: If you believe that the PHI I have is incorrect or incomplete, you may request an amendment, although I am not obligated to agree to the amendment.
Right to an Accounting of Disclosures: You have the right to request a record of certain disclosures of your PHI that I have made.
Right to Request Restrictions: You have the right to request limitations on the use or disclosure of your PHI for treatment, payment, or healthcare operations. However, I am not required to agree to your request.
Right to Request Confidential Communications: You have the right to ask that I communicate with you about medical matters in a specific way or at a particular location.
Right to a Copy of This Notice: You are entitled to a copy of this Privacy Practices Notice.
COMPLAINTS
If you believe your privacy rights have been violated, you can file a written complaint with me or with the Secretary of Health and Human Services. I assure you that there will be no retaliation for filing a complaint.
Last Updated: August 1, 2024