THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1) MY PLEDGE REGARDING HEALTH INFORMATION:

a) I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Sound Mind Therapy, LLC. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

i) Make sure that protected health information (PHI) that identifies you is kept private.

ii) Give you this notice of my legal duties and privacy practices with respect to health information.

iii) Follow the terms and the notice that is currently in effect.

iv) I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office and/or on my website.

2) HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

a) The following categories describe different ways that I use and disclose health information. For each category of uses and disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed, however, all the ways I am permitted to use and disclose information will fall within one of the categories.

b) For treatment payment or health care operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment of activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

c) Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from on health care provider to another.

d) Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

3) CERTAIN USES AND DISCLOSES REQUIRE YOUR AUTHORIZATION:

a) Psychotherapy notes: I do keep “psychotherapy notes” as that term is defined in 45 CFR 164.501, and any use or disclosure of such notes requires you authorization unless the use or disclosure is:

i) For my use in treating you.

ii) For my use is training or supervising mental health practitioners to help them improve their skills in group, joint, family or individual counseling or therapy.

iii) For my use in defending myself in legal proceedings instituted by you.

iv) For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.

v) Required by law and the use or disclosure is limited to the requirements of such law.

vi) Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

vii) Required by a coroner who is performing duties authorized by law.

viii) Required to help avert a serious threat to the health and safety of others.

b) Marketing purposes: As a counselor, I will not use or disclose your PHI for marketing purposes.

c) Sales of PHI: As a counselor, I will not sell your PHI in the regular course of business.

4) CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your authorization for the following reasons:

a) When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

b) For public health activities, including reporting suspected child, elder, or dependent adult abuse or preventing or reducing a serious threat to anyone’s health or safety.