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HIPAA Notice of 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.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of my responsibilities to help you.

  • Get a copy of your records: Complete a request form and you will receive a summary of the requested information within 30 days. If hard copies are needed, you will be charged a service fee which will be provided to you prior to completion of request.

  • Correct records: Complete a request form and indicate the mistake and the correction. The right to deny this request is at the discretion of the clinician and will be explained to the client in writing if this is the case. 

  • Request confidential communications: You may request that you are contacted in a specific way (for example, home or office phone) or to send mail to a different address. All reasonable requests will be considered, and must be accommodated if you would be in danger if your request is denied. 

  • File a complaint if you feel your rights are violated:  You can complain if you feel we have violated your rights by contacting the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

 

You will not be retaliated against if you file a complaint. 

Uses and Disclosures

Your information may be shared in the following circumstances: 

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  • Help manage the treatment you receive. 

  • Coordinate with other professionals that are providing you services. 

  • When insurance claims are made.

  • If state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I am complying with federal privacy law.

My Responsibilities

  •  I am required by law to maintain the privacy and security of your protected health information. You will be promptly informed if a breach occurs that may have compromised the privacy or security of your information. Duties and privacy practices described in this notice will be followed and you will be given a copy of it.  Your information will not be used or shared with others, other than as described here unless you advise otherwise in writing. 

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

  • Changes to the Terms of This Notice. The terms of this notice, may be changed and and the changes will apply to all information on file about you. The new notice will be available upon request, on the web site, and a copy will be mailed to you.

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