Notice of Privacy Practices
In general, laws protect the privacy of all communications between the patient and the therapist. I can only release information about our work to others with your written permission. However, there are a few exceptions.
IN LEGAL PROCEEDINGS:
In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.
There are some situations where I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example,
FOR TREATMENT:
I may occasionally find it helpful to consult other professionals about a case. There are two situations in which I might talk about part of your case with another therapist. I ask your understanding and agreement to let me do so in these two situations.
First, when I am away from the office for a few days, I have a trusted fellow therapist to "cover" for me. This therapist will be available to you in emergencies. Therefore, he or she needs to know about you. Generally, I will tell this therapist only what he or she would need to know for an emergency. Of course, this therapist is bound by the same laws and rules as I am to protect your confidentiality.
Second, I sometimes consult other therapists or other professionals about my clients. This helps me in giving high-quality treatment. These persons are also required to keep your information private. Your name will never be given to them, and they will be told only as much as they need to know to understand your situation. If you do not object, I will not tell you about these consultations unless I feel that it is important to our work together.
FOR PAYMENT / SCHEDULING APPOINTMENTS:
I may use and disclose your treatment information to obtain payment for services I provide you, including—but not limited to—businesses in connection with billing and collection activities. For example, I may contact your insurer to verify benefits and obtain prior authorization to make sure they will pay for your care.
I may use your phone numbers to call you and leave messages to schedule or remind you of appointments.
Except for the situations I have described above, my office and I will always maintain your privacy. I also ask you not to disclose the name or identity of any other client being seen in this office.
While this summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.
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YOUR HEALTH INFORMATION RIGHTS:
You have the right to:
QUESTIONS AND COMPLAINTS:
If you believe your privacy rights have been violated, please contact me ASAP to discuss your concerns. After we discus the matter and you feel it was not resolved, you may file a complaint with the Secretary of Health and Human Services, Office of Civil Rights. There will be no retaliation for filing a complaint.
IN LEGAL PROCEEDINGS:
In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.
There are some situations where I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example,
- if I believe that a child, elderly person, or disabled person is being abused, I must file a report with the appropriate state agency.
- if I believe that a client is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.
- if the client threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.
FOR TREATMENT:
I may occasionally find it helpful to consult other professionals about a case. There are two situations in which I might talk about part of your case with another therapist. I ask your understanding and agreement to let me do so in these two situations.
First, when I am away from the office for a few days, I have a trusted fellow therapist to "cover" for me. This therapist will be available to you in emergencies. Therefore, he or she needs to know about you. Generally, I will tell this therapist only what he or she would need to know for an emergency. Of course, this therapist is bound by the same laws and rules as I am to protect your confidentiality.
Second, I sometimes consult other therapists or other professionals about my clients. This helps me in giving high-quality treatment. These persons are also required to keep your information private. Your name will never be given to them, and they will be told only as much as they need to know to understand your situation. If you do not object, I will not tell you about these consultations unless I feel that it is important to our work together.
FOR PAYMENT / SCHEDULING APPOINTMENTS:
I may use and disclose your treatment information to obtain payment for services I provide you, including—but not limited to—businesses in connection with billing and collection activities. For example, I may contact your insurer to verify benefits and obtain prior authorization to make sure they will pay for your care.
I may use your phone numbers to call you and leave messages to schedule or remind you of appointments.
Except for the situations I have described above, my office and I will always maintain your privacy. I also ask you not to disclose the name or identity of any other client being seen in this office.
While this summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.
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YOUR HEALTH INFORMATION RIGHTS:
You have the right to:
- Inspect or copy treatment information that may be used to make decisions about your care with limited exceptions. You must make a request in writing by sending a letter to me.
- Request restrictions on uses and disclosures of your treatment information for the purposes of treatment, payment, or healthcare operations. I am not required to allow your request. If I do agree with the request, I will comply with it except to the extent that disclosure has already occurred or if you are in need of emergency treatment and the information is needed to provide that treatment.
- Inspect or copy treatment information that may be used to make decisions about your care, with limited exceptions. You must make a request in writing by sending a letter to me.
- Request that I amend or make changes to your treatment record. Your request must be in writing and it must explain why the information should be changed.
- To receive a list of instances in which I disclosed your information for purposes other than treatment, payment, or those disclosures you have authorized in writing.
- To request that I contact you by alternative means or at alternative locations. For instance, you may ask that I contact you at work. You must inform me in writing that alternative means are required.
QUESTIONS AND COMPLAINTS:
If you believe your privacy rights have been violated, please contact me ASAP to discuss your concerns. After we discus the matter and you feel it was not resolved, you may file a complaint with the Secretary of Health and Human Services, Office of Civil Rights. There will be no retaliation for filing a complaint.
