NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

1. We have a legal, ethical, and moral obligation to protect your confidentiality.  Any information about you and/or your family will be held strictly confidential by all employees.  No discussions about you outside of the patient care framework will be allowed, and any conversation between staff members that pertains to delivering you quality care will be held in a confidential and professional manner.
2. In order to provide quality care to you, as well as operate this office in an efficient manner, we will need to access your private health care information for purposes of treatment, payment and operations [such as quality assurance].  In using this information this office will comply with all state and federal laws pertaining to your privacy rights, including the Privacy and Security protections provided to you by the Health Insurance Portability and Accountability Act [HIPAA].
3. Specifically, we will need to disclose your private information under the following circumstances:
4. a)Sharing Information for Purpose of Treatment:  We will share information with all members of your treatment team, both within this office and with other providers [personal and institutional] in order to provide you with quality care and the educational/wellness program specified in your insurance plan.
5. b)Sharing information for Purpose of Payment:  We will share all necessary information with your insurer[s], payer[s], governmental entities [such as Medicare, etc.] and their representatives [including, but not limited to benefit determination and utilization review] as well as our representatives involved in the billing process [including, but not limited to claims representatives, data warehouses, and billing companies].
6. c)  Sharing of Information for Purpose of Operations:  We will share all information necessary for ongoing operations of this office, including [but not limited to] credentialing processes, peer review, accreditations and compliance with all federal and state laws.     
7. Your consent for use and disclosure of information as described may be revoked in writing at anytime.  Please notify the office/Privacy Officer if you ever decide to revoke your consent.
8. Your specific authorization will be required for release of information not included above. Your authorization will need to be in writing and it will be specific to the disclosure requested.  Incidences which may require authorization under the HIPAA regulations include [but are not limited to] some marketing purposes, the disclosure of any psychotherapy records in our possession and disclosure for fundraising by any entity.
9. Your consent will give us authorization to fax or leave messages on your answering machine/service, regarding appointment reminder calls, test results, or other messages relating to your care in this office. It will also give us authorization to send postcards reminding you to schedule an appointment.
10. This office will not release any information other than those incidents described above, unless disclosure is required by law, a court, a legal process or government agencies.