Notice of privacy practices
patient health information:
I want you to know how your Patient Health Information (PHI) is going to be used in this office and your rights concerning those records. Before we begin any health care operations I must require you to read and sign a consent form stating that you understand and agree with how your records will be used. If you would like to have a more detailed account of policies and procedures concerning the privacy of your Patient Health Information I encourage you to read the HIPAA NOTICE that is available to you to review before signing this consent. 1. The patient understands and agrees to allow this office to use Patient Health Information (PHI) for the purpose of treatment, payment, healthcare operations, and coordination of care. As an example, the patient agrees to allow this office to submit requested PHI to the Health Insurance Company (or companies) provided by the patient for the purpose of payment. Be assured that this office will limit the release of all PHI to the minimum needed for what the insurance companies require for payment. 2. Clinical records, psychotherapy notes, and other disclosures require a separate signed release of information. You have a right to or will receive notification of a breach of any unsecured personal health information. You have the right to restrict any disclosure of personal health information where you have paid for services out-of-pocket and in full. 3. The patient has the right to examine and obtain a copy of her or his own health records at any time and request corrections. Psychotherapy contact notes are not available for the patient to review. The patient may request to know what disclosures have been made and submit in writing any further restrictions on the use of their PHI. My office is obligated to agree to those restrictions only to the extent they coincide with state and federal law. 4. A patient's written consent need only be obtained one time for all subsequent care given the patient in this office. 5. The patient may provide a written request to revoke consent at any time during care. This would not affect the use of those records for the care given prior to the written request to revoke consent but would apply to any care given after the request has been presented. 6. For your security and right to privacy, staff has been trained in the area of patient record privacy and a privacy official has been designated to enforce those procedures in the office. I have taken all precautions that are known by this office to assure that your records are not readily available to those who do not need them. 7. Patients have the right to file a formal complaint with the privacy official and the Secretary of HHS about any possible violations of these policies and procedures without retaliation by this office. 8. My office reserves the right to make changes to this notice and to make new notice provisions effective for all protected health information that it maintains. You will be provided with the new notice at your next visit following any change.
CONFIDENTIALITY: Everything you say in our sessions and the written notes I take are confidential and may not be released to anyone without your written permission except when disclosure is required by law. WHEN DISCLOSURE IS REQUIRED BY LAW: • Abuse/neglect of a child or abuse/neglect of a vulnerable adult is suspected; • Client presents a danger to self and refuses appropriate care; • Client threatens to harm someone else or poses a threat to the safety of others; • Legally ordered by a court of law. ADDITIONAL REASONS FOR DISCLOSURE: • When case consultation is presented in an anonymous manner to other professionals; • To collect on a debt for services rendered.
CONFIDENTIALITY: Everything you say in our sessions and the written notes I take are confidential and may not be released to anyone without your written permission except when disclosure is required by law. WHEN DISCLOSURE IS REQUIRED BY LAW: • Abuse/neglect of a child or abuse/neglect of a vulnerable adult is suspected; • Client presents a danger to self and refuses appropriate care; • Client threatens to harm someone else or poses a threat to the safety of others; • Legally ordered by a court of law. ADDITIONAL REASONS FOR DISCLOSURE: • When case consultation is presented in an anonymous manner to other professionals; • To collect on a debt for services rendered.