HIPPA POLICY - PDF
NOTICE OF HIPPA POLICY
And Privacy Practices
Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted
by congress to help protect health coverage for workers and their families. It
also addresses electronic transaction standards and the need to ensure the
security and privacy of health data. We are required by law to maintain the
privacy of protected health information, and must inform you of our privacy
practices and legal duties. The security and privacy of your protected health
information is the subject of this Privacy Notice.
I. Use and Disclosure of Your Protected Health Information
for Treatment, Payment, and Health Care Operations:
We may use or disclose information in your records for treatment,
payment, and health care operations purposes with your consent.
Personal health information (PHI)
refers to information in a client’s health record that could identify that
Use of this information
refers only to activities within this office such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you.
Disclosure of information
refers to activities outside of this office such as releasing, transferring, or
providing access to information about you to other parties. Throughout this
notice, the term “you” may refer to the individual who is the client or the
individual’s parent, legal guardian or adult who has been legally determined to
be responsible for the client.
In providing for your treatment,
we may use or disclose information in your record to help you obtain
health care services from another provider, or to assist us in providing for
your care. For example, we might consult with another health care provider,
such as your physician or another psychologist. In order to obtain payment for services, we may
use or disclose information from your record, with your consent. For example,
we may submit the appropriate diagnosis to your health insurer to help you
obtain reimbursement for your care.
We also may use or disclose information from your record to
allow health care operations (e.g., quality assessment and improvement
activities, business-related matters such as audits and administrative
services, and case management and care coordination).
II. Use and Disclosure Requiring Authorization:
Except as described in this Notice, we may not make any use
or disclosure of information from your record for purposes outside of
treatment, payment, and health care operations unless you give your written
You may revoke an authorization in writing at any time, but
this will not affect any use or disclosure already completed before the
revocation. In addition, if the authorization was obtained as a condition of
obtaining insurance coverage, the insurer may have the right to contest the
policy or a claim under the policy even if you revoke the authorization.
It is important for you to understand that we cannot control disclosure of information from your records once written authorization has been obtained and records have been sent to an outside party. For example, any individual that has obtained your records via your written consent and request (e.g., attorney, other provider) may of their own accord and beyond our control, transmit your records to other parties. Please carefully consider the nature of your written consent to disclose any personal documents that originate in our office.
III. Use and Disclosure Without Consent or Authorization:
There are certain circumstances, listed below, in which we
are allowed (or, in some cases, required) to use or disclose information from
your record without your permission:
• Child Abuse: If
there is reasonable cause to suspect that a child is or has been abused,
abandoned, or neglected by a parent, legal custodian, caregiver or other person
responsible for the child’s welfare, or person over the age of fourteen living
in the home of the child, the law requires us to report this to the Department
of Public Welfare, and/or appropriate governmental agency. The Pennsylvania
State Board of Psychology specifically requires that: “psychologists
who, in the course of their employment, occupation or practice of their
profession, come into contact with children shall report or cause a report to
be made to the Department of Public Welfare when they have reasonable cause to
suspect on the basis of their professional or other training or experience,
that a child coming before them in their professional or official capacity is a
victim of child abuse.”
• Adult and Domestic
Abuse: If there is reasonable cause to suspect, that a vulnerable adult
(disabled or elderly) has been or is being abused, neglected, or exploited, we reserve
the right to report this to responsible agencies or providers involved with the
vulnerable adult (e.g., physician, residential or nursing facility, Office of
Aging). Your signature of this form indicates your consent with our right to
report elder abuse.
• Driving Risk: Pennsylvania
law specifically requires that healthcare providers report concern about an
individual’s ability to operate a motor vehicle safely to the medical
department of the Pennsylvania Department of Transportation.
• Judicial or
Administrative Proceedings: Personal Health Information is privileged by
state law. If you are involved in a court proceeding and a request is made for
your records, we will not release information without the written authorization
of your or your legal representative, including a subpoena. The privilege does
not apply if you are being evaluated for a third party, or if the evaluation is
court-ordered, or in certain other limited instances. You will be informed in
advance if this is the case.
• Serious Threat to
Health or Safety: If a client presents a clear and immediate probability of
physical harm to him or herself, to other individuals, or to society, we may
communicate relevant information concerning this to the potential victim,
appropriate family member, or appropriate authorities.
Compensation and Disability Claims: If you file a workers’ compensation
claim or are in the process filing a disability claim, we may disclose information
from your record as authorized by applicable laws.
• Right to Request
Restrictions: You have the right to request restrictions on certain uses
and disclosures of protected heath information. However, I am not required to
agree to a restriction you request.
• Right to Receive
Confidential Communications by Alternative Means and at Alternative
have the right to request to have confidential communications of PHI delivered
by alternative means and/or at alternative locations. (For example, you may not
want a family member to know that you are being seen at this office. Upon your
request, we may be able to arrange to send your bills to another address.)
• Right to Inspect
and Copy: You have the right to inspect or obtain a copy (or both) of PHI in
our mental health and billing records used to make decisions about you for as
long as the
PHI is maintained in the record, given your written request.
This may be subject to certain limitations and fees. Upon request, the details
of the request process will be discussed with you. Please understand that older
records may be destroyed, and therefore no longer available, in accordance with
applicable law or standards.
• Right to Amend:
You have the right to request an amendment of PHI for as long as the PHI is
maintained in the record. Your request must be in writing, and we reserve the
right to deny your request.
• Right to an
Accounting: You have the right to request an accounting of certain
disclosures that have been made. Upon request, the details of the accounting
process will be discussed with you.
• Right to a Paper
Copy: You have the right to obtain a paper copy of the notice from this
office upon request, even if you have agreed to receive the notice
electronically. Please see www.centrepsychology.com
to review this notice at any time.
• Right to restrict
disclosures associated with marketing: Disclosures of PHI for marketing
purposes, and disclosures that constitute a sale of PHI require client
• Right to restrict
disclosures associated with out of pocket payment: Clients have the right
to restrict certain disclosures of PHI to health plans or insurance companies
if the client pays out of pocket in full for services.
• Right of
notification: Clients have the right to be notified following a breach of
unsecured protected health information.
• We are required by law to maintain the privacy of PHI and
to provide you with a notice of our legal duties and privacy practices with
respect to PHI.
• We reserve the right to change the privacy policies and
practices described in this notice.
Unless we notify you of such changes, however, we are
required to abide by the terms currently in effect.
• If we make significant revisions to policies and
procedures which might affect the privacy of your personal health information,
we will provide you with a copy of those revisions. If you are still in
treatment at this office, you will be provided with a copy of the revisions in
the manner permitted by law, generally by hand delivery at your next
appointment. As needed, former clients may be mailed a copy of significant
revisions to the most recent mailing address on file at our office. Updated
notices of our privacy policies will always be available for review upon request
at this office.
V. Questions and Complaints
If you have questions about this notice, disagree with a
decision made about access to your records, or have other concerns about your
privacy rights, you may contact this office in writing or by phone (address and
phone number above). We recommend that such inquiries be done in writing.
If you believe that your privacy rights have been violated
and wish to file a complaint, you may send your written complaint to our office
You may also send a written complaint to the Secretary of
the U.S. Department of Health and
Human Services, or the appropriate administrative office. We
can provide you with the appropriate address upon request.
You have specific rights under the Privacy Rule. We will not
retaliate against you for exercising your right to file a complaint, in
accordance with the provisions of applicable law.
VI. Effective Date, Restrictions and Changes to Privacy
the case of a minor child, age thirteen and under, the child’s legal guardian
has the right to inspect or obtain a copy (or both) of PHI in the mental health
and billing records used to make decisions about the child for as long as the
PHI is maintained in the record. However, psychotherapy notes including
statements made by a child during therapy sessions will not be released, in
order to protect the child’s right to confidentiality, unless required by law
or deemed to be in the best interests of the child.
Individuals with legal authorization (Power of Attorney) have the right to
inspect or obtain a copy (or both) of PHI in the mental health or billing
records used to make decisions about the individual, purpose of evaluation, or
purpose of treatment. However, psychotherapy notes and/or written reports will
not be released without written documentation of power of attorney that
specifies responsibility for health-related issues.
office expressly recommends against the client’s use of electronic means of
communication. This includes but is not limited to email and social media
(e.g., Facebook). We will not initiate electronic communications unless
absolutely necessary or no other means exist, and only with your written
consent unless this is not possible.
Existing or former clients who decide to initiate electronic
communication do so knowing that these communications cannot be protected, and
will be discussed with the clinician as an aspect of treatment or evaluation.
Use of our website contact form for changing appointments or
other purposes does not require you to include PHI (e.g. state your appointment
date and time and our office will contact you).
If other providers or individuals contact this office about
you by means of electronic communication (email, texting, etc.) we will not
respond without your express written consent. If you anticipate this, please
complete a written authorization today.
This notice will go into effect on February 24, 2014