Privacy Notice

Notice of Privacy Practices



The Health Insurance Portability & Accountability Act of 1996 (HIPAA) with the amendment through the Health Information Technology for Clinical Health Act (HITECH) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your Protected Health Information (PHI) is used, HIPAA provides penalties for covered entities that misuses personal health information.

As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information.

We may use and disclose your medical records only for each of the following purposes:

  • Treatment: Providing, coordinating, or managing health care and related services by one or more healthcare providers. An example is a referral to a specialist doctor by your provider.
  • Payment: Includes activities such as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. Examples are sending your insurance company a bill for your visit and/or verifying coverage prior to a test or procedure.
  • Health Care Operations: Includes business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis and customer service.
  • Legal Reasons: Includes the provision of information required for law enforcement and other legal services/reasons.

In all situations, we shall do our best to assure the confidentiality of your PHI in accordance with the Minimum Necessary Rule which states that only the minimum necessary information should be accessed, used, or disclosed in any situation.

We may also create and distribute de-identified health information by removing all references to individually identifiable information. We may contact you by phone or in writing to provide appointment reminders or information regarding treatment or other health-related benefits and services.

The following use and disclosure of PHI will only be made if we receive a written authorization from you, the patient:

  • Most uses and disclosures of psychotherapy notes
  • Marketing purposes, including subsidized treatment and health care operations
  • Disclosures that constitute a sale of PHI under HIPAA
  • Other uses and disclosures not described in this notice
  • Release of PHI to an authorized recipient such as a legal representative, family member or otherwise authorized personnel

You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your prior authorization.

You may have the following rights with respect to your PHI:

  • The right to request restrictions for certain uses and disclosures of PHI, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.
  • The right to reasonable requests to receive confidential communications of PHI by alternative means.
  • The right to inspect and copy your PHI.
  • The right to amend your PHI.
  • The right to receive an accounting of disclosures of your PHI.
  • The right to obtain a paper copy of this notice from us upon request.
  • The right to be advised if your unprotected PHI is intentionally or unintentionally disclosed.

If you have paid for services “out of pocket”, in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.

We are required by law to maintain the privacy of your PHI and to provide you the notice of your legal duties and our privacy practice with respect to PHI.

This notice is effective as of September 23, 2013 and has been amended January 22, 2019. It is our intention to abide by the terms of the Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practices from our office.

You have the ability to file a complaint if you feel that your protections have been violated by our office. You can file a formal written complaint with our office and with the Department of Health and Human Services, Office of Civil Right. We will not retaliate against you for filing a complaint.

Feel free to contact the Practice Security Officer, at 724-352-8840 ex. 2 for more information, in person or in writing.