THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
By law, I am required to provide you with notice of my practice’s llegal duties and the privacy practices concerning your individually identifiable health information, and that it may be used in treatment planning, payment procedures, appointment reminders, health-related benefits, and disclosures required by federal, state or local law, or self-defense in litigation.
Confidentiality and Limits
Your privacy is paramount. Written permission from you, as client or parent, is necessary for information to be shared with any outside third party. Confidentiality may be broken when a client is a danger to self or others; when there is suspected child or adult (disabled and elderly) abuse or neglect (past or present) and I am required to report these incidents to the proper federal, state or local authorities; when hospitalization is needed; when signed releases allow the exchange of information; when providing me claim forms or requesting that I contact your insurance company; when accounts must be put into collections; or when a court has mandated the release of information from records via subpoena, or in cases where a therapist must defend against malpractice claims or lawsuits. In these cases, clients must understand that confidentiality of information shared may be broken.
HIPAA & Privacy Notice
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that all healthcare records and other protected health information (PHI) used or disclosed to me in any form be kept confidential. This includes names, addresses, and phone numbers as well as medical information, including but not limited to, diagnoses and medication. HIPPA requires me to give you notice that I will:
- Protect your past, present, and future PHI, provide you with this notice of privacy, and adhere to it myself.
- Disclose your information to you, unless medical authorities determine such disclosure would harm you.
- Use and disclose the information you’ve provided to me in your treatment and care.
- Use this information to receive payment for health care services (including collection agencies for past due accounts), submit claims online, determine eligibility, obtain referrals or approval for your admission and emergency care.
- Disclose this information if law or regulation requires it, including but not limited to report abuse or neglect of a child, elderly or disabled person, report a death, prevent or control disease, injury, or disability, notify a person who might have been exposed to a disease or may be at risk for contracting or spreading a disease or condition, or to cooperate with an oversight agency conducting audits, investigations or inspections. I may find it necessary to comply with court orders, warrants, subpoenas, or discovery required by state law, and to defend against malpractice litigation, disclosing information if absolutely necessary.
- Use this information for scheduling and discussing appointments with you, calling you from the waiting area, and having you sign in. Third parties who work with me may have access to this information but all adhere to these stated privacy practices and protect your PHI in the same manner I do. I may use your information to provide alternative sources of care; i.e., I may ask if you wish to receive notice of literature that may be helpful, and send you information about products/services that may benefit you, your family, and treatment.
- Disclose your PHI to parents, guardians, or persons acting in a similar legal capacity where required by law. I make every effort to protect a child’s or adolescent’s rights to a private therapist/patient relationship, and work with a minor to self-disclose pertinent information if parents/guardians may need to know it.
As you visit many healthcare providers, you may find different pieces of the HIPAA notice that apply to certain kinds of healthcare or providers. If you would like to read more about the legislation involving your privacy, click here. If you would like to read a summary of your privacy rights, download this PDF.