Notice of Psychologists and Psychotherapists 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
We
may use or disclose your protected health information (PHI),
for treatment, payment, and health care operations purposes with your consent.
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 we
provide, coordinate, or manage your health care and other services related to
your health care. An example of treatment would be when we consult with another
health care provider, such as your family physician or another psychologist.
– Payment is when we
obtain reimbursement for your healthcare. Examples of payment are when we
disclose your PHI to your health insurer to obtain reimbursement for your
health care or to determine eligibility or coverage.
– Health Care Operations
are activities that relate to the performance and operation of our 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 our office, such as sharing, employing, applying,
utilizing, examining, and analyzing information that identifies you.
"Disclosure"
applies to activities outside of our office, such as releasing, transferring,
or providing access to information about you to other parties.
II. Uses and Disclosures Requiring
Authorization
We
may use or disclose PHI for purposes outside of treatment, payment, or health
care operations when your appropriate authorization is obtained. An "authorization"
is written permission above and beyond the general consent that permits only
specific disclosures. In those instances when we are asked for information for
purposes outside of treatment, payment or health care operations, we will
obtain an authorization from you before releasing this information. We will
also need to obtain an authorization before releasing your Psychotherapy Notes.
"Psychotherapy Notes" are notes we have made about our
conversation during a private, group, joint, or family counseling session,
which we 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) we 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 with Neither
Consent nor Authorization
We
may use or disclose PHI without your consent or authorization in the following
circumstances:
Child Abuse – If we have reasonable
cause to suspect child abuse or neglect, we must report this suspicion to the
appropriate authorities as required by law.
Adult and Domestic Abuse – If we have reasonable
cause to suspect you have been criminally abused, we must report this suspicion
to the appropriate authorities as required by law.
Health Oversight
Activities – If we receive a subpoena or
other lawful request from the Department of Health, the California Board of
Psychology, or the California Board of Behavioral Science Examiners, we must
disclose the relevant PHI pursuant to that subpoena or lawful request.
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 we 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 threat of physical violence
against a reasonably identifiable third person and/or property and you have the
apparent intent and ability to carry out that threat in the foreseeable future,
we may disclose relevant PHI and take the reasonable steps permitted by law to
prevent the threatened harm from occurring. If we believe that there is an
imminent risk that you will inflict serious physical harm on yourself, we may
disclose information in order to protect you.
Worker’s Compensation – we may disclose protected health information regarding you
as authorized by and to the extent necessary to comply with laws relating to
worker’s compensation or other similar programs, established by law, that
provide benefits for work-related injuries or illness without regard to fault.
IV. Patient’s Rights and Psychologist’s /
Psychotherapist’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, we are 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 us. On your request, we will send your bills to another address.)
Right to Inspect and
Copy – You have the right to inspect or obtain a copy (or both) of
PHI in our mental health and billing records used to make decisions about you
for as long as the PHI is maintained in the record. we
may deny your access to PHI under certain circumstances, but in some cases you
may have this decision reviewed. On your request, we will discuss with you the
details of the request and denial process.
Right to Amend – You have the right to request an amendment of PHI for as
long as the PHI is maintained in the record. we may
deny your request. On your request, we 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, we 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 us upon request, even if you have agreed
to receive the notice electronically.
Psychologist’s
/ Psychotherapist’s Duties:
We are required by law to
maintain the privacy of PHI and to provide you with a notice of our legal
duties and privacy practices with respect to PHI. We reserve the right to change the privacy
policies and practices described in this notice. Unless we notify you of such
changes, however, we are required to abide by the terms currently in effect. If
we revise our policies and procedures, we will notify you either in person or
by mail.
V. Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services, Region IX, at 415-437-8310. To file a complaint with our office, contact Matt Hamilton, Office and Privacy Manager, at 530-756-0555, Ext. 101. You will not be penalized for filing a complaint.
VI. Effective Date, Restrictions, and
Changes to Privacy Policy
This
notice will go into effect on
We
reserve the right to change the terms of this notice and to make the new notice
provisions effective for all clients that we maintain.