Privacy Policy

Your privacy is very important to me, and to the work we do, and will be treated with the utmost respect and consideration. I understand that the information you share is personal and I am committed to protecting that information to the greatest extent allowable. Information that you share in session will be handled with great care. I respect and understand that the information you share with me is personal and I am committed to protecting any and all information that you share with me about yourself, your child and/or your family.

RECORDS

I create a record of the therapy and services you and/or your child receive here. The information contained in the record is necessary to provide you with quality care. This information is also required to comply with certain legal requirements as well as for insurance purposes. Individually identifiable information about your past, present, or future condition, the provision of therapy services to you or the payment for the services is considered protected health information. Whenever possible, protected information contained in your record (or your child’s record) remains private. In some circumstances, it is necessary for me to share some of the protected information contained in your record. In all but certain circumstances, which are described here, I will share only the minimum necessary protected information to accomplish the intended purpose of the disclosure.

The Law Requires Me To:

Make sure health/mental health information that identifies you is kept private

Provide you with a notice of your rights to privacy of health/mental health information and my privacy practices

Follow the practices that are provided to you in the notice

HOW I MAY USE AND/OR DISCLOSE HEALTH/MENTAL HEALTH INFORMATION ABOUT YOU

In most situations I must have a written authorization to release information about you. There are times when the law does not require me to obtain your authorization. The following instances do not require a written and signed authorization. All other circumstances not described here must have a written and signed authorization to release information.

Situations That Do Not Require A Signed Authorization:

For Treatment: I may use/disclose information about you (your child) to provide you with psychotherapy treatment or services, such as development of a treatment plan. For Payment: I may use and disclose your (or your child’s) health/mental health information in order to bill and collect payment (from you, your insurance company, or another third party) for services that I provide to you and/or your family. For example, I may provide information about your diagnosis and type of services you (or your child) are receiving to your private insurer in order to be reimbursed for services.

For Practice Operations: I may us/disclose you (your child’s) health/mental health information in the course of operating my practice. For example, I may utilize a service to oversee the billing and records of my practice.

Appointment Reminders: I may contact you as a reminder that you have an appointment. I may also notify you of a change in your appointment. For example, if you (or your child) have an appointment with me I may call you the day before as a reminder. Unless you provide other instructions, I may leave a message on your answering machine. Please inform me if you do not wish to receive appointment reminders.

Oversight Activities, Utilization Management and Peer Review: I may disclose certain information about you to your insurance provider or other health oversight agency for oversight of service activities that are authorized by law. These activities may include audits, investigations, inspections, utilization management and peer reviews and licensure. These activities are necessary for the monitoring of the services that I provide and compliance with civil rights laws. Consultation with other professionals: On occasion, I find it helpful to consult with other professionals regarding particular issues that come up in my work with clients. I take measures to avoid revealing the identity of any client in these situations. The consultant is legally bound to keep the information confidential as well. In most cases, it will not be necessary for me to discuss these consultations with you. You may request to be informed if any outside consultation occurs.

When Required By Law: I may use or disclose health/mental health information about you or your child when a law requires that I report information about suspected child, elder or dependent adult abuse or neglect. I may also use or disclose information about you or your child when there is a court order. I must disclose information to authorities that monitor compliance with these privacy requirements. I may disclose protected information about you in the course of a judicial or administrative proceeding in response to a legal order or other lawful process. I may disclose information about you or your child to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or subpoena. I may disclose information about you or your child when required by any other law not listed here.

Specialized Government Functions: I may disclose you (your child’s) health/mental health information to special units such as U.S. military or U.S. Department of State under certain circumstances. To Prevent A Threat to Safety: I may use or disclose information about you or your child in order to prevent a serious threat to the health or safety of you, your child, another person or the public. This may include disclosing information to someone who can reasonably prevent or lessen the threat of harm. For example, if a client threatens to harm him/herself, I might notify family members to keep them safe, or hospital personnel for evaluation of potential psychiatric hospitalization. These situations are sometimes referred to as Exceptions to confidentiality. In these situations I am legally required to take the necessary steps to protect others from harm, I may reveal information about you (your child).

• If there is an indication that a child, elderly person or a dependent adult is being abused, I must file a report with the appropriate agency.

• If a client has given an indication of a threat of harm to self, I am required to take steps to protect that individual. This may include initializing a hospitalization or contacting family members or others who could intervene and provide protection.

• If a client has indicated a threat to seriously harm another, I am required to take protective actions, which may include notifying the potential victim and the police as well as seeking hospitalization for the client to ensure safety.

• In some proceedings, involving child custody or in which your emotional condition is the subject, the court may order that I testify and/or reveal therapy records. However, in most judicial proceedings, you have the right to prevent me from providing any information about your treatment. If any of the situations mentioned above occur, I will make every effort to discuss it with you in detail before any action is taken, even though I am not legally required to do so.

Situations That Do Require A Signed Authorization:

All situations that do not fall into any of the above-described categories must have a written authorization signed by you in order for information to be disclosed. In these situations, you may revoke authorization at any time to stop future uses/disclosures. Your revocation does not affect those contacts that have already occurred and were previously authorized. I will ask that you sign a permission form that will authorize me to release or collect information in almost all situations that arise in the course of our work together.

YOUR RIGHTS TO PRIVACY:

You have the right to expect that information you share in the course of therapy and the associated records are kept private and confidential to the greatest extent allowable. The following is a list of your rights regarding the information that I keep in your record.

Right to review and copy: You have the right to view information that is contained in your (or your child’s) record, upon your written request. However, some mental health information may not be accessed for treatment reasons and for other reasons pertaining to California State law regarding confidentiality of mental health information. I will respond to your written request to view records within 5 working days of receiving your request. If I deny your access, I will provide written reasons for the denial and explain any right to have the denial reviewed. If you would like copies of your information, I must provide the copies within 15 days of receiving your request. A charge for copying, mailing and related expenses will apply. You have the right to choose what portions of your information you want copied. You have the right to have prior information on the cost of copying.

Right to Request limitations on the Disclosure/Use of Information: You have the right to ask that I limit the use and disclosure of your (your child’s) information. I will consider your request, but am not legally required to agree to the request. If I do agree to your request, I will provide you with a written notice to comply except in emergency situations. I cannot agree to limit uses and/or disclosures that are required by law. Any request to restrict disclosure/use of information must be in writing and signed by you. The request must include what information you wish to limit and to whom you want the limits to apply.

Right to Amend Record: You have the right to amend your record if you believe there is a mistake or missing information about your or your child. You may provide a written request to correct or add to the record. I will respond to your request within 60 days of receiving it. I may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition I may deny your request to amend information that is not my work; is not part of the information that keep in the record; is not part of the information which you would be permitted to view and copy; or is already accurate and complete.

 Right to be Informed of Disclosures: You have the right to be informed of disclosures, including when, to whom, purpose, and content of information disclosed. This applies to disclosures other than those made for purposes of payment. Please submit your request in writing. There may be a minimal charge for copy if frequent accounts of disclosures are needed.

Right to Request Confidential Communications: You have the right to make special requests for confidential communications. For instance you may request that I only contact you at home, or that any mail sent to your home does not have a return address. All requests must be in writing and provide specific details about your wish. I will accommodate all reasonable requests. Right to a Copy of this Notice: You have the right to receive a copy of this notice for your personal record and later review. You may ask for a copy of this notice at any time. I will provide you with a copy of the notice at our initial meeting.

CHANGES TO THIS NOTICE:

I reserve the right to change this notice at any time. I reserve the right to make the revised or changed notice effective for information I already have about you as well as information I receive in the future. I will provide you with a copy of the current notice and ask that you sign to show that you have received it. The notice will contain the effective date on the page that you sign. The effective date of this notice can be found on the first page in the top, right-hand corner.

COMPLAINTS:

If you think that your privacy rights have been violated you may file a complaint. All complaints must be submitted in writing. I will review and discuss with you. You may also file a complaint with the Secretary of the United States Department of Health and Human Services. You will not be penalized for filing a complaint.