Notice of Privacy Practices
(Version 1)
This Notice is effective as of April 14, 2003.
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.
We are required by law to
maintain the privacy of protected health information, and must inform you of our privacy
practices and legal duties. You have the right to obtain a paper copy of this Notice upon
request.
We are required to abide by the terms of the Notice of Privacy
Practices that is most current. We reserve the right to change the terms of the Notice at
any time. Any changes will be effective for all protected health information that we
maintain. The revised Notice will be posted in the waiting room and on our web site. You
may request a copy of the revised Notice at any time.
We have designated a Privacy Officer to answer your questions about our
privacy practices and to ensure that we comply with applicable laws and regulations. The
Privacy Officer also will take your complaints and can give you information about how to
file a complaint.
Our Privacy Officer is Joseph E. Maio, Ph.D. You can contact the
Privacy Officer at 758-7710.
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Use and disclosure of your protected health information that we
may make, with your consent, to carry out treatment, payment, and health care operations.
We may use information in your record to provide treatment to you. We
may disclose information in your record to help you get health care services from another
provider, a hospital, etc. For example, if we consult with another health care provider,
such as your primary care physician, we may share information with him or her.
We may use or disclose information from your record to obtain payment
for the services you receive. For example, we may submit information to your insurance
company in order to demonstrate to the insurer that the service should be covered.
We may use or disclose information from your record to allow
"health care operations." These operations include activities like reviewing
records to see how care can be improved, contacting you with information about treatment
alternatives, and coordinating care with other providers. For example, we may use
information in your record if we are audited by a health oversight agency (such as
Medicare) in order to prove that we provided the services we billed for.
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Your rights
You may ask us to restrict the use and disclosure of certain
information in your record that otherwise would be allowed for treatment, payment, or
health care operations. However, we do not have to agree to these restrictions.
You have a right to receive confidential communications from us. For
example, if you want to receive bills and other information at an alternative address,
please notify us.
You have a right to inspect the information in your record, and may
obtain a copy of it. This may be subject to certain limitations and fees. Your request
must be in writing. Because these are professional records, they can be misinterpreted
and/or upsetting to untrained readers. For this reason, we recommend that you initially
review them in our presence, or have them forwarded to another mental health professional
so you can discuss the contents. Patients under 14 years of age who are not emancipated
and their parents should be aware that the law may allow parents to examine their
childs treatment records unless I decide that such access is likely to injure the
child, or we agree otherwise.
If you believe information in your record is inaccurate or incomplete,
you may request amendment of the information. You must submit sufficient information to
support your request for amendment. Your request must be in writing.
You have the right to request an accounting of certain disclosures made
by us.
You have the right to complain to us about our privacy practices
(including the actions of our staff with respect to the privacy of your health
information). You have the right to complain to the Secretary of the Department of Health
and Human Services about our privacy practices. You will not face retaliation from us for
making complaints.
Except as described in this Notice, we may not make any use or
disclosure of information from your record unless you give your written authorization. You
may revoke an authorization in writing at any time, but this will not affect any use or
disclosure made by us before the revocation. In addition, if the authorization was
obtained as a condition of obtaining insurance coverage, the insurer may have the right to
contest the policy or a claim under the policy even if you revoke the authorization.
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Use or disclosure of your protected health information that we
are required to make without your permission
In certain circumstances, we are required by law to make a disclosure
of your health information. For example, state law requires us to report suspected child
abuse or neglect (a child is anyone under age 18). We also must report suspected abuse,
neglect, or exploitation of elders and other adults who may be considered
"protected," such as disabled individuals and others who cannot take care of
themselves. Also, we must disclose information to the Department of Health and Human
Services, if requested, to prove that we are complying with regulations that safeguard
your health information.
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Use or disclosure of your protected health information that we
are allowed to make without your permission
There are certain situations where we are allowed to disclose
information from your record without your permission. In these situations, we must use our
professional judgment before disclosing information about you. Usually, we must determine
that the disclosure is in your best interest, or we may have to meet certain guidelines
and limitations.
Information related to mental health care, including treatment for
substance abuse, may be more protected than other forms of health information.
Communications between a psychotherapist and patient in treatment are privileged and may
not be disclosed without your permission, except as required by law or as specified below.
We may use or disclose information from your record if we believe it is
necessary to prevent or lessen a serious and imminent threat to the safety of a person or
the public.
We may assist in health oversight activities, such as investigations of
possible health care fraud. If the Alabama Board of Examiners in Psychology (the licensing
authority for psychologists) ever chooses to conduct an investigation into our practice,
we must disclose information from your record in response to a subpoena from the Board.
We may disclose information from your record as authorized by
workers compensation laws. This information may be disclosed to your employer or the
insurer.
We may disclose information from your record if ordered to do so by a
court, grand jury, or administrative tribunal.
We may disclose information from your record if you file a complaint or
lawsuit against us, in order to defend ourselves.
We may disclose information from your record if you are being evaluated
by us for a third party (e.g., a lawyer) or if the evaluation is court-ordered. You will
be informed in advance if this is the case.
We may disclose information from your record to a law enforcement
official if certain criteria are met. For example, if you become a missing person and such
information would help locate you, we are allowed to disclose it. We may disclose
information from your record to a medical examiner or coroner.
If you tell us that you have committed a violent crime that caused
serious physical harm to the victim, we may disclose that information to law enforcement
officials. However, if you reveal that information in a counseling or psychotherapy
session, or in the course of treatment for this sort of behavior, we may not
disclose the information to law enforcement officials.
We may use or disclose information from your record for research under
certain conditions.
Under certain conditions, we may disclose information for specialized
government purposes, such as the military, national security and intelligence, or
protection of the President.
We may contact you to provide appointment reminders as a courtesy.
However, you are responsible for remembering your appointment.
We may contact you with information about treatment alternatives or
other health-related benefits or services that may be of interest to you.
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