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| 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. |
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| Notice of Privacy Practices
Privacy is a very important concern for all those
who come to this office. It is also complicated because of federal
and state laws and our profession. Because the rules are so complicated,
some parts of this Notice are quite detailed and you probably
will have to read them several times to understand them. If you
have any questions, our Privacy Officer will be happy to help
you.
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| Contents
of this Notice |
| A. Introduction - To Our Clients
B. What we mean by your medical
information
C. Privacy and the laws about privacy
D. How your protected health
information can be used and shared
1. Uses and disclosures with your
consent
a. The basic uses and disclosures
- For treatment, payment, and health care operations (TPO)
b. Other uses and disclosures
in health care
2. Uses and disclosures requiring
your Authorization
3. Uses and disclosures not requiring
your Consent or Authorization
4. Uses and disclosures requiring
you to have an opportunity to object
5. An Accounting of disclosures we
have made
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| A.
Introduction - To our clients |
| This notice will tell you about how we handle
information about you. It tells how we use this information here
in this office, how we share it with other professionals and organizations,
and how you can see it. We want you to know all of this so you can
make the best decisions for yourself and your family. We are also
required to tell you about this because of the privacy regulations
of a federal law, the Health Insurance Portability and Accountability
Act of 1996 (HIPAA). Because this law and the laws of this state
are very complicated and we don't want to make you read a lot that
may not apply to you, we have simplified some parts. If you have
any questions or want to know more about anything in this Notice,
please ask your Privacy Officer for more explanation or more details.
Back to Top |
| B. What
we mean by your medical information |
| Each time you visit us or any doctor's
office, hospital, clinic, or any other "healthcare provider"
information is collected about you and your physical and mental
health. It may be information about your past, present or future
health or conditions, or the treatment or other services you got
from us or from others, or about payment for healthcare. The information
we collect from you is called, in the law, PHI, which stands for
Protected Health Information. This information goes into your
medical or healthcare record on file at our office. In this office
this PHI is likely to include these kinds of information:
| • Your history. As a child, in school
and at work, and marital and personal history.
• Reasons you came for treatment. Your problems,
complaints, symptoms, needs, goals.
• Diagnoses. Diagnoses are the medical terms for
your problems or symptoms.
• A treatment plan. These are the treatments and
other services which we think will best help you.
• Progress notes. Each time you come in we write
down some things about how you are doing, what we observe
about you, and what you tell us.
• Records we get from others who treated you or evaluated
you.
• Psychological test scores, school records, etc.
• Information about medications you took or are taking.
• Legal matters
• Billing and insurance information
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This list is just to give you an idea; there may
be other kinds of information that go into your healthcare record
here.
We use this information for many purposes.
For example, we may use it:
| • To plan your care and treatment.
• To decide how well our treatments are working for
you.
• When we talk with other healthcare professionals
who are also treating you, such as your family doctor or
the professional who referred you to us.
• To show that you actually received the services
from us which we billed to you or to your health insurance
company.
• For teaching and training other healthcare professionals.
• For medical or psychological research.
• For public health officials trying to improve health
care in this country.
• To improve the way we do our job by measuring the
results of our work.
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When you understand what is in your record
and what it is used for, you can make better decisions about who,
when, and why others should have this information.
Although your health record is the physical
property of the healthcare practitioner or facility that collected
it, the information belongs to you. You can inspect, read, or
review it. If you want a copy we can make one for you but may
charge you for the costs of copying (and mailing if you want it
mailed to you). In some very unusual situations you cannot see
all of what is in your records. If you find anything in your records
that you think is incorrect, or something important is missing,
you can ask to amend (add information to) your record, although
in some rare situations we don't have to agree to do that. Our
Privacy Officer, whose name is at the end of this Notice, can
explain more about this. Back to Top
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| C. Privacy
and the laws |
| The HIPAA law requires us to keep your PHI private
and to give you this notice of our legal duties and our privacy
practices, which is called the Notice of Privacy Practices or NPP.
We will obey the rules of this notice as long as it is in effect,
but if we change it, the rules of the new NPP will apply to all
the PHI we keep. If we change the NPP we will post the new Notice
in our office where everyone can see. You or anyone else can get
a copy by contacting us. Back
to Top |
| D.
How your protected health information can be used and shared |
| When your information is read
by me or others in this office, that is called, in the law, "use."
If the information is shared with or sent to others outside this
office, that is called, in the law, "disclosure." Except
in some special circumstances, when we use your PHI here or disclose
it to others, we share only the minimum necessary PHI needed for
the purpose. The law gives you rights to know about your PHI, how
it is used and to have a say in how it is disclosed and so we will
tell you more about what we do with your information.
We use and disclose PHI for several reasons. Mainly, we will use
and disclose (share) it for routine purposes and we will explain
more about these below. For other uses we must tell you about
them and have a written Authorization Form, unless the law lets
or requires us to make the use or disclosure without your authorization.
However, the law also says that we are allowed to make some uses
and disclosures without your consent or authorization.
Back to Top
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1. Uses and disclosures of PHI in
healthcare with your consent
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| After you have read this Notice you will be asked
to sign a separate Consent Form to allow us to use and share your
PHI. In almost all cases we intend to use your PHI here or share
your PHI with other people or organizations to provide treatment
to you, arrange for payment for our services, or some other business
functions called health care operations. Together these routine
purposes are called TPO and the Consent Form allows us to use and
disclose your PHI for TPO. Re-read that last sentence until it is
clear because it is very important. Back to Top |
1a. For treatment,
payment, or health care operations
|
| We need information about you
and your condition to provide care to you. You have to agree to
let us collect the information and to use it and share it as necessary
to care for you properly. You must sign the Consent Form before
we begin to treat you because if you do not agree and consent we
cannot treat you. When you come to see
us, several people in our office may collect information about
you and all of it may go into your healthcare records here. Generally,
we may use or disclose your PHI for three purposes: treatment,
obtaining payment, and what are called healthcare operations.
Let's see what these are about:
For treatment
We use your medical information to provide you with
psychological treatment or services. These might include individual,
family, or group therapy, psychological, educational, or vocational
testing, treatment planning, or measuring the effects of our services.
We may share or disclose your PHI to others who
provide treatment to you. We are likely to share your information
with your personal physician. If you are being treated by a team,
we can share some of your PHI with them so that the services you
receive will be coordinated. They will also enter their findings,
the actions they took, and their plans into your record so we
all can decide what treatments work best for you and make up a
Treatment Plan. We may refer you to other professionals or consultants
for services we cannot offer, such as special testing or treatments.
When we do this we need to tell them some things about you and
your conditions. We will get their findings and opinions and those
will go into your records here. If you receive treatment in the
future from other professionals we can also share your PHI with
them. These are some examples so that you can see how we use and
disclose your PHI for treatment.
For payment
We may use your information to bill you, your insurance,
or others to be paid for the treatment we provide to you. We may
contact your insurance company to check on exactly what your insurance
covers. We may have to tell them about your diagnoses, what treatments
you have received, and what we expect as we treat you. We will
need to tell them when we met, your progress, and other similar
things.
For health care operations
There are some other ways we may use or disclose
your PHI which are called health care operations. For example,
we may use your PHI to see where we can make improvements in the
care and services we provide. We may be required to supply some
information to some government health agencies so they can study
disorders and treatment and make plans for services that are needed.
If we do, you name and identity will be removed from what we send.
Back to Top
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1b. Other uses in health care
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| Appointment Reminders.
We may use and disclose medical information to reschedule or remind
you of appointments for treatment or other care. If you want us
to call or write to you only at your home or your work or prefer
some other way to reach you, we usually can arrange that. Just tell
us. Treatment Alternatives.
We may use and disclose your PHI to tell you about or recommend
possible treatments or alternatives that may be of interest to
you.
Other Benefits and Services. We
may use and disclose your PHI to tell you about health-related
benefits or services that may be of interest to you.
Research. We may use or share your
information to do research and improve treatments. For example,
we may compare two treatments for the same disorder to see which
works better or faster or costs less. In all cases your name,
address and other information that reveals who you are will be
removed from the information given to researchers. If they need
to know who you are, we will discuss the research project with
you and you will have to sign a special Authorization Form before
any information is shared.
Business Associates. There
are some jobs we hire other businesses to do for us. They are
called our Business Associates in the law. Examples include a
copy service we use to make copies of your health record and a
billing service who figures out, prints, and mails our bills.
These business associates need to receive some of your PHI to
do their jobs properly. To protect your privacy they have agreed
in their contract with us to safeguard your information.
Back to Top
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2. Uses and disclosures requiring your
Authorization
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| If we want to use your information
for any purpose besides the TPO or those we described above, we
need your permission on an Authorization Form.
We don't expect to need this very often.
If you do authorize us to use or disclose your PHI, you can revoke
(cancel) that permission, in writing, at any time. After that
time we will use or disclose your information for the purposes
that we agreed to. Of course, we cannot take back any information
we had already disclosed with your permission or that we had used
in our office. Back to Top |
3. Uses and disclosures of PHI from
mental health records Not requiring Consent or Authorization
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| The laws let us use and disclose
some of your PHI without your consent or authorization in some cases.
When required by law
There are some federal, state, or local laws which
require us to disclose PHI.
• We have to report suspected child abuse.
• If you are involved in a lawsuit or legal
proceeding and we receive a subpoena, discovery request, or other
lawful process, we may have to release some of your PHI. We will
only do so after trying to tell you about the request, consulting
your lawyer, or trying to get a court order to protect the information
they requested.
• We have to release (disclose) some information
to the government agencies which check on us to see that we are
obeying the privacy laws.
For Law Enforcement Purposes
We may release medical information if asked to do
so by a law enforcement official to investigate a crime or criminal.
For public health activities
We might disclose some of your PER to agencies which
investigate diseases or injuries.
Relating to decedents**
We might disclose PHI to coroners, medical examiners
or funeral directors, and to organizations relating to organ,
eye, or tissue donations or transplants.
For specific government functions
We may disclose PHI of military personnel and veterans
to government benefit programs relating to eligibility and enrollment,
to Worker's Compensation programs to correctional facilities if
you are an inmate, and for national security reasons.
To Prevent a Serious Threat to Health or
Safety***
If we come to believe that there is a serious threat
to your health or safety of that of another person or the public,
we can disclose some of your PHI. We will only do this to persons
who can prevent the danger. Back to Top |
4. Uses and disclosures requiring you
to have an opportunity to object
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| We can share some information
about you with your family or close others. We will only share information
with those involved in your care and annyone else you choose, such
a close friends or clergy. We will ask you about who you want us
to tell what information about your condition or treatment. You
can tell us what you want and we will honor your wishes as long
as it is not against the law. If
it is an emergency - so we cannot ask if you disagree - we can
share information if we believe that it is what you would have
wanted and if we believe it will help you if we do share it. If
we do share information, in an emergency, we will tell you as
soon as we can. If you don't approve we will stop, as long as
it is not against the law. Back to Top
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5. An accounting of disclosures
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| When we disclose your PHI we keep records of whom
we sent it to, when we sent it, and what we sent. You can get an
accounting (a list) of many of these disclosures. Back
to Top |
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