To my patients: This notice describes how psychological information about you may be used and disclosed and how you can get access to this information. My practice is committed to maintaining your privacy. I am required by law to provide you with this information explaining your rights and my obligation to maintaining the privacy of your health information. Please review this carefully.
Uses and Disclosures Requiring Authorization
I may use or disclose Protected Health Information (PHI) for purposes outside of treatment, payment and health care operations when you give me written authorization. This would include consultations with other professional who are also legally bound to keep the information confidential; any administrative personnel responsible for billing; and any contract I may have with an agency associated with your care and health service, which promises to maintain confidentiality except as specifically allowed in the contract or otherwise required by law.
With your permission, I may release information for purposes outside of treatment, payment and health care operations. I will obtain authorization from you before releasing this information. You may revoke all such authorizations of PHI at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I 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.
Uses and Disclosures Requiring Neither Consent nor Authorization
I may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse: If I have cause to believe that a child has been, or may be, abused, neglected, or sexually abused, I must make a report of such within 48 hours to the Texas Department of Protective and Regulatory Services or to any local or state law enforcement agency.
- Adult and Domestic Abuse: If I have cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, I must immediately report such to the Department of Protective and Regulatory Services.
- Health Oversight: To public health authorities and health oversight agencies that are authorized by law to collect information.
- Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered, and I am required to release information.
- National Security: If you are a member of US or foreign military forces (including veterans) and if required by the appropriate authorities; to federal officials for intelligence and national security activities authorized by law.
- Law Enforcement Officials: To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
- Serious Threat to Health or Safety: If I determine that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to you, I may disclose relevant confidential mental health information to medical or law enforcement personnel.
- Worker’s Compensation: If you file a worker’s compensation claim, I may disclose records relating to your diagnosis and treatment to your employer’s insurance carrier.
- Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
- Right to Inspect and Copy: You have the right to inspect or obtain a copy of PHI and Psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, I will discuss with you the details the request and denial process.
- 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 ask that I contact you at home rather than at work.
- Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request. On your request, I will discuss with you the details of the amendment process.
- Complaints: if you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to me. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
- 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. On your request, I will discuss with you the details of the accounting process.
If you have any questions regarding this notice or my health information privacy policies, please contact me at 972-458-9890. I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.