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Under the federal Health Insurance Portability and Accountability Act (HIPAA), health plans and practitioners are required to take special measures or create specific practices to protect patients’ protected health information (known by the acronym PHI). This must be done by mid-April 2003. The posting here is a copy of a handout, "Policies and Practices to Protect the Privacy of Your Health Information," which I am providing my patients when they contract with me.
This copy of Policies and Practices will help you understand how I protect clients' privacy when I collect and/or use their health information, and the measures I take to safeguard that information.
OF JEFFREY S. KAYE, PH.D.
CALIFORNIA LICENSE NO. PSY 15476
NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
use or disclose your protected health
information (PHI), for certain treatment,
payment, and health care operations purposes without your authorization.
In certain circumstances I can only do so when the person or business requesting
your PHI gives me a written request that includes certain promises regarding
protecting the confidentiality of your PHI. To help clarify these terms, here
are some definitions:
refers to information in your health record that could identify you.
and Payment Operations”
is when I provide or another healthcare provider diagnoses or treats you. An
example of treatment would be when I consult with another health care provider,
such as your family physician or another psychologist, regarding your treatment.
Payment is when I obtain reimbursement for your healthcare. Examples
of payment are when I disclose your PHI to your health insurer to obtain
reimbursement for your health care or to determine eligibility or coverage.
applies only to activities within my office, such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you.
applies to activities outside of my office, such as releasing, transferring, or
providing access to information about you to other parties.
means written permission for specific uses or disclosures.
use or disclose PHI for purposes outside of treatment, payment, and health care
operations when your appropriate authorization is obtained. In those instances
when I am asked for information for purposes outside of treatment and payment
operations, I will obtain an authorization from you before releasing this
information. I will also need to obtain an authorization before releasing your
psychotherapy notes. “Psychotherapy
notes” are notes I have made about our conversation during a private,
group, joint, or family counseling session, which I have kept separate from the
rest of your medical record. These notes are given a greater degree of
protection than PHI.
may revoke or modify all such authorizations (of PHI or psychotherapy notes) at
any time; however, the revocation or modification is not effective until I
use or disclose PHI without your consent or authorization in the following
I, in my professional capacity, have knowledge of or observe a child I know or
reasonably suspect, has been the victim of child abuse or neglect, I must
immediately report such to a police department or sheriff’s department, county
probation department, or county welfare department (Child Protective Services).
Also, if I have knowledge of or reasonably suspect that mental suffering has
been inflicted upon a child or that his or her emotional well-being is
endangered in any other way, I may report such to the above agencies.
and Domestic Abuse: If
I, in my professional capacity, have observed or have knowledge of an incident
that reasonably appears to be physical abuse, abandonment, abduction, isolation,
financial abuse or neglect of an elder or dependent adult, or if I am told by an
elder or dependent adult that he or she has experienced these or if I reasonably
suspect such, I must report the known or suspected abuse immediately to
the local ombudsman or the local law enforcement agency.
do not have to report such an incident if:
1) I have been told by an elder or dependent adult that he or she has experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse or neglect;
2) I am not aware of any independent evidence that corroborates the statement that the abuse has occurred;
3) the elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia; and
in the exercise of clinical judgment, I reasonably believe that the abuse did
Oversight: If a
complaint is filed against me with the California Board of Psychology, the Board
has the authority to subpoena confidential mental health information from me
relevant to that complaint.
If you are
involved in a court proceeding and a request is made about the professional
services that I have provided you, I must not release your information without
1) your written authorization or the authorization of your attorney or personal
representative; 2) a court order; or 3) a subpoena duces tecum (a subpoena to
produce records) where the party seeking your records provides me with a showing
that you or your attorney have been served with a copy of the subpoena,
affidavit and the appropriate notice, and you have not notified me that you are
bringing a motion in the court to quash (block) or modify the subpoena.
The privilege does not apply when you are being evaluated for a third
party or where the evaluation is court-ordered. I will inform you in advance if
this is the case.
Threat to Health or Safety: If
you communicate to me a serious threat of physical violence against an
identifiable victim, I must make reasonable efforts to communicate that
information to the potential victim and the police. If I have reasonable cause
to believe that you are in such a condition, as to be dangerous to yourself or
others, I may release relevant information as necessary to prevent the
If you file a worker's compensation claim, I must furnish a report to your
employer, incorporating my findings about your injury and treatment, within five
working days from the date of the your initial examination, and at subsequent
intervals as may be required by the administrative director of the Worker’s
Compensation Commission in order to determine your eligibility for worker’s
to Request Restrictions –You
have the right to request restrictions on certain uses and disclosures of
protected health information about you. However, I am not required to agree to a
restriction you request.
to Receive Confidential
Communications by Alternative Means and at Alternative Locations –
You have the right to request and receive confidential communications of PHI
by alternative means and at alternative locations. (For example, you may not
want a family member to know that you are seeing me. Upon your request, I will
send your bills or correspondence to another address.)
to Inspect and Copy –
You have the right to inspect or obtain a copy (or both) of PHI in my mental
health and billing records used to make decisions about you for as long as the
PHI is maintained in the record. I may deny your access to PHI under certain
circumstances, but in some cases you may have this decision reviewed. On your
request, I will discuss with you the details of the request and denial process.
to Amend –
You have the right to request an amendment of PHI for as long as the PHI is
maintained in the record. I may deny your request. On your request, I will
discuss with you the details of the amendment process.
to an Accounting
– You generally have the right to receive an accounting of disclosures of PHI
for which you have neither provided consent nor authorization (as described in
Section III of this Notice). On your request, I will discuss with you the
details of the accounting process.
to a Paper Copy –
You have the right to obtain a paper copy of the notice from me upon request,
even if you have agreed to receive the notice electronically.
required by law to maintain the privacy of PHI and to provide you with a notice
of my legal duties and privacy practices with respect to PHI.
the right to change the privacy policies and practices described in this notice.
Unless I notify you of such changes, however, I am required to abide by the
terms currently in effect.
If I revise
my policies and procedures, I will provide you with a revised notice by mail or
in person and in writing within 7 days of such change in notice, if at all
you are concerned that I have violated your privacy rights, or you disagree with
a decision I made about access to your records, you may contact the Board of
Psychology, 1422 Howe Ave., #22, Sacramento, CA 95825-3200, telephone
may also send a written complaint to the Secretary of the U.S. Department of
Health and Human Services, 200 Independence Avenue,
S.W., Washington, D.C. 20201, telephone: 202-619-0257 or toll free:
Notice of any future restriction to this notice or of change will be posted promptly within 14 days of such change.
This notice goes into effect on April 14, 2003.
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