Privacy as a foundation,
not a footnote.

For Treatment, Payment, or Health Care Operations

Federal privacy rules allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without written authorization, to carry out treatment, payment or health care operations.

Disclosures for treatment purposes are not limited to the minimum necessary standard. "Treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one provider to another.

Lawsuits and Disputes

If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process — but only if efforts have been made to notify you about the request or to obtain a protective order.

Psychotherapy Notes

I keep "psychotherapy notes" as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

• For my use in treating you.
• For my use in training or supervising mental health practitioners.
• For my use in defending myself in legal proceedings instituted by you.
• For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
• Required by law and the use or disclosure is limited to the requirements of such law.
• Required by law for certain health oversight activities.
• Required by a coroner performing duties authorized by law.
• Required to help avert a serious threat to the health and safety of others.

Marketing Purposes

As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI

As a psychotherapist, I will not sell your PHI in the regular course of my business.

• When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
• For law enforcement purposes, including reporting crimes occurring on my premises.
• To coroners or medical examiners, when such individuals are performing duties authorized by law.
• For research purposes, including studying and comparing the mental health of patients who received different forms of therapy for the same condition.
• For specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; or helping to ensure the safety of those within correctional institutions.
• For workers' compensation purposes. Although my preference is to obtain an Authorization, I may provide your PHI in order to comply with workers' compensation laws.
• Appointment reminders and health related benefits or services.

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.

The Right to Request Limits on Uses and Disclosures of Your PHI

You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.

The Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full

You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or service that you have paid for out-of-pocket in full.

The Right to Choose How I Send PHI to You

You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address. I will agree to all reasonable requests.

The Right to See and Get Copies of Your PHI

Other than "psychotherapy notes," you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request. I may charge a reasonable, cost-based fee.

The Right to Get a List of the Disclosures I Have Made

You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided an Authorization. I will respond within 60 days. The list will include disclosures made in the last six years unless you request a shorter time.

The Right to Correct or Update Your PHI

If you believe there is a mistake in your PHI, or that a piece of important information is missing, you have the right to request that I correct or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days.

The Right to Get a Paper or Electronic Copy of This Notice

You have the right to get a paper copy of this Notice, and a copy by e-mail, even if you have agreed to receive this Notice via e-mail. You also have the right to request a paper copy of it at any time.