NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements.

This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private.

  • Give you this notice of my legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, and in my office.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations

Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations.

I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in the diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes

If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

  1. Psychotherapy Notes
    I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
    a. For my use in treating you.
    b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
    c. For my use in defending myself in legal proceedings instituted by you.
    d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
    e. Required by law and the use or disclosure is limited to the requirements of such law.
    f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
    g. Required by a coroner who is performing duties authorized by law.
    h. Required to help avert a serious threat to the health and safety of others.

  2. Marketing Purposes
    As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

  3. Sale of PHI
    As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

  1. When disclosure is required by state or federal law.

  2. For public health activities (e.g., suspected abuse or preventing threats to health/safety).

  3. For health oversight activities (e.g., audits or investigations).

  4. For judicial and administrative proceedings (e.g., court orders).

  5. Serious threat to health or safety – reasonable efforts may be made to warn potential victims and/or help you access care.

  6. Driving Risk – Pennsylvania law requires reporting concerns about unsafe driving.

  7. For law enforcement purposes.

  8. To coroners or medical examiners.

  9. For research purposes.

  10. For specialized government functions (e.g., military, national security).

  11. For workers’ compensation purposes.

  12. For appointment reminders and health-related benefits or services.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

  1. Disclosures to family, friends, or others
    I may provide your PHI to a family member, friend, or other person involved in your care or payment unless you object. The opportunity to consent may be obtained retroactively in emergency situations.
    If you are under 14, your parent(s) or guardian(s) must sign any authorization and have the right to know about your treatment. Authorization is not required for treatment.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI

  1. The Right to Request Limits
    You may request restrictions on how your PHI is used or disclosed for treatment, payment, or operations. I may deny the request if I believe it may affect your care.

  2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full
    You may restrict disclosure to health plans if you have paid in full out-of-pocket.

  3. The Right to Choose How I Send PHI to You
    You may request contact in a specific way (e.g., phone, address) and I will honor reasonable requests.

  4. The Right to See and Get Copies of Your PHI
    You may request paper or electronic copies (except psychotherapy notes). Copies will be provided within 30 days for a fee of no more than $0.25 per page.

  5. The Right to Get a List of Disclosures
    You may request a list of PHI disclosures made in the past six years (excluding treatment, payment, and operations). First request is free; additional requests may incur a fee.

  6. The Right of Notification Following a Breach
    Ainsley Rager must notify individuals if their unsecured PHI is compromised and maintain documentation for all notifications.

  7. The Right to File a Complaint
    If you believe your PHI has been misused, you may contact Ainsley Rager directly or file a complaint with the U.S. Department of Health and Human Services:

    • Phone: (877) 696-6775

    • Mail: Privacy Complaints, P.O. Box 8050, CMS, 7500 Security Blvd, Baltimore, MD 21244-1850
      You will not be punished or denied treatment for filing a complaint.

  8. The Right to Correct or Update Your PHI
    You may request corrections to your PHI. If denied, you will receive a written explanation within 60 days.

  9. The Right to Get a Paper or Electronic Copy of This Notice
    You have the right to request this notice in paper or email form, even if you previously agreed to receive it electronically.

EFFECTIVE DATE OF THIS NOTICE: 9/7/2020