Notice of Privacy Practices
Effective Date: January 3, 2022
This Notice of Privacy Practices describes how health information may be used and disclosed by Ashley E Allen, LCSW, and how you can access this information. Please review this policy carefully.
I. Pledge Regarding Health Information:
I understand that health information about you and your healthcare is personal. I am committed to protecting your health information and maintaining its confidentiality. As a mental health care practice, I generate records of the care and services you receive from me, which are essential for providing quality care and complying with legal requirements. This notice applies to all records of your care created by this practice. It explains how I may use and disclose your health information, your rights regarding this information, and my obligations in its use and disclosure. I am legally obligated to:
● Ensure that your protected health information (PHI) is kept private.
● Provide you with this notice, explaining my legal duties and privacy practices regarding health information.
● Adhere to the terms of the currently effective notice.
I reserve the right to modify the terms of this Notice, and any changes will apply to all the information I have about you. The updated Notice will be available upon request, in my office, and on my website.
II. Use and Disclosure of Health Information:
The following categories describe how I may use and disclose your health information. While not every use or disclosure will be listed, all actions fall within these categories:
1. Treatment, Payment, and Health Care Operations: As allowed by federal privacy regulations, I may use or disclose your personal health information without written authorization for treatment, payment, or health care operations. This includes coordinating and managing your health care, consultations between providers, and referrals to other health care professionals.
2. Lawsuits and Disputes: In the event of a lawsuit, I may disclose your health information in response to a court or administrative order. If your child’s health information is involved in a legal dispute, I may disclose it in response to a subpoena or discovery request, after making efforts to inform you about the request or seeking a protective order.
III. Authorization Requirements:
Certain uses and disclosures of your health information require your explicit authorization. These include:
1. Psychotherapy Notes: I maintain psychotherapy notes, which necessitate your authorization for any use or disclosure. However, authorization is not required for treatment, training, legal defense, investigation by the Secretary of Health and Human Services, disclosure required by law, certain health oversight activities, duties performed by a coroner, or in response to a serious threat to public health and safety.
2. Marketing Purposes: I do not use or disclose your PHI for marketing purposes.
3. Sale of PHI: I do not sell your PHI as part of my regular business operations.
IV. Uses and Disclosures without Authorization:
Within the limits of the law, I may use and disclose your PHI without your authorization for the following reasons:
1. Compliance with State or Federal Law: When disclosure is mandated by state or federal law, and the use or disclosure adheres to the relevant requirements.
2. Public Health Activities: Reporting suspected abuse of children, elders, or dependent adults, or preventing and reducing serious threats to public health and safety.
3. Health Oversight Activities: Conducting audits and investigations related to health care.
4. Judicial and Administrative Proceedings: Responding to court or administrative orders, although obtaining your authorization is preferred.
5. Law Enforcement Purposes: Reporting crimes that occur on the premises.
6. Coroners and Medical Examiners: Disclosing health information to authorized individuals performing their duties.
7. Research Purposes: Studying and comparing the mental health of patients who received different forms of therapy.
8. Specialized Government Functions: Ensuring proper execution of military missions, protecting the President of the United States, conducting intelligence or counter-intelligence operations, and ensuring safety within correctional institutions.
9. Workers’ Compensation: Providing your PHI to comply with workers’ compensation laws, even without your authorization.
10. Appointment Reminders and Health-Related Communications: Using and disclosing your PHI to remind you of appointments and inform you about treatment alternatives, health care services, or benefits.
V. Right to Object:
You have the opportunity to object to certain uses and disclosures of your PHI. Specifically:
1. Disclosures to Family, Friends, or Others: I may provide your PHI to individuals involved in your care or payment for your care, unless you object. In emergency situations, the opportunity to object may be obtained retrospectively.
VI. Your Rights:
You have the following rights regarding your PHI:
1. Requesting Limits on Uses and Disclosures: You can ask me not to use or disclose specific PHI for treatment, payment, or health care operations. While I am not required to comply, I will consider your request.
2. Requesting Restrictions on Out-of-Pocket Expenses: You may request restrictions on disclosing PHI to health plans for payment or health care operations if you have paid for the service out-of-pocket in full.
3. Choosing the Method of Communication: You can request to be contacted through specific means or at alternative addresses.
4. Accessing and Obtaining Copies of Your PHI: With the exception of psychotherapy notes, you have the right to request electronic or paper copies of your medical records. I will provide the requested information within 30 days of receiving your written request, and a reasonable, cost-based fee may apply.
5. Requesting an Accounting of Disclosures: You can request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations. I will respond to your request within 60 days, and the list will cover the previous six years, unless you request a shorter timeframe. While the initial list is provided at no cost, subsequent requests may incur a reasonable fee.
6. Correcting or Updating Your PHI: If you believe there is an error or missing information in your PHI, you can request its correction or addition. I will respond to your request within 60 days and provide a written explanation if I am unable to fulfill it.
7. Obtaining a Paper or Electronic Copy of this Notice: You have the right to receive a paper copy of this Notice, even if you agreed to receive it electronically.
Acknowledgment of Receipt of Privacy Notice:
By signing below, you acknowledge that you have received a copy of the HIPAA Notice of Privacy Practices, which outlines your rights regarding the use and disclosure of your protected health information.
By signing this document, you confirm that you have read, understood, and agreed to the contents outlined herein.