Privacy Policy | Brain X Dynamics

NOTICE OF PRIVACY PRACTICES

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

I. PLEDGE REGARDING HEALTH INFORMATION:

Your provider understands that health information about you and your health care is personal, and is committed to protecting health information about you. A record of the care and services provided is created to ensure quality care and compliance with legal requirements. This notice applies to all records generated by this practice.. This document also describes your rights to the health information, and describes certain obligations regarding the use and disclosure of your health information. The provider is required by law to:

Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
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 on my website.

II. HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED:

The following categories describe different ways health information may be used and disclosed. Not every use or disclosure in a category will be listed. However, all of the ways provider is permitted to use and disclose information will fall within one of the categories.

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. Provider may also disclose your protected health information for the treatment 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 personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because 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 one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, provider may disclose health information in response to a court or administrative order. Provider 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.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

Psychotherapy Notes. “Psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless: a.Used by the provider for treatment. b. Used for training or supervising mental health practitioners to help them improve their professional skills. c. Used for legal defense. d. Required by law or for certain health oversight activities. e. Required by a coroner or to avert serious threats to safety. f. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. g. Required by law and the use or disclosure is limited to the requirements of such law. h. Required to help avert a serious threat to the health and safety of others.
Marketing Purposes or Sale of PHI: Your provider will not use or sell your PHI for marketing purposes without your authorization.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

Subject to certain limitations in the law, the provider may use and disclose PHI without your authorization for the following reasons, among others:

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.
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.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order.
For law enforcement purposes, including reporting crimes occurring on practice’s premises.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of treatment versus another.
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. Provider may disclose your PHI in order to comply with workers’ compensation laws.
Appointment reminders and health related benefits or services. Provider may use and disclose your PHI to contact you to remind you that you have an appointment with me. Provider may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that the practice offers.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

You may object to the disclosure of your PHI to family members, friends, or others involved in your care. The opportunity to consent may be retroactively obtained in emergencies.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Your provider is not required to agree if it affects care. Your provider may say “no” if it is deemed it could affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You. You have the right to ask to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and provider will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information. The practice will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and you may be charged a reasonable, cost based fee.
The Right to Get a List of the Disclosures. You may request a list of disclosures made without your authorization, except those for treatment, payment, or health care operations. The provider will respond within 60 days. The list has not charge, however you will be charged a reasonable fee for each additional request.
The Right to Correct or Update Your PHI. If there is a mistake or missing information in your PHI, you may request an amendment. The provider may deny the request but will provide a written explanation within 60 days.
The Right to Get a Paper or Electronic Copy of this Notice. You have the right to request a copy of this notice at any time, even if you have agreed to receive it electronically.

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with the U.S. Department of Health and Human Services at:

Secretary of the U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Phone: (202) 619-0257