Notice of Privacy Practices

THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL  INFORMATION ABOUT YOU MAY BE USED AND 

DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.  PLEASE CAREFULLY REVIEW THIS 

INFORMATION. 

Use and Disclosure of Protected Health Information: 

  • For Treatment We use and disclose your health information internally in the course of your  treatment. If we wish to provide information outside of our practice for your treatment by  another health care provider, we will have you sign an authorization for release of information.  Furthermore, an authorization is required for most uses and disclosures of psychotherapy notes.  
  • For Payment – We may use and disclose your health information to obtain payment for  services provided to you. 
  • For Operations – We may use and disclose your health information as part of our internal  operations. For example, this could mean a review of records to assure quality. We may also use  your information to tell you about services, educational activities, and programs that we feel  might be of interest to you. 

For HIV Disclosure– Under the Health Insurance Portability and Accountability Act (HIPAA)  Privacy Rule, public health authorities are authorized to collect and receive private health  information “for the purpose of preventing or controlling disease” and in the “conduct of public  health surveillance…” without patient or provider consent or authorization other than state or  local public health law. This clause authorizes providers to report HIV/AIDS cases to the HIV  Epidemiology Program without obtaining patient consent and it authorizes health department  personnel to review medical records and any other source of information needed to report the  case. 

Any other disclosure of HIV-related information must be made on the “HIPAA- Compliant  Authorization for Release of Medical Information and Confidential HIV-Related  Information”. State law prohibits any further disclosure of HIV-related private health  information without the specific written consent of the person to whom it pertains, or as  otherwise permitted by law. 

Client Rights: 

  • Right to Treatment – You have the right to ethical treatment without discrimination regarding  race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other  protected category. 
  • Right to Confidentiality – You have the right to have your health care information protected.  If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that  information for the purpose of payment or our operations with your health insurer. We will agree  to such unless a law requires us to share that information.
  • Right to Request Restrictions You have the right to request restrictions on certain uses and  disclosures of protected health information about you. However, we are not required to agree to a  restriction you request. 
  • Right to Receive Confidential Communications by Alternative Means and at Alternative  Locations You have the right to request and receive confidential communications of PHI by  alternative means and at alternative locations. 
  • Right to Inspect and Copy You have the right to inspect or obtain a copy (or both) of PHI.  Records must be requested in writing and release of information must be completed.  Furthermore, there is a copying fee charge of 1.50 per page. Please make your request well in  advance and allow 2 weeks to receive the copies. If we refuse your request for access to your  records, you have a right of review, which we will discuss with you upon request. 
  • Right to Amend If you believe the information in your records is incorrect and/or missing  important information, you can ask us to make certain changes, also known as amending, to your  health information. You have to make this request in writing. You must tell us the reasons you  want to make these changes, and we will decide if it is and if we refuse to do so, we will tell you  why within 60 days. 
  • Right to a Copy of This Notice If you received the paperwork electronically, you have a  copy in your email. If you completed this paperwork in the office at your first session a copy will  be provided to you per your request or at any time. 
  • Right to an Accounting You generally have the right to receive an accounting of disclosures  of PHI regarding you. At your request, we will discuss with you the details of the accounting  process. 
  • Right to Choose Someone to Act for You If someone is your legal guardian, that person can  exercise your rights and make choices about your health information; we will make sure the  person has this authority and can act for you before we take any action. 
  • Right to Choose You have the right to decide not to receive services with us. If you wish, we  will provide you with the names of other qualified professionals. 
  • Right to Terminate You have the right to terminate services with us at any time without any  legal or financial obligations other than those already accrued. We ask that you discuss your  decision with us in session before terminating or at least contact must be made by phone letting  us know you are terminating services. 
  • Right to Release Information with Written Consent With your written consent, any part of  your record can be released to any person or agency you designate. Together, we will discuss  whether or not we think releasing the information in question to that person or agency might be  harmful to you. 

Clinician Duties: 

  • We are required by law to maintain the privacy of PHI and to provide you with a notice of our  legal duties and privacy practices with respect to PHI. We reserve the right to change the privacy  policies and practices described in this notice. Unless we notify you of such changes, however, 

we are required to abide by the terms currently in effect. If we revise our policies and  procedures, we will provide you with a revised notice in office during our session. 

Updated 6/2024