Tom Edwards, LCSW
NOTICE OF PRIVACY PRACTICES (HIPPA) *PLEASE PRINT AND KEEP
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.
PROTECTED HEALTH INFORMATION
Information about your health is private. And it should remain private. Tom Edwards is required by federal and state law to protect the privacy of your health information. We call it:
“PROTECTED HEALTH INFORMATION” (PHI)
Tom Edwards must follow legal regulations with respect to:
How we use your PHI
Disclosing your HI to others
Your Privacy Rights
Office contacts for more information or, if necessary, a complaint
USING OR DISCLOSING YOUR PHI
FOR PAYMENT
After providing treatment, we will ask your insurer to pay their fee as appropriate. Some of your PHI will be entered into my computers in order to track sessions and payments. This may include a description of your health problem and the treatment I provided. If you choose to request out of network benefits from your insurance company, I will be required to release information as to session types and diagnoses.
SPECIAL USES
1) Remind you of an appointment
2) Tell you about other health benefits and services
YOUR WRITTEN AUTHORIZATION MAY BE REQUIRED
We may use or disclose your PHI for treatment, payment or health care operations or as required or as permitted by law. We will ask you for authorization with specific instructions and limits on our use or disclosure of your PHI. You may revoke this authorization at any time.
REQUIRED OR PERMITTED USES
1. We may use your PHI in an emergency when you are not able to express yourself.
2. When required by law, when ordered by a Court.
YOUR PRIVACY RIGHTS AND HOW TO EXERCISE THEM
· Right to Request Limited use or Disclosure
· Right to Confidential Communication
· Right to Revoke Your Authorization
· Right to Inspect and Copy
· Right to Amend Your PHI
These above requests need to be made to this Office in writing. We may refuse your request for limited use or disclosure or your request to inspect and copy your record, if we believe that doing so will cause you harm. Similarly, we may refuse your request to amend your PHI and you have a right to disagree in writing. This document will be filed with your medical record.
WHAT IF I HAVE A COMPLAINT?
If you believe that your privacy has been violated, you may file a complaint with us or with the Secretary of Health and Human Services in Washington, DC. We will not retaliate or penalize you for filing a complaint with this office or the Secretary.
SOME OF OUR PRIVACY OBLIGATIONS AND HOW WE FULFILL THEM
Federal health information privacy rules require us to give you notice of our privacy practices. This document is our notice. We will abide by the privacy practices set forth in this notice. However, we reserve the right to change this notice and our privacy practices when permitted or as required by law.