Please read the following privacy statement:






Privacy is a very important concern for all those who come to this office.  It is also complicated because of federal and state laws and our professional standards.  Because the rules are so complicated some parts of this Notice are quite detailed and you probably will have to read them several times to understand them.  If you have any questions our Privacy Officer will be happy to help you.  His or her name and address are at the end of this Notice.


This notice will tell you about how we handle information about you.  It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it.  We want you to know all of this so that you can make the best decisions for yourself and your family.  We are also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Because this law and the laws of this state are very complicated and we do not want to make you read a lot that may not apply to you, we have simplified some parts.  If you have any questions or want to know more about anything in this Notice, please ask our Privacy Officer for more explanation or more details.


What we mean by your medical information

Each time you visit us or any doctor’s office, hospital, clinic, or any other “healthcare provider” information is collected about you and your physical and mental health.  It may be information about your past, present or future health or conditions, or the treatment or other services you got from us or from others, or about payment for healthcare.  The information we collect from you is called, in the law, PHI which stands for Protected Health Information.  This information goes into your medical or healthcare record or file at the office.  In this office this PHI is likely to include these kinds of information:

– Your history. As a child, in school and at work, and marital and personal history.

– Reasons you came for treatment. Your problems, complaints, symptoms, needs, goals.

– Diagnoses.  Diagnoses are the medical terms for your problems and symptoms.

– A Treatment Plan. These are treatments and other services which we think will best help you.

– Progress notes.  Each time you come in we write down some things about how you are doing, what we

observe about you, and what you tell us.

– Records we get from others who treated you or evaluated you.

– Psychological test scores, school records, etc.

– Information about medications you took or are taking.

– Legal matters

– Billing and insurance information


This list is just to give you an idea and there may be other kinds of information that go into your healthcare record here.


We use this information for many purposes. For example, we may use it:

– to plan your care and treatment.

– to decide how well our treatments are working for you.

– when we talk with other healthcare professionals who are also treating you such as your family doctor or

the professional who referred you to us.

– to show that you actually received the services from us which we billed to you or to your health insurance


– for teaching and training other healthcare professionals.

– for medical or psychological research.

– for public health officials trying to improve health care in this country.

– to improve the way we do our job by measuring the results of our work.


When you understand what is in your records and what it is used for you can make better decisions about who, and why others should have this information.  Although your health record is the physical property of the healthcare practitioner or facility that collected it, the information belongs to you. You can inspect, read or review it.  If you want a copy we can make one for you but may charge you for the costs of copying        (and mailing if you want it mailed to you).  In some very unusual situations you cannot see all of what is in your records.  If you find anything in your records that you think is incorrect or something important missing you can ask us to amend (add information to) your record although in some rare situations we don’t have to agree to do that.  Our Privacy Officer, whose name is at the end of this Notice, can explain more about this.


Privacy and the laws

The HIPAA law requires us to keep your PHI private and to give you this notice of our legal duties and our privacy practices which is called the Notice of Privacy Practices or NPP.  We will obey the rules of this notice as long as it is in effect but if we change it the rules of the new NPP will apply to all the PHI we keep. If we change the NPP we will post the new Notice in our office where every one can see it.  You or anyone else can also get a copy from our Privacy Officer at any time.


How your protected health information can be used and shared

When your information is read by the staff in this office that is called, in the law, “use”.  If the information is shared with or sent to other outside this office, that is called in the law, “disclosure”.  Except in some special circumstances, when we use your PHI here or disclose it to others we share only the minimum necessary PHI needed for the purpose.  The law gives you rights to know about your PHI, how it is used and to have a say in how it is disclosed and so we will tell more about what we do with your information.


We use and disclose PHI for several reasons.  Mainly, we will use and disclose (share) it for routine purposes and we will explain more about these below.  For other uses we must tell you about them and have a written Authorization from you unless the law lets or requires us to make the use or disclosure without your authorization. However, the law also requires that we are allowed to make some uses and disclosures without your consent or authorization.


Uses and Disclosures of  PHI in healthcare with your consent

After you have read this Notice you will be asked to sign a separate Consent form to allow us to use and share your PHI.  In almost all cases we intend to use your PHI here or share your PHI with other people or organizations to provide treatment to you, arrange for payment for our services, or some other business functions called health care operations.  Together these routine purposes are called TPO and the Consent form allows us to use and disclose your PHI for TPO.  Re-read that last sentence until it is clear because it is very important.


For treatment, payment, or health care operations (TPO)

We need information about you and your condition to provide care to you.  You have to agree to let us collect the information and to use it and share it as necessary to care for you properly.  Therefore you must sign the consent form before we begin to treat you because if you do not agree and consent we cannot treat you.


When you come to see us, several people in our office may collect information about you and all of it may go into healthcare records here.  Generally, we may use or disclose your PHI for three purposes; treatment, obtaining payment, and what are called healthcare operations.  Let’s see what these are about.


For treatment

We use your medical information to provide you with mental health treatment or services.  These might include evaluation, medication monitoring, individual, family, or group therapy, psychological, educational or vocational testing, treatment planning or measuring the effects of our services.


We may share or disclose your PHI to others who provide treatment to you.  We are likely to share your information with your personal physician. If you are being treated by a team, we can share some of your PHI with them so that the services you receive will be coordinated.  They will also enter their findings, the actions they took, and their plans into your record and so we all can decide what treatments work best for you and make up a Treatment Plan.  We may refer you to other professionals or consultants for services we cannot offer such as special testing or treatments.  When we do this we need to tell them some things about you and your conditions.  We will get back their findings and opinions and those will go into your records here.  If you receive treatment in the future from other professionals we can also share your PHI with them. These are some examples so that you can see how we use and disclose your PHI for treatment.


For payment

We may use your information to bill you, your insurance, or others to be paid for the treatment we provide to you.  We may contact your insurance company to check on exactly what your insurance covers.  We may have to tell them about your diagnoses, what treatments you have received, and what we expect as we treat you.  We will need to tell them about when we met, your progress, and other similar things.


For health care operations

There are some other ways we may use or disclose your PHI which are called health care operations.  For example, we may use your PHI to see where we can make improvements in the care and services we provide.  We may be required to supply some information to some government health agencies so they can study disorders and treatment and make plans for services that are needed.  If we do, your name and identity will be removed from what we send.


Other uses in healthcare

Appointment Reminders. We may use and disclose medical information to reschedule or remind you of appointments for treatment or other care.  If you want us to call or write to you only at your home or your work or prefer some other way to reach you, we usually can arrange that. Just tell us.

Treatment alternatives.  We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of interest to you.

Other Benefits and Services. We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.

Research. We may use or share your information to do research to improve treatments.  For example, comparing two treatments for the same disorder to see which works better or faster or costs less.  In all cases your name, address and other information that reveals who you are will be removed from the information given to researchers. If they need to know who you are we will discuss the research project with you and you will have to sign a special Authorization form before any information is shared.

Business Associates.  There are some jobs we hire other businesses to do for us.  They are called our Business Associates in the law for example our answering service, hospital laboratory, etc.  These business associates need to receive some of your PHI to do their jobs properly.  To protect your privacy they have agreed in their contract with us to safeguard your information.


Uses and disclosures requiring your authorization

If we want to use your information for any purpose besides the TPO or those we described above we need  your permission on an Authorization form.  We don’t expect to need this very often.


If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission, in writing, at any time.  After that time we will not use or disclose your information for the purposes that we agreed to.  Of course, we cannot take back any information we had already disclosed with your permission or that we had used in our office.


Uses and disclosures of PHI from mental health records Not requiring Consent or Authorization

The laws lets us use and disclose some of your PHI without your consent or authorization in some cases.


When required by law

There are some federal, state, or local laws which require us to disclose PHI.

-we have to report suspected child abuse.

-if you are  involved in a lawsuit or legal proceeding and we receive a subpoena, discovery request, or other lawful process we may have to release some of your PHI. We will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested.

-we have to release (disclose) some information to the government agencies which check on us to see that we are obeying the privacy laws.


For Law enforcement Purposes:

We may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.


For public health activities:

We may disclose some of your PHI to agencies which investigate diseases or injuries.


Relating to decedents

We might disclose PHI to coroners, medical examiners or funeral directors, and to organizations relating to organ, eye, or tissue donations or transplants.


For specific government functions

We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment, to Workers’ Compensation programs, to correctional facilities if you are an inmate, and for national security reasons.


To Prevent a Serious Threat to Health or Safety

If we come to believe that there is a serious threat to your health or safety or that of another person or the public we can disclose some of your PHI.  We will only do this to persons who can prevent the danger.


Uses and disclosures requiring you to have an opportunity to object

We can share some information about you with your family or close others.  We will only share information with those involved in your care and anyone else you choose such as close friends or clergy.  We will ask you about who you want us to tell what information about your conditions or treatment. You can tell us what you want and we will honor your wishes as long as it is not against the law.

If it is an emergency – so we cannot ask if you disagree – we can share information if we believe that it is what you would have wanted and if we believe it will help you if we do share it.  If we do share information, in an emergency, we will tell you as soon as we can.  If you don’t approve we will stop, as long as it is not against the law.


An accounting of disclosures

When we disclose your PHI we keep some records of whom we sent it to, when we sent it, and what we sent.  You can get an accounting (a list) of many of these disclosures.


If you have questions or problems

If you need more information or have questions about the privacy practices described above please speak to the Privacy Officer whose name and telephone number are listed below.  If you have a problem with how your PHI has been handled or if you believe your privacy rights have been violated, contact the Privacy Officer.  You have the right to file a complaint with us and with the Secretary of the Federal Department of Health and Human Services.  We promise that we will not in any way limit your care here or take any actions against you if you complain.


If you have any questions regarding this notice or our health information privacy policies, please contact at 847-518-8490.

The effective date of this notice is January 1st 2011.