HIPAA Notice of Privacy Practices for Psychotherapy (Greenhouse)
I. 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 me that can be used to identify you. It includes data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such health care. I am required to provide you with this Notice about my privacy procedures. This Notice must explain when, why, and how I would use and/or disclose your PHI. Use of PHI means when I share, apply, utilize, examine, or analyze information within my practice; PHI is disclosed when I release, transfer, give, or otherwise reveal it to a third party outside my practice. With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made.
II. HOW I WILL USE AND DISCLOSE YOUR PHI.
Some of the uses or disclosures will require your prior written authorization; others, however, will not.
A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent.
I may use and disclose your PHI without your consent for the following reasons:
1. For treatment. I can use your PHI within my practice to provide you with mental health treatment, including discussing or sharing your PHI with my trainees and interns. I may 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.
2. For health care operations. I may disclose your PHI to facilitate the efficient and correct operation of my practice. Examples: Quality control - I might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. I may also provide your PHI to my attorneys, accountants, consultants, and others to make sure that I am in compliance with applicable laws.
3. To obtain payment for treatment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provided you. Example: I might send your PHI to your insurance company or health plan in order to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as my office assistant or bookkeeper to process health care claims for my office.
4. Other disclosures. Examples: Your consent isn't required if you need emergency treatment provided that I attempt to get your consent after treatment is rendered. In the event that I try to get your consent but you are unable to communicate with me but I think that you would consent to such treatment if you could, I may disclose your PHI.
B. Certain Other Uses and Disclosures Do Not Require Your Consent.
I may use and/or disclose your PHI without your consent or authorization for the following reasons:
1. When disclosure is required by federal, state, or local law.
2. If disclosure is compelled by a party to a proceeding before a court.
3. 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.
4. 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.
5. 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.
6. 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.
7. If disclosure is compelled or permitted by the fact that you tell me of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.
C. Other Uses and Disclosures Require Your Prior Written Authorization.
In any other situation 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 I haven't taken any action subsequent to the original authorization) of your PHI by me.
Informed Consent for Psychotherapy (Greenhouse)
Confidentiality
One of the powerful factors involved in developing a healing relationship is confidentiality. We will not disclose any information about the client to outside parties without the client’s or guardian’s explicit written request. However, the law requires that mental health professionals must release information without consent in the following situations: 1) if there is reason to suspect abuse of any child, elder, or dependent adult, 2) if the client is deemed a danger to self or others, 3) if a judge orders us to release client records to the court, or 4) if you have chosen to disclose the client’s mental state in a legal proceeding. Nevertheless, in order to protect the confidentiality of all treatment information, you need to agree that neither you nor your attorney will ask or subpoena me to testify in court or release your therapy records to an attorney or judge.
Minors, Couples, and Families
When minors are in therapy, we provide only general information to parents about the assessment, goals, methods, and progress of the treatment process. However, if a client may be at risk or in danger of harm, we will alert the parents or guardians of our concerns. In couple or family sessions where there are two or more participants attending conjoint therapy sessions regularly, all information shared by participants may be shared with everyone involved in treatment. If you are under eighteen years of age, the law provides your parents the right to review your written treatment records.
If you use insurance or any third party payer, we may be required to release information about your diagnosis, goals, progress, and treatment plan. We cannot guarantee the confidentiality of your information once we send it to your third party payer.