I am NOT accepting new patients for individual therapy as of 01/06/2025.
NOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES (HIPAA)
This notice describes how medical information about you may be used and how you can get access to this information. Please review it carefully.
I have a legal duty to safeguard your protected health information (PHI). I am legally required to protect the privacy of your PHI, which includes information that can be used to identify you that I have created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. I must provide you with this notice about my privacy practices and such Notice must explain how, when and why, I will “use” and “disclose” information within my practice. PHI is “disclosed” when it is released, transferred has been given to, or is otherwise divulged to a third party outside of my practice. With some exceptions, I may not use or disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made. And, I am legally required to follow the privacy practices described in this Notice.
However, I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI on file with me already. Before I make any important changes to my policies, I will promptly change this Notice and provide you with a new copy.
How I may use and disclose your PHI: I will use and disclose your PHI for many different reasons. For some of the uses or disclosures I will need your prior authorization; for others, however, I do not. Listed below are the different categories of my uses and disclosures along with some examples of each category.
- Uses and Disclosures relating to treatment, payment, or health care operations do not require your prior written consent. I can use your PHI without your consent for the following reasons:
- For treatment. I can disclose your PHI to physicians, and other licensed health care providers who are involved in your care. For example, if you are being treated by a psychiatrist or other doctor, I may disclose your PHI in order to coordinate care.
- To obtain payment for treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to an insurance company or health plan to get paid for the health care services that I have provided to you.
- Other disclosures. I may also disclose your PHI to others without your consent in certain situations. For example, your consent is not required if you need emergency treatment as long I try to get your consent after treatment is rendered, or if I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so.
- Certain Uses and Disclosures Do Not Require Your Consent. I can use and disclose your PHI without your consent or authorization for the following reasons:
- When disclosure is required by the federal, state, or local law; judicial or administrative proceedings; or law enforcement. For example, I may make a disclosure to applicable officials when a lawvrequires me to report information to government agencies and law enforcement personnel about victims of abuse or neglect, or when ordered in a judicial or administrative proceeding.
- For public health activities. For example, I may have to report information about you to the county coroner.
- For health oversight activities. For example, I may have to provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
- For research purposes. In certain circumstances, I may provide PHI in order to conduct medical research.
- To avoid harm. In order to avoid a serious threat to the health or safety of a person, property or yourself, I may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.
- For specific government functions. I may disclose PHI of military personnel and veterans in certain situations. And I may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
- For workers compensation purposes. I may provide PHI in order to comply with workers’ compensation laws.
- Appointment reminders and health related benefits or services. I may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits I offer.
- Certain Uses and Disclosures Require You to Have the Opportunity to Object.
- Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care of the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
- Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in the sections above, I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent that I haven’t taken any action in reliance on such authorization) of your PHI by me.
You have the following rights regarding your PHI:
- The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how I use and disclose your PHI. I will consider your request, but I am not legally required to accept it. If I accept your request, I will put limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that I am legally required or allowed to make.
- The Right to Choose How I Send Your PHI to You. You have the right to ask that I send information to you to an alternate address (for example, sending information to your work address rather than your home address) or by alternative means (for example e-mail). I must agree to your request so long as I can easily provide the PHI to you in the format requested.
- The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of PHI that I have, but you must make the request in writing. If I do not have your PHI, but I know who does, I will tell you how to get it. I will respond to you within 30 days of receiving your written request. In certain situations, I may deny your request. If I do, I will tell you, in writing, my reasons for the denial and explain your right to have my denial reviewed. If you request copies of your PHI, I may provide you instead with a summary or explanation of the PHI as long as you agree to that.
- The Right to Get a List of the Disclosures I Have Made. You have the right to get a list of instances in which I have disclosed your PHI. This list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, or to your family. The list also won’t include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before August 4, 2013.
I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address if known), a description of the information disclosed, and the reason for the disclosure. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you up to $15 for each additional request.
- The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that I correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. I will respond within 60 days of receiving your request in writing if the PHI is: 1. Correct and complete. 2. Not created by me. 3. Not allowed to be disclosed, or 4. Not part of my records. My written denial will state the reasons for denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your initial request and my denial be attached to all future disclosures of your PHI. If I approve your request, I will make the change to your PHI, tell you that I have done it, and tell others that need to know about the change to your PHI.
- The Right to Get This Notice by E-mail. You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive this notice via e-mail, you also have the right to request a paper copy of it.
- Redisclosure. I understand that there is the potential that the protected health information that is disclosed pursuant to a written authorization may be redisclosed by the recipient and the protected health information will no longer be protected by the HIPAA privacy regulations, unless a State law applies that is more strict than HIPAA and provides additional privacy protections.