Notice of Privacy Practice
Child and Family Psychological Services
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
Child and Family Psychological Services
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
The Health Insurance Portability and Accountability Act of 1996 ("HIPAA") is a federal program the requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or verbally, are kept properly confidential. This Act gives you, the client, significant new rights to understand and control how your health information is used. "HIPPA" provides penalties for covered entities that misuse personal health information.
As required by "HIPPA", we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes:
As required by "HIPPA", we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes:
TREATMENT
PAYMENT
HEALTH CARE OPERATIONS
PAYMENT
HEALTH CARE OPERATIONS
We may also create and distribute de-identified health information by removing all references to individually identifiable information We can use de-identified information for in-house analyses and research.
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.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
We are required by law to maintain the privacy of your protected health information and to provice you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of April 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
If you or your child is court ordered to participate in therapeutic or evaluative services at Child & Family Psychological Services, your confidentiality is limited. Therapists and/or evaluators may be required to disclose personal health information to the Court.
You have recourse if you feel that your privacy portections have been violated. You have the right to file written complaint with our office, or with the Department of Health & Human Services, Office of Civil Rights, about the violations of the provisions of this notice or the policies and procedures of this office We will not retaliate against you for filing a complaint.
Please contact us for more information.
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.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
We are required by law to maintain the privacy of your protected health information and to provice you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of April 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
If you or your child is court ordered to participate in therapeutic or evaluative services at Child & Family Psychological Services, your confidentiality is limited. Therapists and/or evaluators may be required to disclose personal health information to the Court.
You have recourse if you feel that your privacy portections have been violated. You have the right to file written complaint with our office, or with the Department of Health & Human Services, Office of Civil Rights, about the violations of the provisions of this notice or the policies and procedures of this office We will not retaliate against you for filing a complaint.
Please contact us for more information.
For more information about HIPAA or to file a complaint contact:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775