Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Patient’s
Health Information
THIS NOTICE DESCRIBES HOW
PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
I may use or disclose
your protected health information (PHI),
for treatment, payment, and health care operations purposes with your written authorization. To help clarify these terms, here are some definitions:
·
“PHI” refers to information in your health record that could identify you.
·
“Treatment, Payment, and Health Care Operations”
– Treatment is when I provide, coordinate,
or manage your health care and other services related to your health care. An
example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist.
– Payment is when I obtain reimbursement
for your healthcare. Examples of payment are when I or my billing agent disclose
your PHI to your health insurer to obtain reimbursement for services or to determine eligibility or coverage.
– Health Care Operations are activities
that relate to the performance and operation of my practice. Examples of health
care operations are quality assessment and improvement activities, business-related matters such as audits and administrative
services, and case management and care coordination.
·
“Use”
applies only to activities within my office, such as sharing, employing, applying, utilizing, examining, and analyzing information
that identifies you.
·
“Disclosure”
applies to activities outside of my office, such as releasing, transferring, or providing access to information about you
to other parties.
·
“Authorization”
is your written permission to disclose confidential mental health information. All
authorizations to disclose must be on a specific legally required form.
II.
Other Uses and Disclosures Requiring Authorization
I may use or disclose PHI for purposes outside of treatment, payment, or health care operations when
your appropriate authorization is obtained. In those instances when I am asked
for information for purposes outside of treatment, payment, or health care operations, I will obtain an authorization from
you before releasing this information. I will also need to obtain an authorization
before releasing your Psychotherapy Notes. “Psychotherapy Notes” are notes I have made about our conversation
during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation
is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the
authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the
claim under the policy.
III.
Uses and Disclosures without Authorization
I may use or disclose PHI without your consent or authorization in the following circumstances:
·
Child Abuse – If I have reason to believe that a child has been subjected to abuse or neglect, I must report this belief
to the appropriate authorities.
·
Adult and Domestic Abuse – I may disclose protected health information regarding you if I reasonably believe that you are
a victim of abuse, neglect, self-neglector exploitation.
·
Health Oversight Activities – If I receive a subpoena from the Maryland Board of Examiners of Psychologists because they are
investigating my practice, I must disclose any PHI requested by the Board.
·
Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information
about your diagnosis and treatment or the records thereof, such information is privileged under state law, and I will not
release information without your written authorization or a court order. The
privilege does not apply when you are being evaluated or a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
·
Serious Threat to Health or Safety – If you communicate
to me a specific threat of imminent harm against another individual or if I believe that there is clear, imminent risk of
physical or mental injury being inflicted against another individual, I may make disclosures that I believe are necessary
to protect that individual from harm. If I believe that you present an imminent,
serious risk of physical or mental injury or death to yourself, I may make disclosures I consider necessary to protect you
from harm.
IV. Patient’s Rights and Psychologist’s
Duties
Patient’s Rights:
·
Right to Request
Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health
information. However, I am not required to agree to a restriction you request.
·
Right to Receive Confidential Communications by Alternative
Means and at Alternative Locations – 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.
On your request, I will send correspondence to you, such as bills, to another address.)
·
Right to Inspect
and Copy – You have the right to inspect or obtain a copy (or
both) of PHI in my mental health and billing records used to make decisions about you for as long as the PHI is maintained
in the record. I may deny your access to PHI under certain circumstances, but
in some cases you may have this decision reviewed. You have the right to inspect
or obtain a copy (or both) of Psychotherapy Notes unless I believe the disclosure
of the record will be injurious to your health. On your request, I will
discuss with you the details of the request and denial process for both PHI and Psychotherapy Notes.
·
Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is
maintained in the record. I may deny your request. On your request, I will discuss with you the details of the amendment process.
·
Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, I will discuss with you the details of the accounting process.
·
Right to a Paper
Copy – You have the right to obtain a paper copy of the notice
from me upon request, even if you have agreed to receive the notice electronically.
Psychologist’s Duties:
·
I am required by law to maintain the privacy of PHI and
to provide you with a notice of my legal duties and privacy practices with respect to PHI.
·
I reserve the right to change the privacy policies and practices
described in this notice. Unless I notify you of such changes, however, I am
required to abide by the terms currently in effect.
·
If I make material revisions to my policies and procedures,
I will provide you with an updated copy of this document by mail or email. A current copy of my policies and procedures is
always available on my website: http:// www.drlisafreeman.com.
V.
Complaints
If you are concerned that I have violated your privacy rights, or you disagree with a decision I made
about access to your records, you may contact me to discuss your concerns at any time.
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I can provide you with the appropriate address upon request.
VI.
Effective Date and Changes to Privacy Policy
This notice will go into effect on February 1, 2003.
I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI
that I maintain. If I make material revisions to these policies and procedures, I will provide you with an updated copy of this document by mail or email. A current
copy of my policies and procedures is always available on my website: http:// www.drlisafreeman.com.
