Privacy: Private health information (PHI) is identifiable information about: (1) your past, present, or future health or condition(s); (2) the provision of health care to you; or (3) payment for health care. Examples of PHI include information in your medical record such as your health history, the reasons you sought treatment, your treatment plan, progress notes and billing information.

Use of your PHI is necessary in order for me to provide you with care, to develop a treatment plan, and to decide how well treatment is working for you. I also use and/or disclose your PHI for coordinating care with other health professionals who are treating you, and to document the services for which you are billed. 

I am required by law to extend certain protections to you and your PHI, and to give you this notice about my privacy practices that explains how, when, and why I may use and/or disclose your PHI. In most cases, I can release information about your treatment to others only if you sign a written authorization form, and I am required to disclose only the minimum amount of information necessary to accomplish the purpose of my use and/or disclosure.

Some disclosures are allowable without your authorization, although it is my policy to discuss them with you when feasible and appropriate and to obtain your authorization. Additionally, in situations where it is an option, I will not identify your PHI with your name.

USE AND DISCLOSURES ALLOWED WITHOUT YOUR AUTHORIZATION

In general, I am allowed to use and/or disclose your PHI without your authorization for the purposes of treatment, payment for services, and normal health care operations. For example, I may share your PHI with your primary care physician or other health professionals involved in your treatment, or to obtain consultation from another professional. Your PHI can also be used and/or disclosed in order to contact you for appointment reminders, for billing and collection activities, and/or during the course of quality care reviews.

Other allowable /required disclosure include the following:

Child Abuse: Whenever I, in my professional capacity, have knowledge of or observe child abuse or neglect, I must immediately report such to authorities in law enforcement or child welfare. I am also allowed to disclose PHI to these authorities if I have knowledge of or reasonable suspicion that a child has been emotionally abused.

Elder and Dependent Adult Abuse: Whenever I, in my professional capacity, have knowledge of or observe an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult I am required to report this to the local ombudsman or a local law enforcement agency. In some cases I am also required to make a report if an elder or dependent adult tells me that such abuse has occurred. Exceptions would occur if I was not aware of any independent evidence corroborating the allegations, I reasonably believe that the abuse did not occur, and the elder/dependent adult had a diagnosis of a mental illness or dementia, or was the subject of a court-ordered conservatorship for these reasons.

Judicial or Administrative Proceedings: In most legal proceedings, you have the right to prevent me from providing any information about your treatment. There are exceptions, such as when there is a court order to disclose, and in some proceedings involving child custody or Worker’s Compensation claims.

Serious Threat to Health or Safety: If you communicate to me a serious threat of physical violence against an identifiable victim, I must make reasonable efforts to communicate that information to the potential victim and notify the police. I am also allowed to disclose your PHI if I believe that you are a serious danger to yourself.

I encourage you to discuss with me any questions or concerns you may have about disclosures or confidentiality.

DISCLOSURES REQUIRING YOUR AUTHORIZATION

I must obtain your authorization to disclose your PHI for purposes that fall outside the definition of treatment, payment, and health care operations, or the special situations described above. You retain the right to revoke your authorization at any time.

Your Medical/Psychiatric Record: Professional records constitute an important part of the therapy process and help with the continuity of care over time. According to the rules of HIPAA, your treatment and consultations with me are documented in two ways. The Clinical Record, which is a required record that includes the date of your therapy sessions, your reasons for seeking treatment, your diagnosis, therapeutic goals, treatment plan, progress, medical and social history, treatment history, functional status, any past records from other providers, as well as any reports to your insurance carrier. Psychotherapy Notes are optional notes that are kept by some providers to document specific content or analyses of therapy conversations that may assist in the treatment process. When used, psychotherapy notes are kept separately from your clinical record in order to maximize privacy and security.

You have the right to inspect and receive a copy of your Clinical Record. Viewing your record is best done during a professional consultation, rather than on your own, in order to clarify any questions that you may have at the time. You may be charged a nominal fee for accessing and photocopying the record. Psychotherapy Notes, however, if they are created, are never disclosed to third parties, HMOs, insurance companies, billing agencies, patients, or anyone else. They are for the use of the treating therapist in tracking the many details of appointments that are too specific to be included in the Clinical Record. If your case manager or insurance company requests to see the psychotherapy notes, you have a choice about consenting (authorizing release of this information) or denying access to them. If you refuse, it will not affect your coverage or reimbursement in any way, and your insurance provider or HMO is obliged to provide payment as usual.

If you believe that there is an inaccuracy in your clinical record, you may request a correction. If the information is accurate, or if it has been provided by a third party (e.g., previous therapist, primary care physician, etc.), it may remain unchanged, and the request may be denied. In this case you will receive an explanation in writing, with a full description of the rationale. You also have the right to make an addition to your record, if you think it is incomplete.

THE RIGHT TO REQUEST RESTRICTIONS

You have the right to request restrictions on certain uses and disclosures of PHI about you. However, I am not required to agree to all restrictions you request. An important exception is your right to request nondisclosure to your health plan when you pay out-of-pocket in full unless the disclosure is for treatment purposes or in the rare event disclosure is required by law.

THE RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS

You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me. Upon your request, I will send your bills to another address.) 

THE RIGHT TO BE NOTIFIED OF A BREACH

You have the right to be notified if I discover a breach of your PHI.

COMPLAINTS ABOUT MY PRIVACY PRACTICES

If you believe that your privacy rights have been violated or object to a decision I have made about access to your PHI, please let me know. You have the right to file a complaint directly to me and/or the Secretary of the U.S. Department of Health and Human Services (200 Independence Ave., S.W., Washington, D.C. 20201).

CHANGES TO THIS NOTICE

Please note that this privacy notice may be revised from time to time. You will be notified of changes in the laws concerning privacy or your rights as I become aware of them.

If you need more information or have questions about my privacy practices, I encourage you to ask me.