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Notice of Privacy Practices



Privacy is a very important concern for all those who come to therapy. It is also complicated, because of the many federal and state laws and the professional ethics of psychotherapists. Because the rules are so complicated, some parts of this notice are very detailed, and you probably will have to read them several times to understand them. If you have any questions, I will be happy to help you understand my procedures and your rights.



This notice will tell you how I handle your medical information. It tells how I use this information here in this office, in what circumstances I share it with other professionals and organizations, and how you can see it. I want you to know all of this so that you can make the best decisions for yourself. If you have any questions or want to know more about anything in this notice, please ask for more explanations or more details.


What I mean by “your medical information”

Each time you visit any health care provider, including a doctor’s office, hospital, clinic, psychotherapist, or other health care 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 tests and treatment you got from us or from others, or about payment for health care. The information I collect from you is called “PHI,” which stands for “protected health information.” This information goes into your medical or health care records, which I store electronically through the SimplePractice service. In this office, your PHI is likely to include these kinds of information:

  • Your history: Things that happened to you as a child; your school and work experiences; your marriage and other personal history.

  • Reasons you came for therapy: Your problems, complaints, symptoms, or needs.

  • A therapy plan: This is a list of the therapeutic interventions and other services that we think will best help you.

  • Progress notes: Each time you come in, I write down some things about how you are doing, what I notice, and what we do in therapy.

  • Records I get from others who treated you or evaluated you.

  • Information about medications you took or are taking.

  • Billing information.


When you understand what is in your record and what it is used for, you can make better decisions about who, when, and why others should have this information. The information in your record belongs to you. You have the right to request a copy of your record, and I will make one for you for a reasonable fee based on the cost of duplicating and preparing the record. In some very rare situations, you cannot see all of what is in your record. If you find anything in your records that you think is incorrect or believe that something important is missing, you can ask me to amend (add information to) your records, although in some rare situations I don’t have to agree to do that.


Privacy and the Laws About Privacy

I am required to tell you about privacy because of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires me to keep your PHI private and to give you this notice about my legal duties and my privacy practices. I will obey the rules described in this notice. If I change my privacy practices, they will apply to all the PHI I keep. I will also post the new notice of privacy practices in my office. You or anyone else can also get a copy from me at any time. It is also posted on my website.


How your protected health information can be used and shared

Except in some special circumstances, when I use your PHI or disclose it to others, I share only the minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. So I will tell you more about what I do with your information. Mainly, I will use and disclose your PHI for routine purposes to provide for your care. For most other uses, I must tell you about them and ask you to sign a written authorization form. However, the law also says that there are some uses and disclosures that don’t need your consent or authorization.


The basic uses and disclosures: For treatment, payment, and health care operations

The following are the routine ways I use your PHI. By agreeing to receive therapy from me, you agree to have your information used in these ways. If you do not consent to these uses of your information, I cannot provide therapy services to you.

  1. For treatment. I use your medical information to provide you with psychological treatments or services. These might include individual, family, or group therapy; psychological testing; treatment planning; or measuring how well therapy with me is working for you. In accordance with best professional practice standards, I regularly consult with a clinical supervisor as well as a small consultation group of other therapists to discuss challenging cases, changes in the field, and ethics issues. If I consult with other professionals about your case, I will provide only as much information about you as is necessary to meet my consultation goals, with the sole exception of my clinical supervisor who is required by law to have access to your entire treatment record. I may also share your PHI with others who provide treatment to you, such as your family doctor or your psychiatrist if you are taking prescribed psychiatric medications, to ensure your healthcare services are coordinated with each other and different providers are not working toward opposing goals.

  2. For payment. I may use your information to bill you or others so I can be paid for the service I provide to you. I do not bill insurance, but I can prepare a superbill for you to submit to your insurance at your request.

  3. For health care operations. Using or disclosing your PHI for health care operations goes beyond your care and your payment. For example, I may use your PHI to see where I can make improvements in the care and services I provide. I 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 I do, your name and other identifying information will be removed from what I send.


Other uses and disclosures that do not require your written consent

  1. Appointment reminders. I may use and disclose your PHI to reschedule or remind you of appointments. If you want me to call or write to you only at your home or your work, or you prefer some other way to reach you, I can usually arrange that.

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

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

  4. Research. I may use or share your PHI 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 personal information will be removed from any information given to researchers.

  5. Business associates. I hire other businesses to do some jobs for us. In the law, they are called my “business associates.” For example, I use the SimplePractice service to store my electronic health records, to schedule appointments, and for videoconferencing appointments. 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 me to safeguard your information.


Uses and disclosures that require your authorization

Except in specific cases (described in the next section), if I want to use or disclosed your information for any purpose besides those described above, I need your permission on an authorization form. I don’t expect to need this very often. If you do allow me to use or disclose your PHI, you can cancel that permission in writing at any time. I would then stop using or disclosing your information for that purpose. Of course, I cannot take back any information I have already disclosed or used with your permission.


Uses and disclosures that don’t require your consent or authorization

The law permits, and sometimes requires me, to disclose some of your PHI without your consent or authorization in some cases. Here are some examples of when I might do this:

  1. I am legally required to report suspected child abuse/neglect, or the abuse/neglect of a vulnerable adult.

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

  3. If you are involved in a lawsuit or legal proceeding, and I receive a subpoena, discovery request, or other lawful process, I may be legally required to release some of your PHI. I 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 requested.

  4. I may be required to disclose some information to the government agencies that check on me to see that I am obeying the privacy laws.

  5. I may disclose some of your PHI to agencies that investigate diseases or injuries, such as in a public health emergency.

  6. I may disclose PHI to a coroner who is performing duties authorized by law upon your death.

  7. I may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment.

  8. I may disclose your PHI to workers’ compensation and disability programs, to correctional facilities if you are an inmate, or to other government agencies for national security reasons.


Uses and disclosures where you have an opportunity to object

With your permission, I can share some information about you with your family or close others. I will only share information with those involved in your care and anyone else you choose, such as close friends or clergy. I will ask you which persons you want me to tell, and what information you want me to tell them about your condition or treatment. You can tell me what you want, and I will honor your wishes as long as it is not against the law. If it is an emergency, and so I cannot ask if you disagree, I can share information if I believe that it is what you would have wanted and if I believe it will help you if I do share it. If I do share information in an emergency, I will tell you as soon as I can. If you don’t approve, I will stop as long as it is not against the law.


An accounting of disclosures we have made

When I disclose your PHI for any reason other than routine health care operations, I will keep a records of whom I sent it to, when I sent it, and what I sent. You can request to receive an accounting (a list) of many of these disclosures and I will provide it to you within 60 days.


Your rights concerning your health information

You may ask me to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you. For example, you can ask me to call you at home, and not at work, to schedule or cancel an appointment. I will try my best to do as you ask. You have the right to ask me to limit what I tell people involved in your care or with payment for your care, such as family members and friends. I don’t have to agree to your request, but if I do agree, I will honor it except when it is against the law, or in an emergency, or when the information is necessary to treat you. You have the right to look at the health information I have about you, such as your medical and billing records. You can get a copy of these records, but I may charge you for them. If you believe that the information in your records is incorrect or missing something important, you can ask me to make additions to your records to correct the situation. You must make this request in writing. You must also tell me the reasons you want to make the changes. You have the right to a copy of this notice. If I change this notice, I will post the new one in my office, and you are free to receive a copy. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with me and with the Secretary of the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care I provide to you in any way. You may have other rights that are granted to you by the laws of our state, and these may be the same as or different from the rights described above. I will be happy to discuss these situations with you now or as they arise.


If you have questions or problems

If you need more information or have questions about the privacy practices described above, please tell me. If you have a problem with how your PHI has been handled, or if you believe your privacy rights have been violated, please tell me so in writing. As stated above, you have the right to file a complaint with me and with the Secretary of the U.S. Department of Health and Human Services. I promise that I will not in any way limit your care here or take any actions against you if you complain. If you have any questions or problems about this notice or our health information privacy policies, please contact me.

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