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This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully…
Protected Health Information (PHI) about you is obtained as a record of your contacts or visits for healthcare services with Corinna Young Casey, PhD at San Diego Behavioral Medicine. Specifically, PHI is information about you, including demographic information (e.g., name, address, phone, etc.) that may identify you and relates to your past, present or future physical or mental health condition and related health care services.
We are required to follow specific rules on maintaining the confidentiality of your protected health information, how we use your information, and how we disclose or share this information with other healthcare professionals involved in your care. This notice describes your rights to access and control your protected health information. It also describes how we follow those rules and how we use and disclose your protected health information to provide your treatment, obtain payment for services you receive, manage our health care operations, and for other purposes that are permitted or required by law.
You have the right to receive and we are required to provide you with a copy of this Notice of Privacy Practices. We are required to follow the terms of this notice. We reserve the right to change the terms of our notice at any time. If needed, new versions of this notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.
You have the right to authorize other use and disclosure. This means you have the right to authorize or deny any other use or disclosure of protected health information not specified in this notice. You may revoke an authorization, any time, in writing, except to the extent that your psychologist or our office has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative. This means you may designate a person with the delegated authority to consent and authorize the use or disclosure of protected health information.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in your patient record. (If you request copies, you may be charged $1.00 per page to locate and copy your health information, and postage if you want the copies mailed to you.)
You have the right to request a restriction of your protected health information. This request must be made in writing, and it must explain why the information should be restricted. Such restrictions do not apply to information we are legally required and permitted to use and disclose. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care. In certain cases, we may deny your request for a restriction.
You may have the right to have us amend your protected health information. This request must be made in writing, and it must explain why the information should be amended. You may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request for an amendment.
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 receiving psychological services from this office.) Upon your written request, we will send your bills to another address. It must specify how and/or where you wish to be contacted. We will accommodate all reasonable requests.
We may use or disclose your health information to a physician or other healthcare provider providing treatment to you or for the management of healthcare and related services. This also includes but is not limited to consultations and referrals between one or more providers. For example, an insurance company may contact a provider on your behalf to facilitate your access to mental health treatment.
Unless you request that we contact you by other means, the Privacy Rule permits us to contact you by phone/voicemail to schedule appointments and to leave appointment reminders.
We may use or disclose your health information to obtain reimbursement for your healthcare. For example we may disclose your PHI to your health insurer to determine eligibility or coverage for psychological services. We may disclose PHI when we obtain reimbursement from your health insurer for your healthcare.
We may use or disclose your health information in healthcare operations. For example, we may disclose your PHI to your health insurer for care coordination or case management.
We will obtain an authorization before releasing your psychotherapy notes. Psychotherapy notes are notes made about our conversation during an individual, group, conjoint, or family counseling session, which are kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
We may use or disclose PHI for purposes outside of treatment, payment and healthcare operations when your authorization is obtained. In those instances when we are asked for information for purposes outside of treatment and payment operations, we will obtain an authorization from you before releasing this information.
We may use or disclose PHI without your consent or authorization in the following circumstances:
Whenever we, in our professional capacity, have knowledge of or observe a child we know or reasonably suspect, has been the victim of child abuse or neglect, we must immediately report this to a police department or sheriff’s department, county probation department, or county welfare department. Also, if we have knowledge of or reasonably suspect that mental suffering has been inflicted upon a child or that his or her emotional well being is endangered in any other way, we may report it to the above agencies.
If we, in our professional capacity, have observed or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if we are told by an elder or dependent adult that she or he has experienced these, or if we reasonably suspect such, we must report the known or suspected abuse immediately to the local ombudsman or the local law enforcement agency.
We do not have to report such an incident if we have been told by an elder or dependent adult that he or she has experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse or neglect and:
We are not aware of any independent evidence that corroborates the statement that the abuse has occurred
The elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia; or
We may use and/or disclose your PHI to designated activities and functions including audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, or civil, administrative, or criminal proceedings or actions, or other activities necessary for appropriate oversight of government benefit programs. For example, if a complaint is filed against San Diego Behavioral Medicine or Dr. Corinna Young Casey with the Board of Psychology, the Board has the authority to subpoena confidential mental health information from us that is relevant to the complaint.
If you are involved in a court proceeding and a request is made about the professional services that we have provided you, we will not release your information without:
your written authorization or the authorization of your attorney or personal representative;
a court order; or
Privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. We will inform you in advance if this is the case.
If you communicate to us a serious threat of physical violence against an identifiable victim, we must make reasonable efforts to communicate that information to the potential victim and the police. If we have reasonable cause to believe that you are in such a condition, as to be dangerous to yourself or others, we may release relevant information as necessary to prevent the threatened danger.
If you file a workers’ compensation claim, we must furnish a report to your employer, incorporating our findings about your injury and treatment, within five working days from the date of your initial examination, and at subsequent intervals as may be required by the administrative director of the Workers’ Compensation Commission in order to determine your eligibility for workers’ compensation.
For specific government functions: If you are a member of the U.S. Armed Forces, we must disclose relevant information, if required, to the government in certain situations. Additionally, we may disclose your PHI, if required, for national security reasons.
If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about privacy rights, you may contact us at:
Corinna Young Casey, PhD
San Diego Behavioral Medicine
2262 Carmel Valley Road, Suite E
Del Mar, California 92014
If you believe that your patient privacy rights have been violated and wish to file a complaint, send your written complaint to:
Secretary of the Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint.
This notice went into effect on April 13, 2003.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. If requested, we will provide you with a revised notice.