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.
What is "Medical Information"?
The term "medical information" is synonymous with the terms "personal health information" and "protected health information" for purposes of this Notice. It essentially means any individually identifiable health information (either directly or indirectly identifiable), whether oral or recorded in any form or medium, that is created or received by a health care provider (me), health plan, or others and 2) relates to the past, present, or future physical or mental health or condition of an individual (you); the provision of health care (e.g., mental health) to an individual (you); or the past, present, or future payment for the provision of health care to an individual (you). Elizabeth Sloan, LPC, LCPC is the Privacy Officer for this practice and directs the creation and maintenance of individually identifiable health information about clients. These records are generally referred to as "medical records" or "mental health records," and this notice, among other things, concerns the privacy and confidentiality of those records and the information contained therein.
Uses and Disclosures without Your Authorization - For Treatment, Payment, or Health Care Operations
Federal privacy rules allow health care providers who have a direct treatment relationship with the patient to use or disclose the patient’s personal health information, without the patient’s written authorization, to carry out the health care provider’s own treatment, payment, or health care operations. Health care providers may also disclose your protected health information for the treatment activities of any health care provider working in cooperation for your benefit. This too can be done without your written authorization.
An example of a use or disclosure for treatment purposes: If a mental health provider decides to consult with another licensed health care provider about your condition, he or she would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist in your diagnosis or treatment. Disclosures for treatment purposes are not limited to the minimum necessary standard, because physicians and other health care providers may need access to the full record and/or full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care among health care providers or by a health care provider with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.
An example of a use or disclosure for payment purposes: If your health plan requests a copy of your health records, or a portion thereof, in order to determine whether or not payment is warranted under the terms of your policy or contract, health care providers are permitted to use and disclose your personal health information.
An example of a use or disclosure for health care operations purposes: If your health plan decides to audit this practice in order to review performance or to detect possible fraud or abuse, your mental health records may be used or disclosed for those purposes.
PLEASE NOTE: We may contact you to provide appointment reminders or information about treatment alternatives
or other health-related benefits and services that may be of interest to you. These communications may be in printed,
faxed, or e-mail format. Your prior written authorization is not required for such contact.
Other Uses and Disclosures without Your Authorization:
We may be required or permitted to disclose your personal health information (e.g., your mental health records)
without your written authorization. The following circumstances are examples of when such disclosures may or will be
made:
1) If disclosure is compelled by a court pursuant to an order of that court.
2) If disclosure is compelled by a board, commission, or administrative agency for purposes of adjudication
pursuant to its lawful authority.
3)If disclosure is compelled by a party to a proceeding before a court or administrative agency pursuant to a
subpoena, subpoena duces tecum (e.g., a subpoena for mental health records), notice to appear, or any
provision authorizing discovery in a proceeding before a court or administrative agency.
4) If disclosure is compelled by a board, commission, or administrative agency pursuant to an investigative
subpoena issued pursuant to its lawful authority.
5) If disclosure is compelled by an arbitrator or arbitration panel, when arbitration is lawfully requested by either
party, pursuant to a subpoena duces tecum (e.g., a subpoena for mental health records), or any other
provision authorizing discovery in a proceeding before an arbitrator or arbitration panel.
6) If disclosure is compelled by a search warrant lawfully issued to a governmental law enforcement agency.
7) If disclosure is compelled by the patient or the patient’s representative pursuant to state law or corresponding
federal statutes or regulations (e.g., the federal "Privacy Rule," which requires this Notice).
8) If disclosure is compelled because of mandatory reporting requirements for suspected child abuse or neglect.
9) If disclosure is compelled because of mandatory reporting requirements for suspected elder abuse neglect,
or dependent adult abuse or neglect.
10) If disclosure is compelled or permitted by the fact that the client is in such mental or emotional condition as to
be dangerous to himself or herself, or to the person or property of others, and if disclosure is necessary to
prevent the threatened danger.
11) If disclosure is compelled or permitted by the fact that you disclose a serious threat (imminent) of physical
violence to be committed by you against a reasonably identifiable victim or victims.
12) If disclosure is compelled or permitted, in the event of your death, to the coroner in order to determine the
cause of your death.
13) As indicated above, we are permitted to contact you without your prior authorization to provide appointment
reminders or information about alternatives or other health-related benefits and services that may be of
interest to you. Be sure to let us know where and by what means (e.g., telephone, letter, email, fax) you
prefer to be contacted.
14) If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law,
including but limited to, audits, criminal or civil investigations, or licensure or disciplinary actions.
15) If disclosure is compelled by the U. S. Secretary of Health and Human Services to investigate or determine
compliance with privacy requirements under the federal regulations (the “Privacy Rule”).
16) If disclosure is otherwise specifically required by law.
PLEASE NOTE: The above list is not an exhaustive list, but informs you of most circumstances when disclosures
without your written authorization may be made. Other uses and disclosures will generally (but not always) be made
only with your written authorization, even though federal privacy regulations or state law may allow additional uses or
disclosures without your written authorization. Uses or disclosures made with your written authorization will be limited
in scope to the information specified in the authorization form, which must identify the information “in a specific and
meaningful fashion.” You may revoke your written authorization at any time, provided that the revocation is in writing
and except to the extent that action has been taken in reliance on your written authorization. Your right to revoke an
authorization is also limited if the authorization was obtained as a condition of obtaining insurance coverage for you.
If state law protects your confidentiality or privacy more than the federal “Privacy Rule” does, or if state law gives you
greater rights than the federal rule does with respect to access to your records, we will abide by state law. In general,
uses or disclosures of your personal health information (without your authorization) will be limited to the minimum
necessary to accomplish the intended purpose of the use or disclosure. Similarly, when requesting your personal
health information from another health care provider, health plan or health care clearinghouse, we will make an effort
to limit the information requested to the minimum necessary to accomplish the intended purpose of the request. As
mentioned above, in the section dealing with uses or disclosures for treatment purposes, the “minimum necessary”
standard does not apply to disclosures to or requests by a health care provider for treatment purposes because
health care providers need complete access to information in order to provide quality care.
Your Rights Regarding Protected Health Information
1) You have the right to request restrictions on certain uses and disclosures of protected health information
about you, such as those necessary to carry out treatment, payment, or health care operations. We are not
required to agree to your requested restriction. If we do agree, we will maintain a written record of the agreed
upon restriction.
2) You have the right to receive confidential communications of protected health information by alternative
means or at alternative locations.
3) You have the right to inspect and copy protected health information about you by making a specific request
to do so in writing. This right to inspect and copy is not absolute – in other words, we are permitted to deny
access for specified reasons. For instance, you do not have this right of access with respect to
“psychotherapy notes.” The term “psychotherapy notes” means notes recorded (in any medium) by a health
care provider who is a mental health professional documenting or analyzing the contents of conversation
during a private counseling session or a group, joint, or family counseling session and that are separated
from the rest of the individual’s medical (includes mental health) record. The term excludes medication
prescription and monitoring, counseling session start and stop times, the modalities and frequencies of
treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional
status, the treatment plan, symptoms, prognosis, and progress to date.
4) You have the right to amend protected health information in your records by making a request to do so in a
writing that provides a reason to support the requested amendment. This right to amend is not absolute – in
other words, we are permitted to deny the requested amendment for specified reasons. You also have the
right, subject to limitations, to provide a written addendum with respect to any item or statement in your
records that you believe to be incorrect or incomplete and to have the addendum become a part of your
record.
5) You have the right to receive an accounting of the disclosures of protected health information made in the six
years prior to the date on which the accounting is requested. As with other rights, this right is not absolute. In
other words, we are permitted to deny the request for specified reasons. For instance, we do not have to
account for disclosures made in order to carry out treatment, payment, or health care operations. We also do
not have to account for disclosures of protected health information that are made with your written
authorization, since you have a right to receive a copy of any such authorization you might sign.
6) You have the right to obtain a paper copy of this notice upon request.
PLEASE NOTE: In order to avoid confusion or misunderstanding, if you wish to exercise any of the rights
enumerated above, put your request in writing and deliver or send the writing to Caring Couples, Happy Lives. If
you wish to learn more detailed information about any of the above rights, or their limitations, please let us know.
We are willing to discuss any of these matters with you. As mentioned elsewhere in this document, Elizabeth
Sloan, LPC, LCPC is the Privacy Officer of this practice.
Our Duties
We are required by law to maintain the privacy and confidentiality of your personal health information. This notice is
intended to let you know of our legal duties, your rights, and our privacy practices with respect to such information.
We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of
this notice and/or our privacy practices and to make the changes effective for all protected health information that we
maintain, even if it was created or received prior to the effective date of the notice revision. If we make a revision to
this notice, we will make the notice available at our offices upon request on or after the effective date of the revision
and we will post the revised notice in a clear and prominent location.
As the Privacy Officer of this practice, Elizabeth Sloan, LPC, LCPC has a duty to develop, implement and adopt clear
privacy policies and procedures for this practice and these have been implemented and adopted. Elizabeth Sloan,
LPC, LCPC is the individual who is responsible for assuring that these privacy policies and procedures are followed
by any responsible persons bound by HIPAA that work or may work in the practice presently or in the future. We
have trained or will train any persons that may work in the practice so that they understand privacy policies and
procedures. In general, patient records, and information about patients, are treated as confidential and are released
to no one without the written authorization of the patient, except as indicated in this notice or except as may be
otherwise permitted by law. Patient records are kept secured so that they are not readily available to those who do
not need them.
Because Elizabeth Sloan, LPC, LCPC is the Contact Person of this practice, you may complain to her and to the
Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights may have been
violated. You may file a complaint by simply providing the Contact Person with a written document that specifies the
manner in which you believe the violation occurred, the approximate date of such occurrence, and any details that
you believe are pertinent. You may send such documents to
Elizabeth Sloan, LPC, LCPC
6008 Bell Station Rd.
Glenn Dale, MD 20769
(866) 588-0477
No one in this practice will retaliate against you in any way for filing a complaint with the Contact Person or with the
Secretary of Health of the United States. Complaints to the Secretary must be filed in writing.
A complaint to the Secretary can be sent to
U.S Department of Health and Human Services, Region III, Office for Civil Rights
150 S. Independence Mall West, Suite 372
Philadelphia, PA 19106-9111.
Main Line (215) 861-4441. Hotline (800) 368-1019. FAX (215) 861-4431. TDD (215) 861-4440.
If you need or desire further information related to this Notice or its contents, or if you have any questions about this
Notice or its contents, please feel free to contact Elizabeth Sloan, LPC, LCPC, who will answer your questions or
provide you with additional information.