HIPAA:
Notice
of Psychologists' Policies and Practices to Protect the Privacy
of Your Health Information
THIS NOTICE DESCRIBES HOW
PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
I. Uses and Disclosures for Treatment, Payment, and Health
Care Operations
We (heretofore RSM Psychology Center and its psychologists)
may use or disclose your protected health information (PHI),
for treatment, payment, and health care operations purposes
with your consent. To help clarify these terms, here are some
definitions:
- "PHI" refers to information in your health
record that could identify you."
- "Treatment, 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.
- "Use" applies only to activities within
our practice group such as sharing, employing, applying,
utilizing, examining, and analyzing information that
identifies you.
- "Disclosure" applies to activities outside
of practice group such as releasing, transferring, or
providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
We may use or disclose PHI for purposes outside of treatment,
payment, and health care operations when your appropriate
authorization is obtained. An "authorization" is
written permission above and beyond the general consent that
permits only specific disclosures. In those instances when
we are asked for information for purposes outside of treatment,
payment and 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.
You 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,
and the law provides the insurer the right to contest the
claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
We may use or disclose PHI without your consent or authorization
in the following circumstances:
- Child Abuse: If we have reasonable cause to believe
that a child has been subject to abuse, we must report
this immediately to the New Jersey Division of Youth and
Family Services.
- Adult and Domestic Abuse: If we reasonably believe
that a vulnerable adult is the subject of abuse, neglect,
or exploitation, we may report the information to the county
adult protective services provider.
- Health Oversight: If the New Jersey State Board
of Psychological Examiners issues a subpoena, we may be
compelled to testify before the Board and produce your
relevant records and papers.
- Judicial or Administrative Proceedings: If you are
involved in a court proceeding and a request is made for
information about the professional services that we have
provided you and/or the records thereof, such information
is privileged under state law, and we must not release
this information without written authorization from you
or your legally appointed representative, or a court order.
This privilege does not apply when you are being evaluated
for a third party or where the evaluation is court ordered.
We must inform you in advance if this is the case.
- Serious Threat to Health or Safety: If you communicate
to us a threat of imminent serious physical violence against
a readily identifiable victim or yourself or to the public
and we believe you intend to carry out that threat, we
must take steps to warn and protect. We also must take
such steps if we believe you intend to carry out such violence,
even if you have not made a specific verbal threat. The
steps we take to warn and protect may include arranging
for you to be admitted to a psychiatric unit of a hospital
or other health care facility, advising the police of your
threat and the identity of the intended victim, warning
the intended victim or his or her parents if the intended
victim is under 18, and warning your parents if you are
under 18.
- Worker's Compensation: If you file a worker's compensation
claim, we may be required to release relevant information
from your mental health records to a participant in the
worker's compensation case, a reinsurer, the health care
provider, medical and non-medical experts in connection
with the case, the Division of Worker's Compensation, or
the Compensation Rating and Inspection Bureau.
IV. Patient's Rights and Psychologist's Duties
Patient's Rights:
- Right to Request Restrictions: You have the right
to request restrictions on certain uses and disclosures
of protected health information about you. However, we
are not required to agree to a restriction you request.
- Right to Receive Confidential Communications
by Alternative Means and at Alternative Locations: You have the right
to request and receive confidential communications of PHI
by alternative means and at alternative locations. (For
example, you may not want a family member to know that
you are seeing us. Upon your request, we will 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.
We may choose to provide you with a summary of your record.
We may deny your access to PHI under certain circumstances,
but in some cases, you may have this decision reviewed.
On your request, we will discuss with you the details of
the request and denial process.
- Right to Amend: You have the right to request an
amendment of PHI for as long as the PHI is maintained in
the record. We may deny your request. On your request,
we will discuss with you the details of the amendment process.
- Right to an Accounting: You generally have the right
to receive an accounting of disclosures of PHI for which
you have neither provided consent nor authorization (as
described in Section III of this Notice). On your request,
we will discuss with you the details of the accounting
process.
- Right to a Paper Copy: You have the right to obtain
a paper copy of the notice from us upon request, even if
you have agreed to receive the notice electronically.
Psychologists' Duties:
- 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 revise our policies and procedures, we will
post such a notice in our offices and give you a copy at
your next appointment.
V. Complaints:
If 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 contact Dr. Rosemarie Scolaro Moser,
Director, 609-896-1070 and/or the NJ State Board of Psychological
Examiners in Newark, NJ, as posted in our office.
You 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.
VI. Effective Date, Restrictions and Changes to Privacy
Policy
This notice went into affect on April 14, 2003.
We 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 in our office and giving you a copy at your next
appointment.
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