888 475 0033
Updated 11 05 2015
Privacy and Policy
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
• Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
• If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
• If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
Effective July 15, 2010
Your Personal Health Information
We collect personal health information from you through treatment, payment and related healthcare operations, the application and enrollment process, and/or healthcare providers or health plans, or through other means, as applicable. Your personal health information that is protected by law broadly includes any information, oral, written or recorded, that is created or received by our clinicians, including health care providers, such as physicians and hospitals, as well as, health insurance companies or plans. The law specifically protects health information that contains data, such as your name, address, social security number, and others, that could be used to identify you as the individual patient who is associated with that health information and we will only release this information with your consent and authorization, except as required by law. Examples of entities that may legally obtain your records, under certain circumstances, include the FDA, the DEA and certain law enforcement authorities; your healthcare coverage or insurance plans; certain State oversight agencies, etc.
Uses or Disclosures of Your Personal Health Information
Generally, we may not use or disclose your personal health information without your permission. Further, once your permission has been obtained, can only use or disclose your personal health information in accordance with the specific terms that permission. The following are the circumstances under which we are permitted by law to use or disclose your personal health information. Without your consent, we may use or disclose your personal health information in order to provide you with services and the treatment you require or request, or to collect payment for those services, and to conduct other related health care operations otherwise permitted or required by law. Also, we are permitted to disclose your personal health information within and among our workforce in order to accomplish these same purposes.
However, even with your permission, we are still required to limit such uses or disclosures to the minimal amount of personal health information that is reasonably required to provide those services or complete those activities. For example, we may disclose information about you in the coordination or provision of healthcare services provided to you by other healthcare entities such as your hospital, your doctors, and when we make referrals in order for you to obtain services, evaluations, laboratory tests, etc. We are required to make certain information about you available to legally authorized parties for the purpose of utilization review activities.
We may use or disclose your personal health information to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirement of such law. We may be required by law to disclose your health records in conjunction with: public health activities including, preventing or controlling disease or other injury, public health surveillance or investigations, reporting adverse events with respect to food or dietary supplements or product defects or problems to the Food and Drug Administration, medical surveillance of the workplace or to evaluate whether the individual has a work-related illness or injury in order to comply with Federal or state law; health oversight activities including, audits, inspections, licensure or disciplinary actions, or civil or criminal proceedings or actions, or other activities necessary for appropriate oversight of government benefit programs; in response to a court order; to avert a serious threat to health or safety; certain military and veterans activities; threats made to the President of the United States or to the protective services of the United States of America; correctional officers and institutions, under certain circumstances covered entities that are government programs providing public benefits, and for workers’ compensation; legal obligations under a set of rules knows as the Tarasoff rulings; disasters and emergencies. Except as otherwise permitted or required, as described above, we may not use or disclose your personal health information without your written authorization.
Further, we are required to use or disclose your personal health information consistent with the terms of your authorization. You may revoke your authorization to use or disclose any personal health information at any time, except to the extent that we have taken action in reliance on such authorization, or, if you provided the authorization as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may contact you to raise funds for on our behalf or on behalf of a charitable organization. We may contact you at the telephone number and/or address with which you have provided us; and we may leave voice messages for you.
Your Rights With Respect to Your Personal Health Information
You have the right to request restrictions on certain uses and disclosures of your personal health information about yourself. You may request restrictions on or disclosures of your personal health information. Except as outlined above, we will not disclose your healthcare information without your express written consent. While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your personal healthcare information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures that are otherwise required by law.
We must permit you to request and must accommodate reasonable requests by you to receive communications of personal health information from us by alternative means or at alternative locations. Your designated record set, chart, is a group of records we maintain that includes medical, psychological and psychiatric records as well as billing records about you, and enrollment, payment, claims adjudication, and case or medical management records systems, as applicable. You have the right of access in order to inspect and obtain a copy your personal health information contained in your designated chart, except in certain circumstances, and our office may elect to provide a treatment summary instead of actual copies of your charted records.
We will not provide you with your records pertaining to: (a) psychotherapy notes, (b) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding, (c) health information maintained by us to the extent to which the provision of access to you would be prohibited by law and (d) in the opinion of your mental health provider the information in your chart could reasonably cause harm to you or another individual. We require that your request be made in writing. We will discuss the scope, format, and other aspects of your request for access as necessary to facilitate timely access. If you request a copy of your personal health information or agree to a summary or explanation of such information, we may charge a reasonable cost-based fee for copying, postage, if you request a mailing, and the costs of preparing an explanation or summary as agreed upon in advance. We reserve the right to deny you access to or copies of certain personal health information as permitted or required by law. We will reasonably attempt to accommodate any request for personal health information by, to the extent possible, giving you access to other personal health information after excluding the information as to which we have a ground to deny access.
Right To Amend Your Personal Health Information
You have the right to request that we amend your personal health information or a record about you contained in your designated record set, for as long as the designated record set is maintained by us. We have the right to deny your request for amendment, if: (a) we determine that the information or record that is the subject of the request was not created by us, unless you provide a reasonable basis to believe that the originator of the information is no longer available to act on the requested amendment, (b) the information is not part of your designated record set maintained by us, (c) the information is prohibited from inspection by law, or (d) the information is accurate and complete. We require that all requests to review your records be made in writing. Copies of all requests, denials, and statements of disagreement will be included in your designated chart. If we accept your request for amendment, we will make reasonable efforts to inform and provide the amendment within a reasonable time to persons identified by you as having received personal health information of yours prior to amendment.
Right To Receive An Accounting Of Disclosures Of Your Personal Health Information
You have the right to receive a written accounting of all disclosures of your personal health information that we have made within the six (6) year period immediately preceding the date on which the accounting is requested. You may request an accounting of disclosures for a period of time less than six (6) years from the date of the request. Such disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure or, in lieu of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accountings of disclosures for the following purposes: (a) treatment, payment, and healthcare operations, (b) disclosures pursuant to your authorization, (c) disclosures to you, (d) for a facility directory or to persons involved in your care, (e) for national security or intelligence purposes. We reserve our right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law. We will provide you, upon written request, with an accounting of disclosures free of charge once during each twelve month period.
firstname.lastname@example.org | Baxter Village | 1012 Market Street, Suite 305 | Fort Mill, SC 29708 | 888-475-0033
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