Your health care privacy is our priority and is governed by law. A complete description of your privacy rights and how we protect your privacy is posted in our office and is also available in print form by request.
Your health record contains personal information about you and your health. This information that is about you, that may identify you, and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We may use your PHI…
We may use your PHI to provide, coordinate and manage your treatment and care. If we need to consult with other providers we will only do so with your written permission.
We may use your PHI so that we can receive payment for the treatment services provided to you. This will only be done with your written authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
Release of PHI With Your Authorization:
Uses and disclosures of your PHI not specifically permitted by applicable law will be made only with your written authorization. Any authorizations that you make can be revoked at any time.
As Required by Law:
Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purposes of investigating or determining our compliance with the requirements of the Privacy Rule. In addition, we are permitted to use PHI without your permission under certain conditions (listed below) that have to do with your safety, the safety of others, or when required by law. The following is a list of categories where disclosure may be permitted without written authorization.
Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.
Self harm or the intention to harm others. We may use or disclose your protected health information in a medical emergency in order to prevent serious harm to yourself or to others. If your therapist determines that you may be a danger to yourself or others PHI may be used as appropriate to keep you or others safe.
Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
Concerns, questions or complaints. If you have any concerns, questions or complaints you may address them with your service provider or with our Privacy Officer, Dawn Royer who can be reached at 804.320.1007 or at email@example.com. We will do everything we can to address your concern.