DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Portability & Accountability Act of 1996 (HIPAA) requires all health care
records and other individually identifiable health information (Protected
Health Information) used or disclosed to us in any form, whether,
electronically, on paper, or orally, be kept confidential. This federal law
gives you, the patient, significant new rights to understand and control how
your health information is used. HIPAA provides penalties for covered entities
that misuse personal health information. As required by HIPAA, we have prepared
this explanation of how we are required to maintain the privacy of your health
information and how we may use and disclose your health information.
specific written authorization, we are permitted to use and disclose your
health care records for the purposes of treatment, payment, and health care
means providing, coordinating, or managing health care and related services by
one or more health care providers. An example of this would be speaking with
your primary care physician. However, in that case, I will ask you for an
Authorization form from use, giving me permission to speak to another
means such activities as obtaining reimbursement for services, confirming
coverage, billing or collection activities, and utilization review. An example
of this would be billing your insurance company.
Care Operations include the business aspects of offering clinical services,
such as quality assessment, auditing functions, cost analysis. An example would
be a periodic assessment of documentation protocols.
your confidential information may be used to remind you of an appointment (by
phone or mail), or provide you with information about treatment options or
other health-related services. We will use and disclose your Protected Health
Information when we are required to do so by federal, state, or local law. We
may disclose your Protected Health Information to public health authorities
that are authorized by law to collect information; to a health oversight agency
for activities authorized by law included but not limited to: response to a
court or administrative order, if you are involved in a lawsuit or similar
proceeding; response to a discovery request, subpoena, or other lawful process
by another party involved in the dispute, but only if we have made an effort to
inform you of the request or to obtain an order protecting the information the
party has requested. We may release your Protected Health Information to a
medical examiner or coroner to identify a deceased individual or to identify
the cause of death. We may use and disclose your Protected Health Information
when necessary to reduce or prevent serious threat to your health and safety or
to the health and safety of another individual or the public. Under these
circumstances, we will only make disclosure to a person or organization able to
help prevent the threat.
uses and disclosures will be made only with your written authorization. You may
revoke such authorization in writing, and we are required to honor and abide by
that written request, except to the extent that we have already taken actions
relying on your authorization.
certain rights in regards to your Health Protected Information, which you can
exercise by presenting a written request to this entity.
to request restrictions on certain uses and disclosures of Protected Health
Information, including those related to disclosures to family members, other
relatives, close personal friends, or any other person identified by you. We
are, however, not required to agree to a requested restriction. If we do agree
to a restriction, we must abide by it unless you agree in writing to remove it.
to request to receive confidential communications of Protected Health
Information from us by alternative means or at alternative locations.
to request an amendment to your Protected Health Information.
to receive an accounting of disclosures of Protected Health Information outside
of treatment, payment, and health care operations.
to obtain a paper copy of this notice from us upon request.
required by law to maintain the privacy of your Protected Health Information
and to provide you with notice of our legal duties and privacy practices with
respect to Protected Health Information. We are required to abide by the terms
of the Notice of Privacy Practices currently in effect. We reserve the right to
change the terms of our Notice of Privacy Practices and to make the new notice
provisions effective for all Protected Health Information that we maintain.
Revisions to our Notice of Privacy Practices will be posted on the effective
date, and you may request a written copy of the Revised Notice.
the right to file a formal, written complaint with use at the address below, or
with the Department of Health & Human Services, Office of Client Rights, in
the event that you feel your privacy rights have been violated. We will not
retaliate against you for filing a complaint.
information about our Privacy Practices, contact:
Mel Langston, PhD,
information about HIPAA or to file a complaint:
The US Department
of Health and Human Services
Office of Civil