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Privacy Policy This notice describes how your medical information may be used, disclosed and safeguarded, and how you can get access to this information. Please review it carefully. In the statement below, “I” and “My”
refers to your individual doctor or therapist at the I. My
Responsibilities The confidentiality of your
personal health information is very important to me. Your health information
includes both clinical (symptoms, diagnoses, treatments) and administrative
(billing, dates) material. Generally speaking, I am required to: 1) Maintain the privacy of your health information as
required by law; 2) Provide you with this Notice of my duties and privacy
practices regarding the health information about you that I collect and
maintain; 3) Follow the terms of this Notice currently in
effect. II. Uses
and Disclosures of Information Under federal law, I am permitted
to use and disclose personal health information for treatment, payment, and
health care operations without authorization.
Whenever possible, I will obtain your consent before disclosing any
such information. Here are some
examples to clarify these terms: Treatment: I consult with your therapist or family
doctor about your condition. Payment: Your health information is disclosed to
your insurer to obtain reimbursement. In these situations, I will disclose
only the minimum amount of information necessary. Health Care Operations: This refers to administrative activities
such as services or audits that relate to the operation of my practice. III. Other Uses and Disclosures In the following situations I may
be ethically or legally obligated to use or disclose your personal
information without authorization: Serious Threat to Health or Safety I may disclose your health
information to protect you or others from a serious threat of harm by you. Abuse, Neglect, or Domestic
Violence If you give me information which
leads me to suspect child abuse, neglect, or death due to maltreatment of a
child; or that a disabled adult is in need of protective services, I must
report such information to the county Department of Social Services. If asked by the Director of Social Services
to turn over information relevant to a child protective services
investigation, I must do so. Minors If you are an unemancipated
minor under Parents If you are a parent of an unemancipated minor, and are acting as the minor’s
personal representative, I may disclose health information about your child
to you under certain circumstances. For example, if I am legally required to
obtain your consent as your child’s personal representative in order for your
child to receive care from us, I may disclose health information about your
child to you. In some circumstances, I may not
disclose health information about an unemancipated
minor to you. For example, if your child is legally authorized to consent to
treatment (without separate consent from you), consents to such treatment,
and does not request that you be treated as his or her personal
representative, I may not disclose health information about your child to you
without your child’s written authorization. Judicial or Administrative
Proceedings In cases where you are involved in
a court proceeding and a request is made for your personal health
information, this information is privileged under state law and I will not
release it without your consent or a court order. Workers’ Compensation I may disclose health information
about you for purposes related to workers’ compensation, as required and
authorized by law. Health Care Oversight I may disclose health information
about you for oversight activities authorized by law or to an authorized
health oversight agency to facilitate auditing, inspection, or investigation
related to my provision of health care, or to the health care system. Food and Drug Administration (FDA) I may disclose health information
about you to the FDA, or to an entity regulated by the FDA, in order, for
example, to report an adverse event or a defect related to a drug or medical
device. Required By Law I may disclose health information
about you as required by federal, state, or other applicable law. You will be
notified, as required and when allowed by law, of any such disclosures. IV. Psychotherapy
Notes In the course of your care with me,
I may keep separate notes about our conversations. These notes, known as
“psychotherapy notes”, are kept apart from the rest of your medical record
and their confidentiality is subject to greater protection. They do not include basic medical information
about your diagnosis or treatment. Psychotherapy
notes may be disclosed only after you have given written authorization to do
so. (Limited exceptions exist, e.g. in order for me to prevent harm to
yourself or others, and to report child abuse/neglect). You cannot be
required to authorize the release of your psychotherapy notes in order to
obtain health-insurance benefits for your treatment, or enroll in a health
plan. Psychotherapy notes are also not among the records that you may request
to review or copy (see discussion of your rights in section VII below). If
you have any questions, feel free to discuss this subject with me. V. Your
Health Information Rights Under the law, you have certain
rights regarding the health information that I collect and maintain about
you. This includes the right to: a) Request that I restrict certain uses and disclosures
of your health information; I am not, however, required to agree to a
requested restriction. b) Request that I communicate with you by alternative
means. I will accommodate reasonable
requests for such confidential communications; for example, if you do
not want a family member to know you are seeing me I can send correspondence
to an alternate address. c) Request to review, or to receive a copy of, the health
information about you that is maintained in my files and the files of
my business associates (if applicable). If I am unable to satisfy your
request, I will tell you in writing the reason for the denial and your right,
if any, to request a review of the decision. d) Request that I amend the health information
about you that is maintained in my files and the files of my business
associates (if applicable). Your request must explain why you believe my
records about you are incorrect, or otherwise require amendment. If I am
unable to satisfy your request, I 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 (of reasonable length) disagreeing with the decision. This
statement will be added to your records. e) Request a list of my 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 operations. f) Request a paper copy of this Notice. In order to exercise any of your
rights described above, you must submit your request in writing to me. If you
have questions about your rights, please speak with me in person or by phone
during normal office hours. VI. For
More Information or to Report a Problem If you need further information or
want to contact me for any reason regarding the handling of your health
information, please direct any communications to:
If you believe your privacy rights
have been violated, you may file a written complaint by mailing it or
delivering it to me. You may complain to the Secretary of Health and Human
Services (HHS) at: Office for Civil Rights I cannot, and will not, make you
waive your right to file a complaint with HHS as a condition of receiving
care from me, or penalize you for filing a complaint with HHS. VII. Revisions to this Notice I 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 I 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, your rights regarding such information, my legal duties, or
other privacy practices described in the Notice, I will promptly distribute
the revised Notice, post it in the waiting area of my office, make copies
available to my patients and others, and post it at www.moodtreatmentcenter.com. Effective Date: |
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