HIPAA PRIVACY PRACTICES
I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
II. IT IS MY LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)
By law, I am required to insure that your PHI is kept private. The PHI constitutes information created or noted by Dina Taylor, LMFT that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of healthcare services to you or the payment for such healthcare.
I am required to provide you with this Notice about your privacy procedures.
This Notice must explain when, why, and how I might or would disclose
your PHI. PHI is disclosed when I release, transfer, give, or otherwise reveal it to
a third party outside of my practice. I will not disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is
made; however, I aam always legally required to follow the privacy practices described in this Notice.
III. DISCLOSURE OF YOUR PHI.
I might have the need to disclose your PHI for many different reasons. Some of the disclosures will require your prior written authorization; others, however, will not. Below you will find the different categories of our uses and disclosures, with some examples.
I may use and disclose your PHI with your consent for the following reasons:
1. For treatment purposes, I may ask to disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care. Example: If a psychiatrist is treating you, I may disclose your PHI to her/him in order
to coordinate your care.
PLEASE NOTE: Disclosures related to collection of payment, prior authorizations for treatment or insurance audits by your health care insurance, or emergency interventions Do Not Require Your Prior Written Consent.
Certain Other Uses and Disclosures Do Not Require Your Consent:
1. When disclosure is required by federal, state, or local law; judicial, board, or
administrative proceedings; or, law enforcement. Example: We may make a disclosure to the appropriate officials when a law requires me to report information to government agencies, law enforcement personnel and/or in an administrative proceeding.
2. If disclosure is compelled by a party to a proceeding before a court of an administrative agency pursuant to its lawful authority.
3. If disclosure is required by a search warrant lawfully issued to a governmental law enforcement agency.
4. If disclosure is compelled by the patient or the patient's representative pursuant to California Health and Safety Codes or to corresponding federal statutes of regulations, such as the Privacy Rule that requires this Notice.
5. To avoid harm. I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety of a person or the public (i.e., adverse reaction to medications).
6. If disclosure is compelled or permitted by the fact that you are in such mental or
emotional condition as to be dangerous to yourself or the person or property of others, and if I determine that disclosure is necessary to prevent the threatened danger.
7. If disclosure is mandated by the California Child Abuse and Neglect Reporting law. For example, if I have a reasonable suspicion of child abuse or neglect.
8. If disclosure is mandated by the California Elder/Dependent Adult Abuse Reporting law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse.
9. If disclosure is compelled or permitted by the fact that you tell your treatment provider of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.
10. For public health activities. Example: In the event of your death, if a disclosure is permitted or compelled, I may need to give the county coroner information about you.
11. For health oversight activities. Example: I may be required to provide information to assist the government in the course of an investigation or inspection of a health care organization or provider.
12. For specific government functions. Examples: I may disclose PHI of military personnel and veterans under certain circumstances. Also, I may disclose PHI in the interests of national security, such as protecting the President of the United States or assisting with intelligence operations.
13. For research purposes. In certain circumstances, I may provide PHI in order to conduct medical research.
14. For Workers' Compensation purposes. I may provide PHI in order to comply with Workers' Compensation laws.
15. Appointment reminders and health related benefits or services. Examples: I may use PHI to provide appointment reminders. I may use PHI to give you information about alternative treatment options, or other health care services or benefits I offer.
16. If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
17. If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law. Example: When compelled by U.S. Secretary of Health and Human Services to investigate or assess my compliance with HIPAA regulations.
18. If disclosure is otherwise specifically required by law.
Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to family, friends, or others. Your treatment provider may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
In any other situation not described above, I will request your written
authorization before using or disclosing any of your PHI. Even if you have signed an
authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that we haven't taken any action subsequent to the original authorization) of your PHI by myself.
In summary, most uses and disclosures of psychotherapy notes, marketing disclosures and sale of PHI do require prior authorization by you, and you have the right to be notified in case of a breach of unsecured PHI.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
These are your rights with respect to your PHI:
A. The Right to See and Get Copies of Your PHI. In general, you have the right to see your PHI that is in this therapist's possession, or to get copies of it; however, you must request it in writing. If I do not have your PHI, but we know who does, we will advise you how you can get it. You will receive a response from your within 30 days of my receiving your written request.
Under certain circumstances, I may deny your request, but if I do, I will give you, in writing, the reasons for the denial. This provider will also explain your right to have my denial reviewed. If you ask for copies of your PHI, I will charge you not more than $.25 per page. I may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.
B. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how we use and disclose your PHI. While I will consider
your request, I am not legally bound to agree. If I agree to your request, I will put those limits in writing and abide by them except in emergency situations. You do not have the right to limit the uses and disclosures that this Therapist is legally required or permitted to make.
C. The Right to Choose How I Send Your PHI to You. It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via email instead of by regular mail). Your treatment provider is obliged to agree to your request providing that I can give you the PHI, in the format you requested, without undue inconvenience. I may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.
D. The Right to Get a List of the Disclosures I Have Made. You are entitled to a list of disclosures of your PHI that your treatment provider has made. The list will not include uses or disclosures to which you have already consented, i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before April 15, 2003. After April 15, 2003, disclosure records will be held for six years. Your treatment provider will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list will include disclosures made in the previous six years unless you indicate a shorter period. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. Your treatment provider will provide the list to you at no cost, unless you make more than one request in the same year, in which case you will be charged a reasonable sum based on a set fee for each additional request.
E. The Right to Amend Your PHI. If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that your treatment provider correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of you treatment provider’s receipt of your request. Your treatment provider may deny your request, in writing, if your treatment provider finds that: the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of my records, or (d) written by someone other than the treatment provider. The denial must be in writing and must state the reasons
for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and my denial be attached to any future disclosures of your PHI. If we approve your request, your treatment provider will make the change(s) to your PHI. Additionally, your treatment provider will tell you that the changes have been made, and we will advise all others who need to know about the change(s) to your PHI.
F. The Right to Get This Notice by Email. You have the right to get this notice by email. You have the right to request a paper copy of it, as well.
HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES:
DINA TAYLOR License LMFT #28767
If, in your opinion, I may have violated your privacy rights, or if you object
to a decision I have made about access to your PHI, you are entitled to file
a complaint with the person listed in Section VI below. You may also send a written
complaint to the Secretary of the Department of Health and Human Services at 200
Independence Avenue S.W. Washington, D.C. 20201. If you file a complaint about Dina Taylor, LMFT, this treatment provider will take no retaliatory action against
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES:
If you have any questions about this notice or any complaints Dina Taylor's
privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact Dina Taylor at
VII. NOTIFICATIONS OF BREACHES:
In the case of a breach, your treatment provider is required to notify each affected
individual whose unsecured PHI has been compromised. Even if such a breach was caused. If the breach involves more than 500 persons, OCR must be notified in accordance with instructions posted on its website.
Dina Taylor, LMFT bears the ultimate burden of proof to demonstrate that all notifications were given or that the impermissible use or disclosure of PHI did not constitute a breach and must maintain supporting documentation, including documentation pertaining to the risk assessment.
VIII. PHI AFTER DEATH:
Generally, PHI excludes any health information of a person who has been deceased for more than 50 years after the date of death. I may disclose deceased
individuals' PHI to non-family members, as well as family members, who were involved in the care or payment for healthcare of the decedent prior to death; however, the disclosure must be limited to PHI relevant to such care or payment and cannot be inconsistent with any prior expressed preference of the deceased individual.
IX. Individuals' Right to Restrict Disclosures; Right of Access:
To implement the 2013 HITECH Act, the Privacy Rule is amended. Dina Taylor, LMFT is required to restrict the disclosure of PHI about you, the patient, to a health plan, upon request, if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law. The PHI must pertain solely to a healthcare item or service for which you have paid the covered entity in full.
The 2013 Amendments also adopt the proposal in the interim rule requiring any mental health provider to provide you, the patient, a copy of PHI if you, the patient, requests it in electronic form. The electronic format must be provided to you if it is readily producible. OCR clarifies that I must provide you only with an electronic copy of their PHI, not direct access to their electronic health record systems. The 2013 Amendments also give you the right to direct me to transmit an electronic copy of PHI to an entity or person designated by you. Furthermore, the amendments restrict the fees that I may charge you for handling and reproduction of PHI, which must be reasonable, cost-based and identify separately the labor for copying PHI (if any). Finally, the 2013 Amendments modify the timeliness requirement for right of access, from up to 90 days currently permitted to 30 days, with a one-time extension of 30 additional days.
EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on 7/1/2019
Acknowledgement of Receipt of Privacy Notice Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.