Notice of Privacy Practices
Debra K Walker, LMFT
This notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please read it carefully.
I am required by applicable federal and state law to maintain the privacy of your health information. I am also required to give you this notice about my privacy practices, legal obligations, and your rights concerning you information (“Protected Health Information” or “PHI”.) I must follow the privacy policies in this notice (which may be amended from time to time.) For more information about my privacy practices, or for additional copies of this notice, please contact me.
Uses and Disclosers of Protected Health Information
For Treatment. Your PHI may be used and disclosed by those involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. I ask you to sign a Release of Information before I consult with other health care professionals. I cannot disclose PHI to any other health care professional without your authorization.
For Payment. I may use and disclose PHI so I can receive payment for treatment and services provided to you. This will be done only with your written authorization. This includes filing for insurance benefits and processing claims. If it becomes necessary to use collection processes due to the lack of payment, I will disclose only the minimum amount of PHI necessary for purposes of collection.
For Health Care Options. I may use or disclose your PHI to support my business activities including, but not limited to, quality assessment activities, licensing, and credentialing. I may share your PHI with third parties that perform various business activities (i.e. accounting or billing services) provided I have a written consent with the business that requires it to safeguard the privacy of your PHI. This includes utilizing Electronic Health Records with Therapy Appointment.
Required by Law. Under the law, I must disclose your PHI to you upon request. In addition, we must disclose to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with requirements of the Privacy Rule.
Without Authorization. Applicable law and ethical standards permit disclosure or information about you without your authorization only in a limited number of other situations. Types of uses and disclosures that may be made without your authorization are as follows:
Required by Law or mandatory Government Agency audits or investigations.
Required by Court Order.
Necessary to prevent or lessen a serious and imminent threat to the health and safety
of a person or the public. If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
If you are a minor, information regarding illegal or harmful acts may be disclosed to parent or guardian.
Verbal Permission. I may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
With Authorization. Uses and disclosures are not specifically permitted by applicable law will be made only with your written authorization. You have the right to revoke your authorization any time by writing me with your request.
Litigation Limitation. Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as but not limited to, divorce and custody disputes, injuries, lawsuits, etc ) neither you nor your attorney, nor anyone else acting on your behalf will call Debra Walker to testify in court or at any other proceeding, nor will a disclosure of the psychological records be requested.
Your Rights Regarding Your PHI. You have the following rights regarding PHI I maintain about you. To exercise any of these rights, please submit your request in writing to me.
Right to Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Restrictions apply only in those situations where compelling evidence indicates that access would cause serious harm to you. If you are a parent or legal guardian of a minor, please know that certain portions of the minor’s record will not be accessible to you. I may charge a reasonable, cost-based fee for copies.
Right to Amend. If you feel the PHI I have about you is incorrect or incomplete, you may ask me to amend the information although I am not required to agree to the amendment.
Right to an Accounting of Disclosures. You may obtain an accounting of certain disclosures of PHI made by me after December 1, 2009. This right applies to disclosures other than those already mentioned.
Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. I am not required to agree to any restriction at your request.
Right to Request Accounting of Disclosures. You have the right to request that I communicate with you about medical matters in a certain way or at a certain location.
Right to a Copy of the Notice. You have the right to a paper copy of this notice. Questions and Complaints.
If you desire further information about your privacy rights or are concerned that I have violated your privacy rights, you may contact me. You may also file a written complaint with the Director, Office of Civil Rights of the U.S. Department of Health and Human Services. I will not retaliate against you if you file a complaint with the Director or me.
Effective Date and Changes to this Notice.
This notice is effective September 27, 2017. I may modify the terms of this notice at any time. If I modify this notice, I will make the new notice terms effective for all PHI that I maintain, including any information created or received prior to issuing the new notice. You may obtain any revised notice by contacting me.