Notice of Privacy Practices of Parent and Child Psychological Services, PLLC
in accordance with the Health Insurance Portability & Accountability Act (HIPAA) of 1996
This notice describes how mental health information about you or your child may be used and disclosed and how I am required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of your privacy rights and my legal duties and privacy practices with respect to your PHI. I am required to abide by the terms of this notice with respect to your PHI but reserve the right to change the terms of this notice and make the new notice provisions effective for all PHI that I maintain. I will provide you with a copy of the revised notice sent by regular mail to the last address you have provided to me for this communication purpose.
Effective May 1, 2010 you can get access to this information. Please read it carefully.
UNDERSTANDING YOUR PERSONAL HEALTH INFORMATION
Each time you visit a hospital, physician, mental health professional or health care provider, a record of your visits is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, in the case of mental health professional, psychotherapy notes, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment.
- Means of communication among the many health professionals who contribute to your care.
- Legal document describing the care you received.
- Means by which you or a third-party payer can verify that services billed were actually provided.
- A source of data for medical research.
- A source of information for public health officials charged with improving the health of the nation.
- A source of data for facility planning and marketing.
- A tool with which we can use to assess and work to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to:
- Ensure its accuracy
- Better understand who, what, when, where, and why others may access your health information.
- Make more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS
Although your health record if the physical property of my practice, the facility that compiled it, the information belongs to you. You have the following privacy rights:
- The right to request restrictions on the use and disclosure of your PHI to carry out treatment, payment or health care operations. You should note that I am not required to agree to be bound by any restrictions that you request if I do not deem them in your best interest, but I am bound by each restriction that I do agree to.
- In connection with any patient directory, the right to request restrictions on the use and disclosure of your name, location at this treatment facility, description of your condition and your religious affiliation. (I do not maintain a patient directory).
- To receive confidential communication of your PHI unless I determine that such disclosure would be harmful
- To inspect and copy your PHI unless I determine in the exercise of my professional judgment that the access requested is reasonably likely to endanger your life or physical safety or that of another person. You may request copies of your PHI by providing me with a written request for such copies. I will provide you with copies within 10 business days of your request at my office. You will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
- To amend your PHI upon your written request to me setting forth your reasons for the requested amendment. I have the right to deny the request if the information is complete or has been created by another entity. I am required to act on your request to amend your PHI within 60 days but this deadline may be extended for another 30 days upon written notice to you. If I deny your requested amendment I will provide you with a written notice of my decision and the basis for my decision. You will then have the right to submit a written statement disagreeing with my decision which will be maintained with your PHI. If you do not wish to submit a statement of disagreement you may request that I provide your request for amendment and my denial with any future disclosures of your PHI.
- Upon request you can receive an accounting of disclosures of your PHI made within the past 6 years of your request for an accounting. Disclosures that are exempted from the accounting requirement include the following:
- Disclosures necessary to carry out treatment, payment and health care operations.
- Disclosures made to you upon request.
- Disclosures made pursuant to your authorization.
- Disclosures made for national security or intelligence purposes.
- Permitted disclosures to correctional institutions or law enforcement officials.
- Disclosures that are part of a limited data set used for research, public health or health care operations.
I am required to act on your request for an accounting within 60 days but this deadline may be extended for another 30 days upon written notice to you of the reason for the delay and the date by which I will provide the accounting. You are entitled to one (1) accounting in any 12 month period free of charge. For any subsequent request in a 12 month period you will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
- To receive a paper copy of this privacy notice even if you agreed to receive a copy electronically.
- The right to complain to me and to the Secretary of the U.S. Department of Health and Human Services (HHS)if you believe your privacy rights have been violated by writing the Office for Civil Rights, US. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, D.C. 20201; by calling 1-800- 368-1019; or by sending an email to [email protected] You may submit your complaint to me in writing setting out the alleged violation. I am prohibited by law from retaliating against you in any way for filing a complaint with me or HHS.
USES AND DISCLOSURES
Your written authorization is required before I can use or disclose my psychotherapy notes which are defined as my notes documenting or analyzing the contents of our conversations during our counseling sessions and that are separated from the rest of your clinical file. Psychotherapy notes do not include medication prescription and monitoring, counseling sessions start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis and It is my policy to protect the confidentiality of your PHI to the best of my ability and to the extent permitted by law. There are times however, when use or disclosure of your PHI including, psychotherapy notes, is permitted or mandated by law even without your authorization.
Situations where I am not required to obtain your consent or authorization for use or disclosure of your PHI psychotherapy notes include the following circumstances:
- By me or my office for treatment, payment or health care operations as they relate to you.
- In the event of an emergency to any treatment provider who provides emergency treatment to you.
- To defend myself in a legal action or other proceeding brought by you against me.
- When required by the Secretary of the Department of Health and Human Services in an investigation to determine my compliance with privacy rules.
- When required by law in so far as the use or disclosure complies with and is limited to the relevant requirements of such law. For example, to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.
In the course of any judicial or administrative proceeding in response to:
- An order of a court or administrative tribunal so long as only the PHI expressly authorized by such order is disclosed, or
- A subpoena, discovery request or other lawful process, that is not accompanied by an order of a court or administrative tribunal so long as reasonable efforts are made to give you notice that your PHI has been requested or reasonable efforts are made to secure a qualified protective order, by the person requesting the PHI.
- In addition I may use your PHI in connection with a suit to collect fees for my services.
- In compliance with a court order or court ordered warrant, or a subpoena or summons issued by a judicial officer, a grand jury subpoena pr summons, a civil or an authorized investigative demand or similar process authorized by law provided that the information sought is relevant and material to a legitimate law enforcement inquiry, the request is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought and de-identified information could not reasonably be used.
- To a health oversight agency for oversight activities authorized by law as they may relate to me (i.e., audits; civil, criminal or administrative investigations, inspections, licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions).
- To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
- To funeral directors consistent with applicable law as necessary to carry out their duties with respect to the decedent.
- To the extent authorized by and the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
- If use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
- To a public health authority that is authorized by law to collect or receive such information for the purposes of preventing or controlling a disease, injury or disability, including but not limited to, the reporting of disease, injury, vital events such as birth, death, and the conduct of public surveillance, public health investigations, and public health interventions.
- To a person who may have been exposed to a communicable disease or may otherwise ne at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such persons as necessary in the conduct of a public health intervention or investigation.
- To a public health authority or other appropriate governmental authority authorized by law to receive reports of child abuse or neglect.
- To a law enforcement official if I believe in good faith that the PHI constitutes evidence of criminal conduct that occurs on my premises.
- Using my best judgment, to a family member, other relative or close personal friend or any others person you identify, I may disclose PHI that is relevant to that person’s involvement in your child’s care or payment related to your child’s care.
- To authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and implementing authority.
- To Business Associates under a written agreement requiring Business Associates to protect the information. Business Associates are entities that assist with or conduct activities on my behalf including individuals or organizations that provide legal, accounting, administrative, and similar functions.
I may contact you with appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you or your child.
If you have any questions and would like additional information you should bring this to my attention at the first opportunity. I will be glad to respond to your questions or request for information.