LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychotherapist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The other professionals are also legally bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together. I will note all consultations in your Clinical Record (which is called “PHI” in my Notice of Psychotherapist’s Policies and Practices to Protect the Privacy of Your Health Information). • You should be aware that I practice with other mental health professionals and that I employ administrative staff. In most cases, I need to share protected information with these individuals for both clinical and administrative purposes, such as scheduling, billing, and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff members have been given training about protecting your privacy and have agreed not to release any information outside of the practice without my permission. • I also have a contract with a billing service. As required by HIPAA, I have a formal business associate contract with this business, in which it promises to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law. If you wish, I can provide you the name of this organization and/or a blank copy of this contract. I also will ask for your permission before having the billing service contact you. • Disclosures required by health insurers or to collect overdue fees are discussed elsewhere in this Agreement. • If a patient threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection. There are some situations where I am permitted or required to disclose information without either your consent or Authorization: • If you are involved in a court proceed...
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA and/or Virginia law. I will always take every precaution and measure to insure the privacy of your confidential information. There are some situations in which a psychologist is legally obligated to take some action that will likely involve revealing information to an outside party, possibly without your consent. These situations are unusual, and are limited to cases in which harm is likely, including: • Cases in which a psychologist is ordered by a judge to release therapy records • Cases in which a psychologist has reason to believe a child under 18 may be abused or neglected • Cases in which a psychologist has reason to believe an adult over the age of 60 has been abused or neglected in the preceding 12 months • Cases in which you have made a specific threat of violence against another, or if a psychologist believes that you present a clear, imminent risk of serious physical harm to another or yourself If such a situation arises, I will make every effort to fully discuss it with you before taking any action or releasing any information about you, and I will limit disclosure of information to only what is necessary. Confidentiality issues can be complicated, so if you have any questions about them, please feel free to ask them now or in the future as needed. In addition, I want to protect your privacy if I happen to run into you in a public setting. If this occurs, I will not acknowledge you. This will give you the option of remaining anonymous. If you speak first, I'll be happy to say 'hello.' PATIENT RIGHTS HIPAA provides you with a number of rights, which briefly include the right to Amend the information in your record, to limit what information is disclosed and to whom, to request restrictions as to how you are contacted, and to receive an Accounting of Disclosures, or a list of all information that has been released about you. You also can file a complaint about our policies and procedures regarding your records with the federal Department of Health and Human Services.
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. With your signature on a proper Authorization form, I may disclose information in the following situations:
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between you and your provider. In most situations, RCC will only release information about your treatment to others if you sign a written Authorization Form for each release. Our release forms meet certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows:
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychologist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: • I may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The other professionals are also legally bound to keep the information
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a licensed therapist. In most situations, your therapist can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA and/or Illinois law. However, in the following situations, no authorization is required (see Appendix B for details):
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a client and a therapist. In most situations, I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by state law and/or HIPAA. There are some situations, which are listed below, in which I am legally obligated to break confidentiality. If any of the following situations arise, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary. • If I have reasonable cause to believe that a person under age 18 has suffered abuse or neglect, the law requires that I file a report with the appropriate government agency, usually the Department of Social and Health Services. Once such a report is filed, I may be required to provide additional information. • If I have reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, the law requires that I file a report with the appropriate government agency, usually the Department of Social and Health Services. Once such a report is filed, I may be required to provide additional information. • If I reasonably believe that there is an imminent danger to the health or safety of the client or any other individual, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, seeking hospitalization for the client, or contacting family members or others who can help provide protection. • If you tell me that you are suffering from HIV-related illness and do not have a physician providing for your care, I may be required to report the identities of your IV drug using or sexual partner(s) to the local health care officer. • Under court order, I can be required to disclose my records and information that I have about you. • If a government agency is requesting the information for health oversight activities, I may be required to provide it for them. • If a client files a complaint or lawsuit against me, I may disclose relevant information regarding that client in order to defend myself. • If a client files a worker’s compensation claim, and the services I am providing are relevant to the injury for which the claim was made, I must, upon appropriate request, provide a copy of the client’s record to the client’s employer and the Department of Labor and Industries.
LIMITS ON CONFIDENTIALITY. The law protects the privacy of all communications between a patient and a psychologist. In most situations, we can only release information about you to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA and/or Maine State law, or in some cases, if you provide oral authorization. However, in the following situations, no authorization is required: • Xx. Xxxxxx Xxxxx manages aspects of our practice software and shares some testing software. In the course of accessing or using these programs, Xx. Xxxxx may see a patient name. If this is a concern for you, please discuss this with us in advance of your appointment so that we can make arrangements to your satisfaction. Xx. Xxxxx is a psychologist and is bound by HIPAA rules as well as the APA ethics code; Xx. Xxxxx also has signed a HIPAA Business Associate agreement, giving added assurance for the correct handling of confidential patient information • If you are being seen for concussion management, you will most likely take ImPACT, which is a computerized test used in concussion management. Your results will be stored as part of the Maine Concussion Management Initiative (MCMI) database (as is your baseline ImPACT test if you had one at a Maine high school or college affiliated with MCMI). Only certain physicians, neuropsychologists, athletic trainers, and other health care professionals access the database and, adhering to their ethical principles, would not be looking at your data unless they are involved in your care. However, no further code is required for them to access your data once they have entered the system using their passwords. MCMI may additionally use your data in research studies, but the data would be de-identified prior to use (i.e., your name would be removed). • When we feel that it would be useful, we consult with Dr. Xxxxxxx Xxxxxxx (one of the developers of ImPACT and an international expert in concussion management). In consulting with Xx. Xxxxxxx or other MCMI credentialed health care providers (e.g., Xx. Xxxx Xxxxx) about your case, they may directly access the MCMI database, using your name, to look at your data and would be given pertinent information by NCMA. • We sometimes use the services of a Neurocognitive Testing Assistant (NTA) to administer tests. The NTA is Xxxxxxxxx (Xxx) Xxxxx, X.X. Xx. Xxxxx has signed a HIPAA Business Associate’s contract, agreeing to HIPAA rules regarding the handling of patient information. Tests ...
