NOTICE OF PSYCHOLOGIST’S POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION (HIPAA)

Laura Minch McLain, PsyD, BC-TMH

Resilient Living Counseling Center, LLC

P.O. Box 2833, Bangor, ME 04402

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION UNDER HIPAA LAWS.

PLEASE REVIEW IT CAREFULLY.

I. USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

I may use or disclose your Protected Health Information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:

 PHI refers to information in your health record that could identify you.

 Treatment is when I provide, coordinate, or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, including but not limited to your family physician, psychiatrist, neurologist, or another psychologist.

 Payment is when I obtain reimbursement for your healthcare. Examples of payment are when I disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

 Health Care Operations are activities that relate to the performance and operation of my practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

 Use applies only to activities within my office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

 Disclosure applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties.

II. USES AND DISCLOSURES REQUIRING AUTHORIZATION

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An authorization is written permission above and beyond the general consent that permits only specific disclosures. In those instances when I am asked for information for purposes outside of treatment, payment, and health care operations, I will obtain an authorization from you before releasing this information. You may revoke all such authorizations 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.

When using, disclosing or requesting PHI, I make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose of use, disclosure or request. I recognize that the requirement also applies to covered entities meet the standard. The minimum necessary requirement does not apply to disclosures for treatment purposes or when I share information with a client. The requirement does not apply for uses and disclosures when client authorization is given. It does not apply for uses and disclosures as required by law or to uses and disclosures that are required for compliance with the Privacy Rule.

Psychotherapy Notes – which are stored separately from the rest of your medical record – are my personal, private notes which I make about our conversations during an individual, group, conjoint, or family therapy session, as well as during other forms of communication such as telephone conversations or via email messages. Psychotherapy Notes exclude session start and stop times, frequencies of treatment, modalities of treatments, results of clinical tests and examinations, medication prescription and monitoring, and any summary of the following information: diagnosis, prognosis, symptoms, functional status, treatment plan, and progress to date. These exclusions are contained in what psychologists traditionally refer to as Progress Notes. Unlike Psychotherapy Notes, which are given a greater degree of protection than PHI, Progress Notes fall under regular PHI.

III. USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION

I may use or disclose PHI without your consent or authorization in the following circumstances:

 Serious Threat to Health or Safety: If I determine, or pursuant to the standards of my profession should determine, that you present a serious danger of violence to yourself or another, I may disclose information in order to provide protection against such danger for you or the intended victim.

 Child Abuse: If, in my professional capacity, a child comes before me which I have reasonable cause to suspect is an abused or maltreated child, or I have reasonable cause to suspect a child is abused or maltreated where the parent, guardian, custodian, or other person legally responsible for such child comes before me in my professional or official capacity and states from personal knowledge facts, conditions, or circumstances which, if correct, would render the child an abused or maltreated child, I must report such abuse or maltreatment to the statewide central register of child abuse and maltreatment, or the local child protective services agency.

 Adult and Domestic Abuse: If I have reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, I must report that belief to the appropriate authority.

 Health Oversight: If there is an inquiry or complaint about my professional conduct to the Georgia State Board of Examiners of Psychologists, I may be required to disclose your confidential mental health records in proceedings before the Board.

 Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that I have provided you and/or the records thereof, such information is privileged under state law, and I must not release this information without your written authorization or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. I must inform you in advance if this is the case.

 Worker’s Compensation: I may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.

IV. CLIENT'S RIGHTS AND CLINICIAN’S DUTIES

CLIENT’S RIGHTS:

 Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. Although I am not required by law to agree to a restriction you request, I will make reasonable efforts to cooperate with your request within the limits of the law and in accordance with the Ethical Principals of Psychologists (American Psychological Association, 2002).

 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. (E.g., you may not want a family member to know that you are seeing me; therefore, upon your request, I will send your bills to another address.)

 Right to Inspect and Copy: You have the right to inspect and/or obtain a copy of PHI 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 you 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 of the request and denial process).

 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.

 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 as described in Section III of this Notice. (On your request, I will discuss with you the details of the accounting process).

 Right to a Paper Copy: You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

MY 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 contact you by telephone or mail if there is ever a request or cause for disclosure of your PHI. For this purpose, please update addresses and telephone numbers as needed.

V. 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 via US mail at 814 Mimosa Boulevard, Building C, Roswell, GA 30075. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. I will not retaliate against you for exercising your right to file a complaint.

VI. RESTRICTIONS

I will limit the uses or disclosures that I will make as follows:

 I will not release the contents of Psychotherapy Notes under any circumstances with the following exceptions:

o If you file a lawsuit or ethics complaint against me, I may release Psychotherapy Notes for use in my defense.

o When the following Uses and Disclosures with Neither Consent nor Authorization (Section III of The Notice, above) apply:

 Child Abuse (suspected and/or actual)

 Adult and Domestic Abuse

 Health Oversight

 Judicial or Administrative Proceedings

 Serious Threat to Health or Safety (NOTE: I reserve the right to make a use or disclosure that is required by law or, when in good faith, to use or disclose to avert a serious threat to health or safety of a person or the public and such use or disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat).

No Surprises Act