Notice of HIPAA Privacy Practices
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.
1. Our Responsibility
The confidentiality of your personal health information is very important
to us. Your health information includes records that we create and obtain when we provide you care, it also includes bills, insurance claims, or other payment information that we maintain related to your care.
This Notice describes how we handle your health information and your rights regarding this information. Generally speaking, we are required to maintain the privacy of your health information as required by law; provide you with this Notice of our duties and privacy practices regarding the health information about you that we collect and maintain; and follow the terms of our Notice currently in effect.
2. Contact Information
After reviewing this Notice, if you need further
information or want to contact us for any reason regarding the handling of your health information please direct any communication to your therapist or the clinical director.
3. Uses and Disclosures of Information
Under federal law, we are permitted to use and disclose personal health information without authorization for treatment, payment, and health care operations. Participlants in this organized health care arrangement also share health information with each other, as necessary to carry out treatment, payment, or health care operations. We may share the minimum amount of personal health information necessary for business associates performing services on our behalf.
4. Other Uses and Disclosures
As required by the Food & Drug Administration
and or required during an investigation by law enforcement.
7. To Request Informaton or File a complaint
Request to review, or to receive a copy of, the health information about you that is maintained in our files and the files of our business associates. We reserve the right to charge a fee for the cost of copying, mailing or other supplies associated with your request. If we are unable to satisfy your request, we will tell you in writing the reason for the denial and your right, if any to request a review of the decision.
Request that we amend the health information about you that is maintained in our files anbd the files of our business associates. Your request must explain why you believe our records require amendment. If we are unable to satisfy your request, we will tell you in writing the reason for the denial and tell you how you may contest the decision, including your right to submit a statement disagreeing with the decision. This statement will be added to your record.
Request a list of disclosures of your health information. This list, known as an "accounting" of disclosures, will not include certain disclosures, such as those made for treatment , payment, or health care operatoins. We will provide you the accounting free of charge, however, if you request more than accounting in any 12 month period, we may impose a reasonable , costbased fee for any subsequent request. Your request should indicate the period of time in which you are interested. We will be unable to provide you an accounting for any disclosures made before
Request a paper copy of this Notice.
In order to exercise any of your rights described above, you must submit a written request to our office. If you have questions about your rights, please speak with our clinican director, available by phone or email during normal office hours.
Health oversight activities
In response to legal proceedings
Other covered entities' payment activities
Other covered entities' healthcare operations activites to the extent under HIPAA
Other healthcare providers' treatment activities
Other public health activities
To prevent a serious threat to public health or safety
To workers' compensation or similar programs for processing of claims
Uses and disclosure required by law
Uses and disclosure required by law for unempancipated minors
Uses and disclosure in domestic violence or neglect situaions.
5. Other Uses or Disclosures
Before using or disclosing your personal health information for any other purpose not identified above, we will obtain your written authorizaton. Unless action has already been taken in compliance with the authorization by submitting your written request to us.
6. Your Health Information Rights
Request that we restrict certain uses and disclosures of your health information; we are not , however, required to agree to a requested restriction.
Request that we communicate with you by alternative means, such as making records available for pick-up or mailing them to you at an alternative address, such as a P.O. Box. We will accomodate reasonable requests for such confidential communications.
If you believe your privacy rights have been violated, you may file a written complaint by mailing it
or delivering it to clinical director. You may complain to the Secretary of Health and Human Services (HHS) by writing to Office of Civil Rights, US Dept. of Health and Human Services, 200 Independence Ave. SW, Rm. 509F, HHH Building, Washington D.C. 20201 or by calling 1 (800) 368-1019. We cannotand will not, make you waive your right to file a complaint as a condition of recieving care from us, or penalized you for filing a complaint.
8. Revisions to this Notice
We reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms shall apply to all health information that we maintain including information about you collected or obtained before the effective date of the revised Notice. If the revisions reflect a material change to the use and disclosure of your information, our legal duties, or other privacy practice described in the Notice, we will promptly distributed the revised Notice, post it in the waiting areas of our office, make copies available to our patients and others, and post it on our website.