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NOTICE OF PRIVACY PRACTICES
Effective: 4/14/2003
This Notice of Privacy Practices describes the privacy policies and procedures adopted by this office under the Federal HIPAA Privacy Regulations and guidelines. This office pledges to uphold privacy and confidentiality concerning your treatment process and records.
I. Your Protected Health Information
The term “Protected Health Information,” or PHI, refers to all individually identifiable information about your past, present or future health or condition, the provision of health care to you, or payment for your health care. Your therapist understands that your health information is personal and confidential and is committed to protecting the physical records of treatment and the information contained therein, including safeguarding their use, transportation and storage. Your therapist reserves the right to change these privacy practices and the terms of this Notice at any time. If this Notice of Privacy Practices is changed, a new Notice will be posted in the Waiting Room and will contain the effective date at the top. A new Notice will show in italics or brackets the changes from the previous Notice. You may request a copy of the Notice of Privacy Practices in effect at any time.
II. Use and Disclosure of Your Protected Health Information
Your therapist will need to use and disclose your Protected Health Information for a variety of reasons. Certain uses/disclosures require your written authorization; however, the law provides that other uses/disclosures do not require your authorization.
A. Uses and Disclosures for Treatment, Payment & Business Operations
Generally, your therapist may use and disclose your Protected Health Information during the normal course of providing and receiving payment for your care. Your voluntary agreement to seek treatment provides this permission by law. These uses and disclosures include:
1) therapist’s consultation with peer professionals, supervisors, attorneys, accountants, etc. (identifying information is not disclosed);
2) information about the cost of care and maintenance of treatment required by third-party payers (e.g., insurance/managed care companies, State agencies, etc.);
3) completion of necessary billing, banking and collection activities;
4) data collection, research and information for monitoring managed care providers by State agencies or to satisfy reporting requirements;
5) phone calls, voice messages, electronic transmissions, written correspondence, and mailings sent to addresses and phone numbers provided, unless specific alternate instructions are given; and
6) disclosures made during the course of therapy involving a client’s partner, family, or other third parties, in which statements made in individual or group sessions may, of necessity or inadvertently, be repeated to others, unless the handling of that disclosure was previously and clearly agreed upon with your therapist.
B. Uses and Disclosures With Authorization
For uses and disclosures of your PHI other than during the normal course of business operations and providing treatment, your therapist is required to have your written authorization, unless the use or disclosure falls within one of the exceptions described below (Section C). If you request or are asked to provide written authorization for the release of any information regarding your treatment or records, you must submit a written, signed, and dated request for release specifying the content or material to be released, to whom, and the purpose of the release. Your therapist can provide an Exchange of Information form to sign. You may specify or limit the scope of information to be released at any time, and it will expire one year, if not otherwise specified, from the date of your signature.
Your signed consent may be required for the release of diagnostic and treatment information to any third-party payers. Your written permission also will be obtained if you or your therapist were to request audio or videotaping of treatment. Any information included in your records from another source (e.g., physician, therapist, family member, etc.) will not be released without a signed authorization from that source.
C. Revoking an Authorization
You may revoke an authorization, in writing, at any time, except: 1) to the extent that your therapist has already made disclosures in reliance upon your prior authorization, and 2) if the authorization was given as a condition of obtaining insurance coverage and law provides the provider or insurer with the right to pursue or contest a claim under the policy. If you do wish to revoke an authorization, your written revocation must include the date of the authorization, the name of the person/organization authorized to receive the PHI, your signature, and the date of the revocation. Your therapist will not refuse to treat you if you refuse to sign any authorization to release PHI.
D. Uses and Disclosures Not Requiring Authorization
The use and disclosure of your Protected Health Information requiring an authorization may be limited by law under the following circumstances:
1) therapy with minors, which requires parental consent;
2) equal access of a minor’s records to both custodial and non- custodial parents if requested, unless a court order states otherwise;
3) threat of bodily harm or death to yourself or others;
4) information is revealed concerning child or elder abuse or neglect;
5) certain crimes have been committed;
6) information is required by a coroner or medical examiner;
7) information is required by a National security or intelligence agency, such as for protection of the President;
8) a judge issues a court order for a court appearance or release of records following a hearing showing good cause;
9) you are involved in certain processes of litigation (e.g., child custody, lawsuit, mental health status); or
10) therapy and/or evaluations are court ordered.
Under some of the circumstances described above, your therapist may be required by law to release requested information about the treatment process and results, and/or to inform the intended victim(s), their families, and appropriate law enforcement authorities.
III. Your Rights Regarding Your Protected Health Information
You have several rights regarding your Protected Health Information. First, you have the right to request, in writing, how you would like your therapist to restrict the uses and disclosures of your PHI. Your therapist will consider this request, but is not legally bound to agree to the restriction. The extent that your therapist agrees with any restrictions will be put in writing. Disclosures already made and those required by law will be exempted.
Second, you have the right to ask, in writing, that your therapist contact or send you information at an alternate address or by an alternate means, such as contacting you only at work. You have the opportunity to specify how you prefer your therapist contact you when you fill out the Personal Data Inventory form at the beginning of therapy. Your therapist will agree to this request as long as it is reasonably easy to do so.
Third, you are generally entitled to inspect and copy your records; however, your therapist is permitted by law to withhold all or any portion of your records 1) in order to permit her to freely record diagnostic and therapeutic information regarding your treatment, or 2) if she believes with reasonable certainty and in her professional judgment that seeing these records may be detrimental to your physical or mental health. If your therapist releases these records to you, you will be responsible for any costs associated with copying, mailing, and time incurred by your therapist in responding to your request to inspect or copy your records. Prior to their release, your therapist may require, at her discretion, a 50-minute session or longer to review your records with you. This time will be charged at the current rate. Your therapist is required by law to retain possession of treatment records for a minimum of seven (7) years.
Fourth, if you believe there is a mistake or missing information in the record of your Protected Health Information, you may request, in writing, that your therapist correct or add to the record. Written requests, must include a reason that supports your request. Your therapist will respond within 60 days of receiving your request. Your therapist may deny your request for an amendment if 1) your request is not in writing or does not include a reason to support the request; 2) your therapist determines that the record is correct and complete; 3) your therapist determines that your PHI is not permitted to be disclosed.
Fifth, you have a right to request, in writing, an accounting of disclosures—a list of what disclosures have been made of your Protected Health Information, including what content, when, to whom, and for what purpose, other than instances of disclosure for which you have given your written authorization. Your request can relate to disclosures going as far back as six (6) years. This list will not include any disclosures made before April 14, 2003, for national security purposes, treatment, payment or operations purposes, or to law enforcement officials or correctional facilities. Your therapist will respond within 60 days of receiving your written request. There will be no charge for the first list requested each year, but may be a charge for subsequent requests.
Sixth, you have a right to receive a paper copy of this Notice of Privacy Practices and/or an electronic copy by email, upon request. Please ask your therapist if you wish a copy.
IV. Safeguarding Your Protected Health Information
Your therapist takes many precautions to safeguard the use, transportation and storage of your Protected Health Information. The policies and procedures described below are comprehensive, but may not be complete. These policies and procedures are designed to maximize the privacy and confidentiality of therapy sessions and your records, realizing that no steps provide a perfect solution.
Physical Office. Your therapist has designed her office so that there are layers of sound-minimizing barriers between the Waiting Room and Therapy Room, including insulated walls, rubber barriers hanging above the ceiling tiles, and a bookcase placed on the wall between the two rooms. The Exit Hall is strategically located between the two rooms to minimize sound as well. Playing music in the Waiting Room and the White Noise provided by electronic equipment (e.g., air cleaner, heater, fan, humidifier, dehymidifier) also help mask sounds.
The two doors to the office are kept locked at all times, except for the Waiting Room door during actual office hours. A chime sounds whenever the Waiting Room door is opened, and the office is protected by a monitored alarm system when activated. Only your Therapist has the code to the Alarm System, although the Maintenance Personnel have the ability to temporarily bypass the system to clean or make repairs to the office. Only your Therapist and Maintenance Personnel have keys to the office. The Maintenance Personnel have been given a brief description of rules regarding respecting privacy.
Transportation. Generally, your therapist transports files back-and-forth from her home to the office as needed. Your therapist believes that the files are safer in a locked file at home than in a public place, and this provides easier access to the files for billing and administrative functions. When being transported, the files are placed in the back seat, or in the trunk with the car locked if she leaves the car briefly.
Storage of Records. Current client files and records are stored in a locked filing cabinet in your therapist’s home office. These files are not left out except when in use. Archived client files and records are stored in locked filing cabinets in a storage space in your therapist’s home. This home is protected by a monitored alarm system.
Destruction & Disposal. All private and confidential documents are disposed of in a confetti-style shredder.
Scheduling. Each client is provided with a unique client number instead of using an identifying name. Sessions are scheduled and written in your therapist’s Planner using this client number. Your therapist keeps in this Planner a master list of current clients’ phone numbers, identified by client number, first name and last name initial. This provides access to phone numbers necessary for communications while reducing the need to carry any more files or records than needed. This Planner remains in your therapist’s possession or protection and is used and transported with the same precautions as client files and records.
Current pending calls received or made are logged on a Call Sheet that remains in the Planner. When completed, each Call Sheet is placed in the same locked filing cabinet as client files.
Information Systems & Media. Most billing and correspondence are conducted on your therapist’s computer at home, with minimal use of the computer at the office. These computers are set up so the “Computer Administrator” and “User Accounts” are Password-protected. All passwords are chosen as combinations of words/letters/numbers that cannot be found in a dictionary.
All important data on the computers are frequently backed up with a hard-drive back-up system that remains attached to the computer. Any other back-ups are stored in the same locked filing cabinets as other stored client records.
Internet access is protected by a Password, Firewall and Virus Programs, and downloads are handled with caution. Your therapist has chosen not to use email as a regular means of communicating with clients because of concerns regarding privacy and the dependability of accessing this information, such as when a computer or Internet Service Provider is down or your therapist is at a location where she cannot easily access her computer. Any confidential email sent to clients or on their behalf, however, is encrypted through Microsoft Outlook.
Your therapist is the only person who accesses the computers and any email addresses provided. When not being used, the computers are generally turned off. All information is expunged professionally from any old computers before they are disposed of or donated.
Communications. Your therapist uses primarily telephone and voicemail to communicate regarding confidential client information. Messages left on voicemail are private and protected by a password. Only your therapist has access to this voicemail or password. Most messages are listened to and then erased, some are saved temporarily, and a few important messages may be tape-recorded and stored in a locked filing cabinet.
Special precautions are taken when communicating by cell phone. Your therapist will identify when she is using the cell phone so that a decision can be made about whether to continue with a conversation. Special care is taken not to give identifying information over a cell phone (e.g., your your therapist does not check the status of insurance claims on the cell phone).
The majority of billing and some other communications are sent by U.S. mail. If confidential, these are marked with “Attention” to the person intended and stamped “Confidential” on both sides of the envelope.
All confidential faxes are sent with a cover sheet containing a “Confidentiality Notice.” To ensure confidential faxes are sent and received correctly, your therapist takes special precautions to notify the receiver by calling ahead, double-check the fax number entered, and follow up with a phone call to the receiver during and/or after the transmission. The fax machine is set up to provide a duplicate cover sheet containing all information about where the fax was sent and provides a monthly log of all faxes sent.
V. How to Complain About Privacy Practices
If you believe your privacy rights have been violated, or if you disagree with a decision made about access to your Protected Health Information, you may discuss or file a formal complaint directly with your therapist. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
This Notice of Privacy Practices has attempted to inform and answer your questions about the protection and safeguarding of your Private Health Information. If you have further questions, suggestions or concerns, please feel free to discuss these with your therapist.
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