NOTICE OF PRIVACY PRACTICES
By law I am required to insure that your Protected Health Information (PHI) is kept private. The PHI constitutes information created or noted by me that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why, and how I would use and/or disclose your PHI. Use of PHI means when I share, apply, utilize, examine, or analyze information within my practice; PHI is disclosed when I release, transfer, give, or otherwise reveal it to a third party outside my practice. With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, I am always legally required to follow the privacy practices described in this Notice.
Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time as permitted by law. Any changes will apply to PHI already on file with me. Before I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office and on my website www.norcalnpsych.com. You may also request a copy of this Notice from me, or you can view a copy of it in my office or on my website, which is located at 61 Avenida de Orinda, Orinda, CA 94563.
HOW I WILL USE AND DISCLOSE YOUR PHI.
I will use and disclose your PHI for many different reasons. Some of the uses or disclosures will require your prior written authorization; others, however, will not. Below you will find the different categories of my uses and disclosures, with some examples.
Uses and Disclosures Related to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent. I may use and disclose your PHI without your consent for the following reasons:
1. Treatment. I will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. I will also disclose PHI to other clinicians or physicians who may be treating you when I have the necessary permission from you to disclose your protected health information. For example, your PHI may be provided to a physician to whom or from whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
2. For health care operations. I may disclose your PHI to facilitate the efficient and correct operation of my practice. Examples: Quality control - I might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. I may also provide your PHI to my attorneys, accountants, consultants, and others to make sure that I am in compliance with applicable laws.
3. Payment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provided you. Example: I might send your PHI to your insurance company or health plan in order to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for my office.
4. Other disclosures. Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) but I think that you would consent to such treatment if you could, I may disclose your PHI.
Certain Other Uses and Disclosures Do Not Require Your Consent. I may use and/or disclose your PHI without your consent or authorization for the following reasons:
1. Required by Law. I may use or disclose your PHI to the extent that such use or disclosure is required by law.
2. Legal Proceedings
3. Law Enforcement.
5. To avoid harm.
6. Imminent Threats: Consistent with applicable federal and state laws, I may disclose your PHI, if I believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
7. If disclosure is mandated by the California Child Abuse and Neglect Reporting law.
8. If disclosure is mandated by the California Elder/Dependent Adult Abuse Reporting law.
10. For public health activities.
11. For health oversight activities.
12. For specific government functions.
13. For research purposes.
14. For Workers' Compensation purposes. I may provide PHI in order to comply with Workers' Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: I may use PHI to provide appointment reminders. I may use PHI to give you information about alternative treatment options, or other health care services or benefits I offer.
16. If an arbitrator or arbitration panel compels disclosure.
18. If disclosure is otherwise specifically required by law.
Other Uses and Disclosures of Protected Health Information:
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke an authorization at any time, in writing, except to the extent that I have taken an action in reliance on the uses or disclosures permitted under that authorization.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the right to inspect and copy your PHI. You may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that your clinician and/or the practice uses for making decisions about you. You may be charged a fee for the copying at the rates prescribed under local law. To obtain access to your medical record, you must submit a written request for such record to the Privacy Officer.
You have the right to request a restriction of your protected health information.
You may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You must submit the request in writing and describe the specific restriction requested and to whom you want the restriction to apply. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, copyrighted test item information, information complied in reasonable anticipation of litigation, or information governed by certain federal laws pertaining to laboratory testing quality. Your clinician is not required to agree to a restriction that you may request. We may deny your request for an amendment if we believe the information at issue is accurate and complete or if we did not create the information originally. If your clinician does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment.
You have the right to request to receive confidential communications from us by
alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request.
You may have the right to have your physician/clinician amend your protected
health information. You may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. We will not delete information from your medical record, but we may make adjustments or note corrections to the record, if so agreed. Please contact our Privacy Contact if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations, as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you or to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice at any time.
HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If, in your opinion, I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W. Washington, D.C. 20201. If you file a complaint about my privacy practices, I will take no retaliatory action against you.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If you have any questions about this notice or any complaints about my privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact me at: 61 Avenida de Orinda, Orinda, CA 94563; 925-588-8906.
VII. EFFECTIVE DATE OF THIS NOIICE
This notice went into effect on April 14, 2003.