HIPAA/Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION:
As a psychotherapy client, a record of your health information is sometimes provided to your therapist. This record contains information including, but not limited to:
Assessment and test results
Treatment plans/goals, and
This information, often referred to as your client record, serves as a basis for planning your care and treatment and serves as means of communication among the professionals who contribute to your care. I would also use your or your child’s health information for purposes of coordinating care and obtaining payment for treatment. I may exchange information with the physician or other professional who referred you to me. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, to better understand who, what, when, where and why others may access your health information, and helps you make informed decisions when authorizing disclosure to others.
North Carolina Statutes (APSM 45-1), Code of Federal Regulation rules 42, part 2; and 45 parts 160 and 164, and Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, require that written consent be given by the client or legally responsible party when disclosing confidential information. However, regarding releasing information without a client’s consent, NC Statute (ASPM 45-1) states the following:
“A provider who maintains client information shall give written notice to the client or client representative that disclosure may be made of pertinent information without his/her expressed authorization in situations in which disclosure is in the best interest of the client or interest of public safety.”
Examples of situations in which confidential information may be released without consent may include, but are not limited to the following:
Likelihood that the client will commit a felony or violent crime
It is deemed detrimental to the client not to release the information to other professionals who are acting on client’s behalf
The client poses an imminent danger to him/herself or others
YOUR HEALTH INFORMATION RIGHTS:
Although your health record is the physical property of your provider/therapist, the information ultimately belongs to you. You have the right to request a restriction on certain uses and disclosures of your information by communicating with your therapist. This includes the right to:
Obtain a paper copy of confidentiality policies upon request
Inspect and obtain a copy of your client record
Obtain an account of disclosures of your health information
Request communications of your health information by alternative means or at alternative locations
Revoke your authorization to use or disclose health information except to the extent that action has already been take
Request that I correct any inaccurate or incomplete information in your or your child’s records.
I am required to maintain privacy of your health information, and if requested, to provide you with a notice as to our legal duties and confidentiality practices with respect to information I collect and maintain about you. I cannot acknowledge our professional relationship with you or your child to any person, including your family and friends, without your written authorization or for one of the above stated exceptions. I am obligated by law to abide by the terms of this notice, to accommodate reasonable requests you may have to communicate client information by alternative means or at alternative locations, and to notify you if I am unable to agree to a requested restriction. I reserve the right to change confidentiality practices and to make subsequent new provisions effective for all confidential information I maintain. Should such practices change, you will be notified. I will not use or disclose confidential information without your authorization except as described in this notice.
If you have any questions or concerns, please let me know. If you feel your confidentiality rights have been violated, you can file a complaint with the Secretary of the United States Department of Health and Human Services or the governing board of the license I hold. Contact information is below.
US Department of Health and Human Services www.hhs.gov
200 Independence Ave SW 877-696-6775
Washington, DC 20201
NC Board of Licensed Professional Counselors www.ncblpc.org
Po Box 77819 844-622-3572 336-217-6007
Greensboro, NC 27529