Privacy Notice
THIS DOCUMENT DESCRIBES THE CONFIDENTIALITY OF YOUR MEDICAL RECORDS, HOW THE INFORMATION IS USED, YOUR RIGHTS, AND HOW YOU OBTAIN THIS INFORMATION. PLEASE REVIEW CAREFULLY.
By law, I am required to provide you with notice of my legal duties and the privacy practices concerning your individually identifiable health information, and that it may be used in treatment planning, payment procedures, appointment reminders, health-related benefits, and disclosures required by federal, state or local law, or self-defense in litigation.
Confidentiality and Limits
The privacy of your mental health information is critically important to me. I understand that your mental health information is personal. I am committed to protecting it. Written permission from you, as client or parent, is necessary for information to be shared with any outside third party. The obligation to maintain confidentiality may not apply when a client is a danger to self or others; when there is suspected child or adult (disabled and elderly) abuse or neglect (past or present) and I am required to report these incidents to the proper federal, state or local authorities; when hospitalization is needed; when signed releases allow the exchange of information; when you provide me claim forms or request that I contact your insurance company; when accounts must be put into collections; or when a court has mandated the release of information from records via subpoena, or in cases where a therapist must defend against malpractice claims or lawsuits. In these cases, clients must understand that confidentiality of information shared may not apply.
HIPAA & Privacy Notice
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that all healthcare records and other protected health information (PHI) used or disclosed to me in any form be kept confidential. This includes names, addresses, and phone numbers as well as medical information, including but not limited to, diagnoses and medication. HIPPA requires me to give you notice that I will:
- Protect your past, present, and future PHI, provide you with this notice of privacy, and adhere to it myself.
- Disclose your information to you, unless medical authorities determine such disclosure would harm you.
- Use and disclose the information you’ve provided to me in your treatment and care.
- Use this information to receive payment for health care services (including collection agencies for past due accounts), submit claims online, determine eligibility, obtain referrals or approval for your admission and emergency care.
- Disclose this information if law or regulation requires it, including but not limited to report abuse or neglect of a child, elderly or disabled person, report a death, prevent or control disease, injury, or disability, notify a person who might have been exposed to a disease or may be at risk for contracting or spreading a disease or condition, or to cooperate with an oversight agency conducting audits, investigations or inspections. I may find it necessary to comply with court orders, warrants, subpoenas, or discovery required by state law, and to defend against malpractice litigation, disclosing information if absolutely necessary.
- Use this information for scheduling and discussing appointments with you, calling you from the waiting area, and having you sign in. Third parties who work with me may have access to this information but all adhere to these stated privacy practices and protect your PHI in the same manner I do. I may use your information to provide alternative sources of care; i.e., I may ask if you wish to receive notice of literature that may be helpful, and send you information about products/services that may benefit you, your family, and treatment.
- Disclose your PHI to parents, guardians, or persons acting in a similar legal capacity where required by law. I make every effort to protect a child’s or adolescent’s rights to a private therapist/patient relationship, and work with a minor to self-disclose pertinent information if parents/guardians may need to know it.
Your Rights
The health and billing records I maintain are the physical property of Loftus Counseling, LLC. The information in it, however, belongs to you. You have a right to:
- Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to my office. I am not required to grant the request but I will carefully review any request received;
- Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information by making a written request at my office;
- Request that you be allowed to inspect and copy your mental health record and billing record – you may exercise this right by delivering the request in writing to my office using the form I provide to you upon your written request. Payment of one dollar per page will be charged for reproducing your mental health record. If you are a parent or a legal guardian of a minor, please note that certain portions of the minor’s mental health record will not be accessible to you. In those situations where your clinician determines that access to your record would be harmful, your clinician will restrict your access to the record;
- Appeal a denial of access to your protected health information except in certain circumstances;
- Request that your mental health care record be amended to correct incomplete or incorrect information by delivering a written request to my office. (I am not required to make such amendments);
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to my office. An accounting will not include internal uses of information for treatment, or payment, or disclosures made to you at your request;
- Request that communication of your health information be made by alternative means or alternative location by delivering the request in writing to my office; and,
- Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to my office;
- You have the right to review the Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment and health care operations purposes.
For additional information on HIPAA legislation click here http://www.aspe.hhs.gov.
For a summary of your privacy rights click here