NOTICE OF PRIVACY PRACTICES
This notice also describes how medical information about you may be used and disclosed in our work together (for privacy related to this website, SMS and Email Messaging click here). It also outlines how you can get access to this information. Read this information carefully. Privacy is a very important concern. It’s also complicated, because of the many federal and state laws and my professional ethics. 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 at all, I’m happy to help you understand anything that feels unclear.
Introduction: Information about HIPAA for my clients
This portion of the notice will tell you how I handle your medical information. It tells how I use this information here in this office, how I disclose (share) it with other health care 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 me for answers or explanations.
What I mean by your medical information
Each time you visit me or any doctor’s office, hospital, clinic, 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 or treatment you got from me or from others, or about payment for health care. All this information is called “PHI,” which stands for “protected health information” which means its privacy must be protected. This information goes into your electronic health record.
In our work together, your PHI might include this kind of information:
· Your history: Things that happened to you as a child; your school and work experiences; your marriage, relationships, and other personal history
· Your medical history of issues and treatments
· Reasons you came for treatment: Your problems, complaints, symptoms, or needs
· Diagnoses: These are the medical terms for your issues or symptoms
· A treatment plan: This is a list of the treatments and other services we collaborate on together to meet desired outcomes and goals
· Progress notes: Each time you come in, I write down some things about how you are doing, what I notice about you, and what you tell me
· Records I get from others who treated you or evaluated you
· Psychological test scores, school records, and other evaluations and reports
· Information about medications you took or are taking
· Billing and insurance information
There may also be other kinds of information that go into your health care records here.
I use PHI for many purposes. For example, I may use it:
· When I talk with other health care professionals who are also treating you, such as your family doctor or the professional who referred you to me. When I do this, I will ask for your consent. Almost always, I will also ask you to sign a release-of-information form, which will explain what information is to be shared and why.
· To show that you actually received services from me, for which I have provided you a superbill if you have requested one.
When you understand what is in your record and what it is used for, you can make better decisions about what other persons or agencies should have this information, when, and why.
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) and the HIPAA Omnibus Final Rule of 2013. HIPAA requires me to keep your PHI private and to give you this notice about my legal duties and my privacy practices.
This form is not legal advice. It is just to educate you about your rights and my procedures. It is based on current federal and state laws and might change if those laws or court decisions change. 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 where everyone can see. You or anyone else can also get a copy from me. I will obey the rules described in this notice.
How your protected health information (PHI) can be used and shared:
Except in some special circumstances, when I use your PHI in this office or disclose it to others, I share only the minimum necessary PHI needed for those other people to do their jobs. The laws give you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. So now I will tell you more about what I do with your information.
Mainly, I will use it here and disclose (share) your PHI for routine purposes to provide for your care, and I will explain more about these below. For other uses, I must tell you about them and ask you to sign a written Release of Information form. However, the HIPAA law also says that there are some uses and disclosures that don’t need your consent or authorization which I will explain below. However, in most cases I will explain the PHI and who it will go to and ask you to agree to this by signing a release-of-information form.
Uses and disclosures with your consent
I need information about you and your condition to provide care to you. In almost all cases, I intend to use your PHI here or share it with other people or organizations to provide treatment to you, arrange for payment for my services. To move forward, I ask that you agree to let me use and share your PHI in the ways that are described in this Notice of Privacy Practices. You can agree by signing the separate consent form before I begin to treat you. If you do not consent to this, I will be unable to treat you because there is a risk of not helping you if I don’t have some information.
The basic uses and disclosures: For treatment, payment, and health care operations
Here I will tell you more about how your information will be used for these purposes.
For treatment, I use your information to provide you with psychotherapy treatments or services. These might include individual therapy; psychological, educational, or vocational testing; treatment planning; or measuring the benefits of my services.
I may share your PHI with others who provide treatment to you with your permission. If you are being treated by a team, I can share some of your PHI with the team members, so that these providers will work best together. The other professionals treating you will also enter their findings, the actions they took, and their plans into your medical record, and so we all can decide what treatments work best for you and follow a treatment plan.
If I want to share your PHI with any other professionals, I will need your permission on a signed release-of-information form. For example, I may refer you to other professionals or consultants for services I cannot provide. When I do this, I need to tell them things about you and your conditions. Later I will get back their findings and opinions, and those will go into your records here. If you receive treatment in the future from other professionals, I can also share your PHI with them. I can do this only when you give your permission by signing a release-of-information form. This is so that you will know what information is being shared and with whom. These are some examples so that you can see how I use and disclose your PHI for treatment.
For payment. If you request it, I will use your information to provide you with a superbill, which you may use to seek partial reimbursement for our sessions. If I am in-network with your insurance, I will submit claims on your behalf. If you choose to pursue reimbursement from your insurance for my services, the superbill or insurance claim I submit will include information about your diagnoses, and the dates of treatment you have received. Your insurance company may contact me to find out about the changes I expect to see in your conditions. They may ask about when we met, your progress, and other similar things. Insurers may also look into a few of my patient records to evaluate the completeness of my record keeping.
Other uses and disclosures in health care
Appointment reminders. I may use and disclose your PHI to reschedule or remind you of appointments for treatment or other care. 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, we usually can arrange that. Just tell me what you prefer.
Business associates - I hire other businesses to do some jobs for me. In the law, they are called my “business associates.” Examples may include a billing service to figure out and process my bills. These business associates need to receive some of your PHI to do their jobs properly. To protect your privacy, they have agreed in their contracts with me to safeguard your information just as I do.
Uses and disclosures that require your consent
If I want to use your information for any purpose besides those described above, I need your permission on a release-of-information form. If you do allow me to use or disclose your PHI, and then change your mind, you can cancel that permission in writing at any time. I will then stop using or disclosing your information for that purpose. Of course, I cannot take back any information used here already or disclosed to anyone with your permission.
As a clinical social worker licensed in Oregon, I maintain your privacy more carefully than is required by HIPAA. The HIPAA rules are described below, but I will almost always discuss these with you and ask you to sign a release of information so that you are fully informed.
Uses and disclosures that don’t require your consent or authorization
The HIPAA laws let medical and mental health professionals use and disclose some of your PHI without getting your consent or authorization in some cases. Here are some examples of when I might do this. I will almost always notify you if any of these situations occur.
When required by law:
There are some federal, state, or local laws that require me to disclose PHI:
I may have to report suspected abuse or neglect of children, elders and the disabled to DHS.
If you are involved in a lawsuit or legal proceeding, and I receive a subpoena, discovery request, or other lawful process, I may have to release some of your PHI. I will only do so after telling you about the request and will suggest that you talk to your lawyer. We will review your record together before I send it to the requester, and I will ask you to sign a release-of-information, though I may be required to send your PHI, even if you choose not to sign a release.
I have to disclose some information to the government agencies that check on my profession to see that I am obeying the privacy laws, and to organizations that review my work for quality and efficiency.
For law enforcement purposes:
I may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.
For public health activities:
I may disclose some of your PHI to agencies that investigate diseases or injuries.
For matters relating to deceased persons:
I may disclose PHI to coroners, medical examiners, or funeral directors.
For specific government functions:
I may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment. 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.
To prevent a serious threat to health or safety:
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 can disclose some of your PHI. I will only do this to those people who can prevent the danger.
If it is an emergency, and I am unable to get your agreement, I can disclose information if I believe that it is what you would have wanted and if I believe it will help you. When 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.
Uses and disclosures where you have an opportunity to object:
I can share some information about you with your family 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. Before I disclose this information, I will ask that you sign a release-of-information.
An accounting of disclosures we have made:
When I disclose your PHI, I will keep a record of whom I sent it to, when I sent it, and what I sent. You can get an accounting (a list) of many of these disclosures. I may charge you a reasonable fee if you request more than one accounting in any 12-month period. If the records were sent as electronic medical records, I will always record that, and there will be no charge for an accounting.
Your rights about your protected health information:
1. You can 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, rather than at work, to schedule or cancel an appointment. I will try my best to do as you ask, and I don’t need an explanation for such a request. Sending your information in emails has some risk that these emails could be read by someone else, and because of this, I do not send information beyond simple messages like changing appointments. I do not use it for any PHI or sensitive information and ask that you be thoughtful before you put any information you would prefer to keep private in an email. By signing the separate consent form, you agree to this use of email. Please note that anything you send me electronically becomes a part of your legal record, even if we do not place it in the chart. Be mindful of this, and please do not forward emails from third parties or others in your life. It is better to print those out and bring them in to discuss them.
2. 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. You can ask me face to face, and I may then ask for your written permission. 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, when there is an emergency, or when the information is necessary to treat you.
3. You have the right to prevent my sharing your PHI with your insurer or payer for its decisions about your benefits or some other uses, if you pay directly (“out of pocket”) for treatment or other services and are not asking the insurer to pay for those services.
4. You have the right to look at your PHI, such as your medical and billing records. In some very unusual circumstances, if there is very strong evidence that reading this would cause serious harm to you or someone else, you may not be able to see all of the information. We would talk carefully about your record if you chose to review it.
5. You can get a copy of these records, but I may charge you a reasonable cost-based fee. If your records are in electronic form, not on paper, you can ask for an electronic copy of your PHI. Contact me to arrange how to see your records. Generally I do not recommend that you get a copy of your records, because the copy might be seen accidentally by others. I will be happy to review the records with you or provide a summary to you, or work out any other review method that satisfies you.
6. You have the right to add to (amend) your records to explain or correct anything in 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 or to include your own written statements to correct the situation. You must make this request in writing and send it to me. Your request will be included in your record, whether your record is amended or not.
7. You have the right to a copy of this notice. If I change this notice, I will have you sign a new one for your record.
8. If you have a problem with how your PHI has been handled, or if you believe your privacy rights have been violated, contact me. I will do my best to resolve any problems and do as you ask. You have the right to file a complaint with me, you may also report your concerns to the Oregon Board of Licensed Social Workers https://www.oregon.gov/blsw/Pages/FileAComplaint.aspx
3218 Pringle Road SE, Suite #240 Salem, OR 97302-6310 or by calling 503-378-5735.
9. I will not in any way limit your care here or take any actions against you if you complain or request changes.
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 have any questions about my health information privacy policies, please contact me at 503-825-2110.
The effective date of this notice is May 11, 2022