Your privacy is important to us, and you can trust that our sessions, as well as any of your personal information, is always held in the strictest of confidence. Additionally, anything you transmit over our website is highly secure, and stored data is HIPAA-compliant.
Confidential information disclosed in private therapy sessions is legally protected. However, there are some exceptions to this, including instances of suspected child or elder abuse, or when a client presents a serious danger of violence toward himself or herself or another person. If you’d like to learn more about our ethical standards and privileged communication exceptions, our office can provide additional information.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This information, which may identify you and relates to your past, present or future physical or mental health or condition and related health care services, is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how I may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI.
I am required by law to maintain the privacy of PHI and to provide you with notice of my legal duties and privacy practices with respect to PHI. I am required to abide by the terms of this Notice of Privacy Practices. I reserve the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that I maintain at that time. I will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on my website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
For Treatment Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. I may disclose PHI to any other consultant only with your authorization.
For Payment I may use or disclose PHI so that I can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, I will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations I may use or disclose, as needed, your PHI in order to support my business activities including, but not limited to, quality assessment activities, reminding you of appointments, to provide information about treatment alternatives or other health related benefits and services, licensing, and conducting or arranging for other business activities. For example, I may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided I have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law Under the law, I must make disclosures of your PHI to you upon your request. In addition, I must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of the Privacy Rule.
Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization.
Abuse and Neglect Judicial and Administrative Proceedings
Emergencies Law Enforcement
National Security Public Safety (Duty to Warn)
Without Authorization. Applicable law and ethical standards permit me to disclose information about you without your authorization only in a limited number of other situations. The types of uses and disclosures that may be made without your authorization are those that are:
Required by law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the Counselor licensing board or health department)
Required by Court Order.
Necessary to prevent or lessen a serious and imminent threat to the health or safety of yourself, another person or the public. If information is disclosed to prevent or lessen a serious threat, it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Verbal Permission. I may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
With Authorization. Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked.
You have the following rights regarding your personal PHI maintained by my office. To exercise any of these rights, please submit your request in writing to Kate Bremer, PCC-S at the above address.
If you believe I have violated your privacy rights, you have the right to file a complaint in writing with the State of Ohio Counselor and Social Worker Board, Marriage and Family Therapist Board, 50 West Broad St., Suite 1075, Columbus, Ohio 43215-5919. Phone: 614-466-0912. I will not retaliate against you for filing a complaint.
The effective date of this Notice is June 1, 2011.