Notice of 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 READ IT CAREFULLY.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a Federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. HIPAA gives you, the patient, the right to understand and control how your personal health information (PHI) is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, your provider prepared this explanation of how the privacy of your health information will be maintained, and how your personal information may be disclosed.
Your medical records may be used and disclosed without your authorization only for the following purposes: treatment, payment, and health care operation.
•Treatment means providing, coordinating, or managing healthcare and related services by one or more healthcare providers. An example of this is if you are referred to a therapist or another specialist.
•Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your visit.
•Health Care Operations include the business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. An example of this would be patient survey cards.
•The practice may also be required or permitted to disclose your PHI for law enforcement , reporting of suspected child, elder or dependent adult abuse, preventing or reducing serious threat to your health or safety, or the health or safety of others, or other legitimate reasons. In all situations, the provider shall do their best to assure its continued confidentiality to the extent possible.
Your provider may also create and distribute de-identified health information by removing all reference to individually identifiable information.
Your provider may contact you, by phone or in writing, to provide appointment reminders.
The following use and disclosures of PHI will only be made pursuant to the practice receiving a written authorization from you:
•Most uses and disclosure of psychotherapy notes (these are not part of your medical record under HIPAA);
•Uses and disclosure of your PHI for marketing purposes, including health care operations;
•Disclosures that constitute a sale of PHI under HIPAA; and
•Other uses and disclosures not described in this notice.
You may revoke such authorization in writing and your provider is required to honor and abide by that written request, except to the extent that action have already been taken that rely on your prior authorization.
You may have the following rights with respect to your PHI.
•The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you.
* The practice is not required to honor a restriction request except in limited circumstances which shall be explained to you if you ask. If the practice agrees to the restriction, it must abide by it unless you agree in writing to remove it.
•The right to reasonable requests to receive confidential communications of Protected Health Information by alternative means or at alternative locations.
•The right to inspect and copy your PHI.
•The right to amend your PHI.
•The right to receive an accounting of disclosures of your PHI.
•The right to obtain a paper copy of this notice upon request.
•The right to be advised if your unprotected PHI is intentionally or unintentionally disclosed.
If you have paid for services "out of pocket", in full and in advance, and you request that the practice not disclose PHI related solely to those services to a health plan, your request will be accommodated, except where required by law to make a disclosure.
Your provider is required by law to maintain the privacy of your Protected Health Information and to provide you the notice of our legal duties and the privacy practice with respect to PHI.
This notice if effective as of September 19, 2023 and it is the practices intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. The practice reserves the right to change the terms of the Notice of Privacy Practice and to make the new notice provision effective for all PHI that is maintained. A revised Notice of Privacy Practice will be posted, and a written copy can be requested by you.
You have recourse if you feel that your protections have been violated by your provider. You have the right to file a formal, written complaint with office and with the Department of Health and Human Services, Office of Civil Rights. Your provider will not retaliate against you for filing a complaint.