Notice of Information Practices and Patient Rights

    Understanding your Mental Health Record Information


    Each time you visit a healthcare provider, the provider makes a record of your visit.  Typically, this record contains your health or mental health history, current symptoms, diagnoses, treatment, and a plan for future care or treatment.  This information, often referred to as your medical record, serves as a:

    ·         Basis for planning your care and treatment.

    ·         Means of communication among the various health professionals who contribute to your care.

    ·         Legal document describing the care you received.

    ·         Means by which you or a third-party payer can verify that you actually received the services billed for.

    ·         Tool to assess the appropriateness and quality of care you received.

    ·         Tool to improve the quality of healthcare and achieve better patient outcome.


    When and How your Information may be disclosed:


    ·         Verifying to your Insurance Company your symptoms, diagnosis, treatment plan, dates and times of service, functional status, prognosis and progress to date.

    ·         Carrying out mandated reporting such as Child Abuse, Disabled Adult and Elder Abuse, clear and present danger to your self or others, and communicable diseases to the health department.

    ·         To a court of law if so ordered by the court, or an administrative tribunal.

    ·         If you waive your right to privacy, or sign a consent-form to release this information to specified parties.

    ·         If state or federal laws require it, including to confirm we are complying with federal privacy law.

    ·         For workers’ compensation and disability claims.


    Your Rights Under the Federal Privacy Standard:


    You have the right to:

    ·         Receive notice of use and disclosure of your Protected Health Information (PHI).

    ·         Consent to use and disclosure of your PHI.

    ·         Access your medical records for inspection and amendment.

    ·         An accounting of how your PHI was used and shared if "non-routine" disclosures -- those other than for treatment, payment, and health care operations.

    ·         Request restrictions on the use and disclosure of PHI for treatment, payment and health care operations purposes.  (However, your insurance company may not pay for services if certain information is not disclosed).  Therapists are not required to agree to all your requests, but are required to agree to reasonable requests.

    ·         Revoke your consent or authorization to use or disclose health information except to the extent that we have already taken action in reliance on the consent or authorization.

    ·         Special written authorization to release substance abuse treatment records.


    You do not have the right to:


    ·         Inspect information compiled in "reasonable anticipation" of, or for use in, a civil, criminal or administrative action.

    ·         Access information systems that are used for quality control or peer-review analysis.

    ·         Inspect your PHI when your therapist has determined that the access is reasonably likely to endanger the life or physical safety of you or another person, or cause you or another person substantial harm. (In such a case, another licensed professional must review this decision and we will inform you about the decision.)


    Our Responsibilities:


    ·         We are required by law to maintain the privacy and security of your protected health information.

    ·         We will let you know promptly if a breach occurs that may have compromised the privacy or security of our information.

    ·         We never market or sell personal information

    ·         We will not use or share your information other than as described here unless you tell us we can in writing.  If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.


    For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.