Patient's right and notice to 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 and keep for your records. You should ask your therapist any questions you may have.

Protecting your privacy:

Psychologists have always managed psychological records with great concern for privacy and confidentiality. Although the security of psychological records has continuously been addressed by Psychology Codes of Ethics as well as State and Federal laws, the rules have been considerably strengthened by the provisions of the Health Insurance Portability and Accountability Act (HIPAA).

The following information provides details about the provisions of the HIPAA and your rights concerning privacy and your psychological records.

Who will observe these rules?

The following individuals are required by HIPAA to comply with the privacy rules:

  • Your treating psychologist Dr. Rebecca Wagner.
  • Any administrative assistant or office staff who may have some access to your identifying information (such as your name, address, telephone number, etc.).
  • Any billing agency or collection agency that handles information about you (name, address, diagnostic codes, treatment codes, consultation dates, but not actual clinical records).

How I may use and disclose your PHI:

I will use and disclose you PHI for may different reasons. For some of these uses or disclosures, I will need your prior authorization; for others, however, I do not. Listed below are the different categories of my uses and disclosures along with some examples of each category.

Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations that Do Not Require Your Prior Written Consent.

I can use and disclose you PHI without your consent for the following reasons:

  1. For Treatment. I can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are involved in your care. For example, if you are being treated by a psychiatrist, I can disclose your PHI to your psychiatrist in order to coordinate your care.
  2. To obtain payment for treatment. I can use and disclose your PHI to bill and collect payment of the treatment and services provided by me to you. For example, I might send your PHI to your insurance company or health plan to get paid for the health care services that I have proved to you. I may also provide your PHI to my business associates, such as billing companies, claims processing companies, and others that process my health care claims.
  3. For health care operations. I can use and disclose your PHI to operate my practice. For example, I might use your PHI to evaluate the quality of health care services that you receive. I may also provide your PHI to our accountants, attorneys, consultants, and other to make sure I’m complying with applicable laws.
  4. Other disclosures. I may also use and disclose your PHI to others without your consent in certain situations. For example, your consent isn’t required if you need emergency treatment, as long as I try to get your consent after treatment is rendered, or if I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so.

Certain Uses and Disclosures Do Not Require Your Consent.

I can use and disclose your PHI without your consent or authorization for the following reasons:

  1. When disclosure is required by law. For example, I may make a disclosure to applicable officials when a law requires me to report information to government agencies and law enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding.
  2. For public health activities. For example, I may have to report information about you to the county coroner.
  3. For health oversight activities. For example, I may have to provide information to assist the government when it conducts and investigation or inspection of a health care provider or organization.
  4. For research purposes. In certain circumstances, I may provide PHI in order to conduct medical research.
  5. To avoid harm. In order to avoid a serious threat, I may disclose your PHI to law enforcement personnel or persons able to prevent or lessen such harm.
  6. For specific government functions. I may disclose PHI of military personnel and veterans in certain situations. And I may disclose your PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
  7. For workers’ compensation purposes. I may provide PHI in order to comply with workers’ compensation laws.
  8. When the information is not personally identifiable. I may use or disclose PHI about you in a way that does not personally identify you or reveal who you are.
  9. Appointment reminders and health related benefits or services. I may use PHI to provide appointment reminders or give you information about treatment alternatives.

Certain Uses and Disclosures Require You to Have the Opportunity to Object.

  1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

Other Uses and Disclosures Require Your Prior Written Authorization.

In any other situation not described above, I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent that I haven’t taken any action in reliance on such authorization) of your PHI by me.

Your rights regarding medical information about you.

You have the following rights regarding your medical information:

The right to inspect and obtain a copy of your medical record. Professional records constitute an important part of the therapy process and help with the continuity of care over time. According to the rules of HIPAA, your consultations may be documented in two ways:

  1. The clinical record (required) may include the date of your consultations, your reasons for seeking therapy, diagnosis, therapeutic goals, treatment plan, progress, medical and social history, treatment history, functional status, any past records from other providers, as well as any reports to your insurance carrier;
  2. Psychotherapy notes (optional), consisting of the specific content or analyses of therapy conversations, how they impact the therapy (including sensitive information that you may reveal that is not required to be included in your clinical record), and notes of your therapist that may assist in treatment. Psychotherapy notes are kept separately from your clinical record in order to maximize privacy and security.

The right to inspect and obtain a copy of your clinical record. Viewing the record is best done during a professional consultation in order to clarify any questions that you might have at the time. You may be charged a nominal fee for accessing and photocopying the record. Psychotherapy notes, however, if they are created, are not disclosed to third parties, HMOs, insurance companies, billing agencies, clients, or anyone else. They are for the use of a treating therapist in tracking the many details of the consultations that are far too specific to be entered into the clinical record.

The right to request a correction or add an addendum to your psychological record if you believe that there is an inaccuracy in your clinical record. If the information is accurate, however, or if it has been provided by a third party (previous therapist, primary care physician, etc.), it may remain unchanged, and the request may be denied. In this case you will receive an explanation in writing with a full description of the rationale. You also have the right to make an addition to your record if you think it is incomplete.

The right to an accounting of disclosures of your psychological information to third parties. You have the right to know if, when, and to whom your psychological information has been disclosed (exclusive of treatment, payment, and health care operations). However, you likely would already be aware of this, as you would have signed consent forms allowing such disclosures (e.g., disclosures to other psychotherapists, primary care physicians, specialists, etc.). This accounting must extend back for a period of six years.

The right to request restrictions on how your information is used. You have the right to request restrictions on certain uses or disclosures of your psychological information. These requests must be in writing. These requests will most likely be honored, although in some cases they may be denied. This office does not use or release your protected health information for marketing purposes or any other purpose aside from treatment, payment, healthcare operations, and other exceptions specified in this notice.

The right to request confidential communications. You have the right to request that your therapist communicates with you about your treatment in a certain way or at a certain location. For example, you may prefer to be contacted at work instead of at home to schedule or cancel an appointment, or you may wish to receive billing statements at a post office box rather than your home address.

The right to receive a copy of this notice upon request. You have the right to have a copy of this Notice of Privacy Practices.

The right to file a complaint. You have the right to file a complaint if you believe your privacy rights have been violated. You must do so in writing. Your complaint may be addressed directly to your therapist or to the Secretary of the Department of Health and Human Services. If you have any questions or concerns about this notice or this health information privacy policy please contact Dr. Wagner.

Changes to this notice.

Please note that this privacy notice may be revised from time to time. You will be notified of changes in the laws concerning privacy or your rights as we become aware of them. In the meantime, please do not hesitate to raise any questions or concern