Notice of Psychologist’s Policies and Practices to
Protect the Privacy of Your Health Information
are some definitions of terms that will helpful in understanding this Notice:
refers to information in your health record that could identify you.
Payment and Health Care Operations”
Treatment is when we provide,
coordinate or manage your health care and other services related to your health
care. An example of treatment would
be when we consult with another health care provider, such as your family
physician or another psychologist.
Payment is when we obtain
reimbursement for your healthcare. Examples
of payment are when we disclose your PHI to your health insurer to obtain
reimbursement for your health care or to determine eligibility or coverage.
Health Care Operations are activities
that relate to the performance and operation of our practice.
Examples of health care operations are quality assessment and improvement
activities, business-related matters such as audits and administrative services,
and case management and care coordination.
applies only to activities within our office, such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you.
applies to activities outside of our office, such as releasing, transferring, or
providing access to information about you to other parties.
for Treatment, Payment, and Health Care Operations
may use your protected health information (PHI),
for treatment, payment, and health care
operations purposes with your consent.
The “consent” is given when you sign the Psychotherapist-Patient
II. Disclosures Requiring Authorization
may disclose PHI for purposes of treatment, payment, or health care operations
with your Authorization. We may
also disclose PHI for purposes outside of treatment, payment, or health care
operations when your appropriate authorization is obtained.
is written permission for specific disclosures, above and beyond the general
“consent.” In those instances when we are asked for information for
purposes outside of treatment, payment or health care operations, we will obtain
an authorization from you before releasing this information.
We will also need to obtain an authorization before releasing your
Psychotherapy Notes. “Psychotherapy
Notes” are notes we have made about our conversation during a private,
group, joint, or family counseling session, which we have kept separate from the
rest of your medical record. These
notes are given a greater degree of protection than PHI.
may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time,
provided each revocation is in writing. You
may not revoke an authorization to the extent that (1) we have relied on that
authorization; or (2) if the authorization was obtained as a condition of
obtaining insurance coverage, law provides the insurer the right to contest the
claim under the policy.
and Disclosures with Neither Consent nor Authorization
may use or disclose PHI without your consent or authorization in the following
Child Abuse – If we know or suspect that child
is a victim of child abuse or neglect, we are required to report the abuse or
neglect to a duly constituted authority.
and Domestic Abuse – If we have
reasonable cause to believe an adult, who is unable to take care of himself or
herself, has been subjected to physical abuse, neglect, exploitation, sexual
abuse, or emotional abuse, we must report this belief to the appropriate
Oversight Activities – If
the Alabama Board of Examiners in Psychology is conducting an investigation into
our practice, then we are required to disclose PHI upon receipt of a subpoena
from the Board.
Judicial and Administrative Proceedings
– If you are
involved in a court proceeding and a request is made for information about your
diagnosis and treatment and the records thereof, such information is privileged
under state law, and we will not release information without the written
authorization from you or your legally appointed representative or a court
order. The privilege does not apply when you are being evaluated for
a third party or where the evaluation is court ordered. You will be informed in advance if this is the case
Worker’s Compensation – We may disclose PHI as
authorized by and to the extent necessary to comply with laws relating to
worker’s compensation or other similar programs, established by law, that
provide benefits for work-related injuries or illness without regard to fault.
IV. Patient’s Rights and Psychologist’s Duties
requests for restrictions, communications, information, inspection, accounting,
amending, and copying will be done in writing.
you are concerned that we have violated your privacy rights, or you disagree
with a decision we made about access to your records, you may your psychologist at this office.
Each of us acts as our own
Privacy Officer for Cahaba Psychology Center.
may also send a written complaint to the Secretary of the U.S. Department of
Health and Human Services. The
person listed above can provide you with the appropriate address upon request.
notice will go into effect on April 14, 2003.
will limit the uses or disclosures that we will make to the minimum necessary.
reserve the right to change the terms of this notice and to make the new notice
provisions effective for all PHI that we maintain.
We will provide you with a revised notice by posting it on the office
bulletin board, and on our website (www.cahabapsychology.com).
A copy is available on request.