Privacy Policy
Notice of Privacy Practices-HIPAA
Sarah Hartman, LMHC
This notice describes how protected health information (PHI) about you may be used and disclosed and how you can access this information.
“PHI” refers to information in your health record that could identify you.
“Treatment, Payment and Health Care Operations”
• Treatment is when I provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist. o 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. o Health Care Operations are activities that relate to the performance and operation of my practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
• “Use” applies only to activities within my [office, clinic, practice group, etc.] such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
• “Disclosure” applies to activities outside of my [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to information about you to other parties.
• “Disclosure” applies to activities outside of my [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to information about you to other parties.
Our Contact
If you have any questions about this notice, please contact 716-218-0669.
Our Pledge Regarding Your Protected Health Information
I understand that your PHI is personal. I am committed to protecting the privacy of this information. Each time you visit my office, we create a record of the care and services you receive. We need this record to provide you with quality care, and comply with certain legal requirements. This notice applies to all records of your care generated by this office. This notice will tell you about ways in which we may use and disclose PHI about you. We also describe your rights and certain obligations we have regarding the use and disclosure of PHI.
Our Responsibilities
Our primary responsibility is to safeguard your PHI. We must also give you this notice of our privacy practices and we must follow the terms of the notice that is currently in effect.
Changes to this Notice
We reserve the right to change this notice, and we reserve the right to make the revised or changed notice effective for the PHI we have already collected as well as any information we receive in the future. We will post a copy of the current notice on premises.
Your PHI Rights
Although your health record is the physical property of Sarah Hartman, LMHC the information belongs to you. You have the right to:
Right 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.
Right 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 to another address.)
Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes 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.
Right to Amend – You may request an amendment to your health record in writing if you feel the information is incorrect or incomplete. Your request must include a reason to support the request. Your request may be denied if the information was not created was not created by our behavioral health team, is not part of the information kept by our facility, is not part of the information we are not permitted to copy (such as information we receive from other facilities), or if that information is not accurate and complete. Please note that if we accept the request, we are not required to delete any information from our record. Right 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.
Special Situations that do not require your consent or authorization
I may use and disclose information about you when necessary to prevent serious threat to your health or safety or the health and safety of another person or the public. These disclosures would be made only to someone able to help prevent the threat.
Public Health Activities
I may disclose PHI about you for public activities including the prevention or control of disease, injury or disability, to report births and deaths, to report child abuse or if we believe the client has been a victim of abuse (including elder abuse), neglect or domestic violence. I am a mandated reporter for the aforementioned services.
Health Oversight Activities
I may disclose PHI to a health oversight agency for activities authorized by law such as investigations, audits, inspections and licensure.
Lawsuits and Disputes
If you are involved in a legal dispute or lawsuit, we may disclose PHI about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute. I would only disclose this information if efforts have been made to tell you about the request to allow you to obtain an order protecting the information requested.
Law Enforcement, Coroners, Medical Examiners, National Security, Inmates
I may disclose PHI in emergency situations as required by law to law enforcement, coroners, medical examiners and/or to authorized federal officials for intelligence. If you are an inmate of a correctional institute we may disclose PHI about you so that you are provided with health care, to protect your health and safety, and the health and safety of others.
Questions and Complaints
If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at Sarah Hartman, LMHC, counselor at 716-218-0669 or by mail at 15 Lincoln Street, Amhest NY 14226. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. I will not retaliate against you for exercising your right to file a complaint.