HIPAA and Privacy Practices.

This document contains important information about federal law, the Health Insurance Portability and Accountability  Act (HIPAA), that provides privacy protections and client rights with regard to the use and disclosure of your  Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.  

HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of  your PHI for treatment, payment and health care operations. The Notice explains HIPAA and its application to  your PHI in greater detail.  

The law requires that I obtain your signature acknowledging that I have provided you with this. If you have any  questions, it is your right and obligation to ask so I can have a further discussion prior to signing this document.  When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in  writing at any time. That revocation will be binding unless I have taken action in reliance on it.  

LIMITS OF CONFIDENTIALITY  

The law protects the privacy of all communication between a client and a clinician. In most  situations, I can only release information about your treatment to others if you sign a written  authorization form that meets certain legal requirements imposed by HIPAA. There are some  situations where I am permitted or required to disclose information without either your consent or  authorization. If such a situation arises, I will limit my disclosure to what is necessary.  

Reasons I May Have to Release Your Information Without Authorization:  

1. If you are involved in a court proceeding and a request is made for information concerning your diagnosis and  treatment, such information is protected by psychologist-client privilege law. I cannot provide any information  without your (or your legal representative's) written authorization, or a court order, or if I receive a subpoena of  which you have been properly notified and you have failed to inform me that you oppose the subpoena. If you are  involved in or are contemplating litigation, you should consult with an attorney to determine whether a court would  be likely to order me to disclose information.  

2. If a government agency is requesting the information for health oversight activities, within its appropriate  legal authority, I may be required to provide it for them.  

3. If a client files a complaint or lawsuit against me, I may disclose relevant information regarding the client in order  to defend myself.  

4. If a client files a worker's compensation claim and I am providing necessary treatment related to that claim, I  must, upon appropriate request, submit treatment reports to the appropriate parties, including the client's employer,  the insurance carrier or an authorized qualified rehabilitation provider.  

5. I may disclose the minimum necessary health information to my business associates that perform functions on  our behalf or provide us with services if the information is necessary for such functions or services. My business  associates sign agreements to protect the privacy of your information and are not allowed to use or disclose any  information other than as specified in our contract. 

There are some situations in which I am legally obligated to take actions, which I  believe are necessary to attempt to protect others from harm, and I may have to  reveal some information about a client's treatment.  

1. If I know, or have reason to suspect that a child under 18 has been abused, abandoned, or neglected by a  parent, legal custodian, caregiver, or any other person responsible for the child's welfare, the law requires that I file  a report with the Minnesota Abuse Hotline. Once such a report is filed, I may be required to provide additional  information.  

2. If I know or have reasonable cause to suspect, that a vulnerable adult has been abused, neglected, or exploited,  the law requires that I file a report with the Minnesota Abuse Hotline. Once such a report is filed, I may be required  to provide additional information.  

3. If I believe that there is a clear and immediate probability of physical harm to a client, or other individuals, or to  society, I may be required to disclose information to take protective action, including communicating the information  to the potential victim, and/or appropriate family member, and/or the police or seek hospitalization of the client.  

CLIENT RIGHTS AND THERAPIST DUTIES  

Use and Disclosure of Protected Health Information:  

  • For Treatment – I use and disclose your health information internally in the course of your treatment. If I wish to  provide information outside of our practice for your treatment by another health care provider, I will have you sign  an authorization for release of information. Furthermore, an authorization is required for most uses and disclosures  of psychotherapy notes.  

  • For Payment – I may use and disclose your health information to obtain payment for services provided to you as  delineated in the Therapy Agreement.  

  • For Operations – I may use and disclose your health information as part of our internal operations. For example,  this could mean a review of records to assure quality. I may also use your information to tell you about services,  educational activities, and programs that I feel might be of interest to you.  

Client's Rights:  

  • Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity,  gender identity, sexual orientation, religion, disability status, age, or any other protected category. 

  • Right to Confidentiality – You have the right to have your health care information protected. If you pay for a  service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of  payment or our operations with your health insurer. I will agree to such unless a law requires us to share that  information.  

  • 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 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.

  • Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be  requested in writing and release of information must be completed. Furthermore, there is a copying fee charge of  $1.00 per page. Please make your request well in advanced and allow at least 2 weeks to receive the copies. If I  refuse your request for access to your records, you have a right of review, which I will discuss with you upon  request.  

  • Right to Amend – If you believe the information in your records is incorrect and/or missing important information,  you can ask us to make certain changes, also known as amending, to your health information. You have to make  this request in writing. You must tell us the reasons you want to make these changes, and I will decide if it is and if  I refuse to do so, I will tell you why within 60 days.  

  • Right to a Copy of This Notice – If you received the paperwork electronically, you have a copy in your email. If  you completed this paperwork in the office at your first session a copy will be provided to you per your request or  at any time.  

  • Right to an Accounting – You generally have the right to receive an accounting of disclosures of your PHI. On  your request, I will discuss with you the details of the accounting process.  

  • Right to Choose Someone to Act for You – If someone is your legal guardian, that person can exercise your  rights and make choices about your health information; I will make sure the person has this authority and can act for  you before I take any action.  

  • Right to Choose – You have the right to decide not to receive services with me. If you wish, I will provide you with  names of other qualified professionals.  

  • Right to Terminate – You have the right to terminate therapeutic services with me at any time without any legal  or financial obligations other than those already accrued. I ask that you discuss your decision with me in session  before terminating or at least contact me by phone letting me know you are terminating services.

  • Right to Release Information with Written Consent – With your written consent, any part of your record can be  released to any person or agency you designate. Together, we will discuss whether or not I think releasing the  information in question to that person or agency might be harmful to you.  

Therapist's Duties:  

I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy  practices with respect to PHI. 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. If I  revise my policies and procedures, I will provide you with a revised notice in office during session.  

COMPLAINTS  

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to  your records, you may contact me, the Minnesota Board of Behavioral Health and Therapy, or State of Minnesota  Department of Health.