Notice of Privacy Practices Revised Effective Date 08/26/2018

This notice provides information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient right with regard to the use and disclosure of the client’s Protected health Information (PHI). In this Notice, we will call all of that protected health information “medical information.” THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT THE CLIENT MAY BE USED AND DISCLOSED AND HOW THE CLIENT CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We will be happy to answer any of the client’s questions.

HIPAA requires that we provide the client with a copy of this Notice, and that we attempt to obtain the client’s signature acknowledging receipt of this Notice.

How We May Use and Disclose Medical Information About The client or the client’s client

We use and disclose medical information about the client for a number of different purposes. Each of those purposes is described below.

For Treatment Referral

We may use medical information about the client to provide, coordinate or manage the client’s health care and related services by both us and other health care providers. We may disclose medical information about the client to doctors, nurses, hospitals and other health facilities who become involved in the client’s care with the client’s consent. We may consult with other health care providers within this practice concerning the client and as part of the consultation share the client's medical information with them. We may refer the client to another health care provider and as part of the referral, may share medical information about the client with that provider with the client's consent. For example, we may conclude the client needs to receive services from a physician or therapist with a particular specialty. When we refer the client to that physician or therapist, we also will contact that physician or therapist’s office and provide medical information about the client to them so they have information they need to provide services for the client.

For Payment (for in-person services only)

We may use and disclose medical information about the client so we can be paid for the services we provide to the client with the client’s consent. This can include billing to the client, the client's insurance company, or a third party payer. For example, we may need to give the client’s insurance company information about the health care services we provide to the client so the client’s insurance company will pay us for those services or reimburse the client for amounts the client have paid. We also may need to provide the client’s insurance company or a government program, such as Medicare or Medicaid, with information about the client’s medical condition and the health care the client need to receive to obtain a determination if the client are covered by that insurance or program.

How We Will Contact The client

Unless the client tells us otherwise in writing, we may contact the client by either telephone or by mail at either the client’s home or the client’s workplace. At either location, we may leave messages for the client on the answering machine or voice mail. If the client wants to request that we communicate to the client in a certain way or at a certain location, see “Right to Receive Confidential Communications.”

Appointment Reminders

We may use and disclose medical information about the client to contact the client to remind the client of an appointment the client has with us.

Treatment Alternatives

We may use and disclose medical information about the client to contact the client about treatment alternatives that may be of interest to the client.

Required or Allowed By Law

We may use or disclose medical information about the client when we are required or allowed to do so by law.

Public Health Activities

We may disclose medical information about the client for public health activities and purposes. This includes reporting medical information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease. Or, one that is authorized to receive reports of child abuse and neglect.

Victims of Abuse or Neglect/Duty to Protect

We may disclose medical information to a government authority authorized by law to receive reports of abuse or neglect, or to other specified individuals/agencies, if we believe the client are or another person is a victim or potential victim of abuse or neglect. This may involve a child under 18, a mentally retarded/developmentally disabled individual, or a senior adult. This will occur to the extent the disclosure is: (a) required by law; (b) agreed to by the client; or (c) authorized by law and we believe the disclosure is necessary to prevent serious harm to the client or to other potential victims.

Health Oversight Activities

We may disclose medical information about the client to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the health care system, government benefit programs, and entities subject to various government regulations.

Judicial and Administrative Proceedings

We may disclose medical information about the client in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal.

Disclosures for Law Enforcement Purposes

We may disclose medical information about the client to a law enforcement official for law enforcement purposes:

1. As required by law.

2. In response to a court, grand jury or administrative order, warrant or subpoena

3. To identify or locate a suspect, fugitive, material witness or missing person.

4. About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be disclosed.

5. About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be disclosed.

6. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.

7. About crimes that occur at our facility.

8. To report a crime in emergency circumstances.

Workers’ Compensation

We may disclose medical information about the client to the extent necessary to comply with workers’ compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.

Mental Health or Chemical Dependency Records

If we receive health information about the client from a health care provider, we will not re-disclose or otherwise reveal any mental health or chemical dependency records contained in that information, beyond the purpose of the disclosure to us, without first obtaining the client’s written authorization, if that is required by law. There are certain other times when we may disclose information, including if the client is a member of the armed forces, in certain instances involving National Security and Intelligence, or if the client is an inmate.

Other Uses and Disclosures

Other uses and disclosures will be made only with the client’s written authorization. The client may revoke such an authorization at any time by notifying the client’s therapist in writing of the client’s desire to revoke it. However, if the client revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.

The client’s Rights With Respect to Medical Information About The client

The client has the following rights with respect to medical information that we maintain about the client.

Right to Request Restrictions

The client has the right to request that we restrict the uses or disclosures of medical information about the client to carry out treatment, payment, or health care operations.

To request a restriction, the client may do so at any time. If the client requests a restriction, the client should do so with the client’s therapist and tell us: (a) what information the client want to limit; (b) whether the client want to limit use or disclosure or both; and, (c) to whom the client want the limits to apply.

We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either the client or we can later terminate the restriction.

Right to Receive Confidential Communications

The client has the right to request that we communicate medical information about the client to the client in a certain way or at a certain location. For example, the client can ask that we only contact the client by mail, email or at work. We will not require the client to tell us why the client is asking for the confidential communication.

If the client wants to request confidential communication, the client must do so in writing to the client’s therapist. The client’s request must state how or where the client can be contacted.

We will accommodate the client’s request. However, we may, when appropriate, require information from the client concerning how payment will be handled. We also may require an alternate address or other method to contact the client.

Right to Inspect and Copy

With a few very limited exceptions, the client has the right to inspect and obtain a copy of medical information about the client. The client has an absolute right to all materials created by the client’s treating therapist.

To inspect or copy medical information about the client, the client must submit the client’s request in writing to the client’s therapist. The client’s request should state specifically what medical information the client want to inspect or copy. If the client requests a copy of the information, we may charge a fee for the costs of copying and, if the client ask that it be mailed to the client, the cost of mailing. The client may be required to sign two authorization forms, one for psychotherapy notes and one for the rest of the records.

We will act on the client’s request within thirty (30) calendar days after we receive the client’s request. If we grant the client’s request, in whole or in part, we will inform the client of our acceptance of the client’s request and provide access and copies.

We may deny the client’s request to inspect and copy medical information if the medical information involved is information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding, i.e. that the information was not created for treatment purposes.

If we deny the client’s request, we will inform the client of the basis for the denial, how the client may have our denial reviewed, and how the client may complain. If the client requests a review of our denial, it will be conducted by a licensed health care professional designated by us who was not directly involved in the denial. We will comply with the outcome of that review.

Right to Amend

The client has the right to ask us to amend medical information about the client. The client has this right for so long as the medical information is maintained by us.

To request an amendment, the client must submit the client’s request in writing to the client’s therapist. The client’s request must state the amendment desired and provide a reason in support of that amendment.

We will act on the client’s request within sixty (60) calendar days after we receive the client’s request. If we grant the client’s request, in whole or in part, we will inform the client of our acceptance of the client’s request and provide access and copying.

If we grant the request, in whole or in part, we will seek the client’s identification of an agreement to share the amendment with relevant other persons. We also will make the appropriate amendment to the medical information by appending or otherwise providing a link to the amendment.

We may deny the client’s request to amend medical information about the client. We may deny the client’s request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny the client’s request to amend medical information if we determine the information:

1. was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;

2. is not a part of the medical information maintained by us;

3. would not be available for the client to inspect or copy; OR

4. is not accurate and complete.

If the client does not submit a statement of disagreement, the client may ask that we include the client’s request for amendment and our denial with any future disclosures of the information. We will include the client’s request for amendment and our denial (or summary of that information) with any subsequent disclosure of the medical information involved.

The client also will have the right to complain about our denial of the client’s request.

Right to an Accounting of Disclosures

The client has the right to receive an accounting of disclosures of medical information about the client. The accounting may be for up to six (6) years prior to the date on which the client requests the accounting but not before 08/26/2018.

Certain types of disclosures are not included in such an accounting, including:

1. Disclosures to carry out treatment, payment and heath care options.

2. Disclosures of the client’s medical information made to the client.

3. Disclosures that are incident to another use or disclosure

4. Disclosures that the client has authorized.

Under certain circumstances the client’s right to an accounting of disclosures to a law enforcement official or health oversight agency may be suspended. Should the client request an accounting during the period of time the client’s right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or to a health oversight agency.

To request an accounting of disclosures the client must submit the client’s request in writing to the client’s therapist. The client’s request must state a time period for the disclosures. It may not be longer that six (6) years from the date we receive the client’s request and may not include dates before 08/26/2018.

Usually, we will act on the client’s request within sixty (60) calendar days after we receive the client’s request. Within that time, we will either provide the accounting of disclosures to the client or give the client a written statement of when we will provide the accounting and why the delay is necessary.

There is no charge for the first accounting we provide to the client in any twelve (12) month period. For additional accountings, we may charge the client for the cost of providing the list. If there will be a charge, we will notify the client of the cost involved and give the client an opportunity to withdraw or modify the client’s request to avoid or reduce the fee.

Right to Copy of This Notice

The client has the right to obtain a paper copy of our Notice of Privacy Practices, upon request, even if the client agreed to receive the notice electronically. The client may request a copy of our Notice of Privacy Practices at any time. To obtain a paper copy of this notice, contact the client’s therapist.

Our Duties

Generally

We are required by law to maintain the privacy of medical information about the client and to provide the individuals with notice or our legal duties and privacy practices with respect to medical information.

We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.

Our Right to Change Notice of Privacy Practices

We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice. We will provide the client with a revised notice by mail or fax upon request.

Availability of Notice of Privacy Practices

At any time, the client may obtain a paper copy of our current Notice of Privacy Practices.

Effective Date of Notice

The effective date of the notice will be stated on the first page of the notice.