NOTICE OF PRIVACY PRACTICES *
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
I care about my patients’ privacy and strive to protect the confidentiality of your medical information. New federal legislation requires that I issue this official notice of my privacy practices. You have the right to confidentiality of your medical information, and I am required by law to maintain the privacy of that protected information. I am required to abide by the terms of this Notice of Privacy Practices, and to provide you with notice of my legal duties and privacy practices in respect to protected health information (PHI) you provide to me. If you have any questions about this Notice, please ask me for further explanation.
Please be aware that privacy and records matters are particularly complex in the case of couples and family therapy, when more than one adult’s privacy rights need to be considered. Also, therapy with adolescents presents various complex situations where relative risks and benefits of disclosing information need to be taken into account. Examples of more complex privacy issues can be discussed so that all share an understanding of these issues at the start of treatment.
Who Will Follow This Notice
All business associates working with me who share your PHI, such as my billing agency and the health insurance companies, must follow these same privacy practices. When personal health information is shared, only the minimum necessary information needed to accomplish the task will be disclosed.
Uses and Disclosures of Protected Health Information Requiring Your Written Authorization
In most cases, I may not use or disclose information in your health records that could identify you (PHI) without your written authorization except for the reasons described below. If you give me authorization to use or disclose medical information about you, you may revoke that authorization in writing, at any time. If you revoke your authorization, I will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that I am unable to take back any disclosures that I have already made with your authorization, and that I am required to retain the records of the care I have provided you.
How I May Use and Disclose Medical Information Without Your Authorization
There are limited circumstances where an authorization is not needed for disclosure of personal information. Most, but not every possible use or disclosure category is listed below. This Notice applies primarily to information contained in your medical and billing records.
- For Payment. I may use and disclose PHI without specific authorization so that the treatment you receive from me may be billed and payment may be collected from you, an insurance company or a third party. For example, I may release your name, address, office visit date, and codes identifying your diagnosis and treatment to your insurance company for payment. In most cases, insurance companies may review your medical record to verify services were rendered and were medically necessary in accordance with your insurance contract.
- For Health Care Operations. I may use and disclose medical information about you for health care operations to assure that you receive quality care. Example: I may share clinical information with other health care providers for consultation in order to enhance the care provided to you.
- Other Uses or Disclosures That Can Be Made Without Consent or Authorization
- to avert a serious threat to health or safety
- Child abuse or neglect
- Abuse of elderly or incapacitated adults
- Court ordered evaluations or information
- Health oversight activities, such as for federal enforcement of these privacy practices
Your Rights Regarding Complaints Concerning Use or Disclosure of Your Health Information
If you believe your privacy rights have been violated, or disagree with a decision I made about access to your records, you may contact me directly. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services at the Office for Civil Rights. There is no retaliation for filing a complaint.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of PHI about you. However, I am not required to automatically agree to a restriction that you request. Your request must be in writing and specifically state what information you wish to limit.
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. Upon your request, I will send your bills to another address or arrange to call you at work instead of home.
Right to Inspect and Copy
You have the right to inspect or obtain a copy (or both) of your PHI contained in my medical or billing records used to make decisions about you for as long as the PHI is maintained in the record. On your request, I will discuss with you the details of the request process.
Right to Amend
You have the right to request an amendment of PHI for as long as the PHI is maintained in your record. I may deny your request if, in my opinion, it would compromise the accuracy of your medical information. 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 the disclosure of PHI for a maximum of six years. On your request, I will discuss with you the details of the accounting process.
Right to Paper Copy
You have the right to obtain a paper copy of this notice from me upon request, even if you have agreed to the notice electronically.
I am required by law to maintain the privacy of PHI and to provide you with this notice of my legal duties and privacy practices with respect to PHI
* See more at NH.gov website on the Health Insurance Portability and Accountability Act (HIPAA)