Azalea Counseling & Psychotherapy

(240) 200-4493   contact@azaleacounselingmd.com

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on February, 2024.

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. MY PLEDGE REGARDING HEALTH INFORMATION:

I recognize that information concerning your health and the mental health care and services you receive is personal and confidential. I am committed to protecting the privacy and confidentiality of your protected health information (“PHI”). As part of providing mental health care, I create and maintain records documenting the care and services you receive. These records are necessary to provide you with appropriate, high-quality care and to fulfill certain legal, regulatory, and professional requirements.

This Notice of Privacy Practices (“Notice”) applies to all records of your care and services maintained by this mental health care practice. This Notice describes the circumstances under which your PHI may be used or disclosed, as permitted or required by applicable law. It also explains your rights with respect to the PHI maintained about you and describes my legal duties and responsibilities regarding the privacy, use, and disclosure of your PHI.

I am required by law to:

  • Maintain the privacy of your PHI and protect information that may reasonably identify you. 

  • Provide you with this Notice describing my legal duties, privacy practices, and your rights with respect to your PHI. 

  • Comply with the terms of the Notice that is currently in effect. 

  • Notify you of any material changes to this Notice and make the revised Notice available to you upon request, at my office, and on my website. 

I reserve the right to change the terms of this Notice and to make the revised Notice applicable to all PHI maintained by this practice, as permitted by applicable law. Any revised Notice will be made available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: 

The following categories describe the various circumstances under which I may use or disclose your protected health information (“PHI”). For each category, I provide a general description and, where appropriate, examples to help explain how your information may be used or disclosed. These examples are illustrative and are not intended to describe every possible use or disclosure within a particular category. However, all uses and disclosures that I am legally permitted to make will fall within one of the categories described below or will otherwise be permitted or required by applicable law.

For Treatment Payment, or Health Care Operations:

Federal privacy regulations permit health care providers who have a direct treatment relationship with a patient or client to use or disclose the patient’s PHI, without obtaining the patient’s written authorization, for purposes of treatment, payment, or health care operations. I may also disclose your PHI, without your written authorization, to another health care provider for purposes of that provider’s treatment activities, as permitted by applicable law. For example, I may consult with another licensed health care professional regarding your condition or treatment. In such circumstances, I may use or disclose relevant PHI as necessary to facilitate the evaluation, diagnosis, coordination, or treatment of your mental health condition. Uses and disclosures of PHI for treatment purposes are not subject to the HIPAA “minimum necessary” standard. This is because health care providers may need access to a complete or sufficiently comprehensive record and relevant clinical information to provide safe, effective, and appropriate care.

For purposes of this Notice, “treatment” includes, among other activities, the coordination and management of health care and related services among health care providers; consultations between health care providers concerning a patient’s care; and referrals of a patient from one health care provider to another for the provision of health care services.

Lawsuits and Disputes

If you are involved in a lawsuit or other legal or administrative proceeding, I may disclose your PHI in response to a court or administrative order, as permitted or required by applicable law.

I may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process initiated by another party involved in the dispute, when the applicable legal requirements have been satisfied. Depending on the circumstances, this may include situations in which reasonable efforts have been made to provide you with notice of the request or to obtain an order or other appropriate legal protection for the information requested.

Where the information concerns a minor or another individual for whom you are a legally authorized representative, any disclosure will be made in accordance with applicable federal and state laws governing the individual’s privacy rights and the authority of the requesting or representing party.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes

I maintain “psychotherapy notes,” as that term is defined under the Health Insurance Portability and Accountability Act (HIPAA) and its implementing regulations at 45 CFR   § 164.501. Psychotherapy notes are maintained separately from the rest of your medical record and receive special protection under HIPAA.

Except as permitted by law, I will obtain your written Authorization before using or disclosing psychotherapy notes. An Authorization is not required for the following uses or disclosures:

  1. Treatment. For my use in providing treatment to you. 

  2. Training and Supervision. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. 

  3. Legal Proceedings. For my use in defending myself in a legal action or other proceeding brought by you. 

  4. HIPAA Compliance. For use by the Secretary of the U.S. Department of Health and Human Services in connection with an investigation of my compliance with HIPAA. 

  5. Required by Law. When the use or disclosure is required by law and the use or disclosure is limited to the requirements of that law. 

  6. Health Oversight. When required by law for certain health oversight activities concerning the originator of the psychotherapy notes. 

  7. Coroners and Medical Examiners. When required by a coroner or medical examiner in the performance of duties authorized by law. 

  8. Serious and Imminent Threats. When necessary to help avert a serious and imminent threat to the health or safety of a person or the public, as permitted by applicable law.

2. Marketing

I will not use or disclose your Protected Health Information (PHI) for marketing purposes without your written Authorization, except as otherwise permitted by applicable law.

3. Sale of Protected Health Information

I will not sell your Protected Health Information (PHI) without your written Authorization, except as otherwise permitted by applicable law. Any Authorization for the sale of PHI will comply with the requirements of HIPAA.

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

Subject to certain limitations and requirements under applicable federal and state law, I may use or disclose your Protected Health Information (PHI) without your written Authorization for the following purposes:

  1. As Required by Law. I may use or disclose your PHI when required by federal or state law, provided that the use or disclosure complies with and is limited to the requirements of such law. 

  2. Public Health Activities. I may use or disclose your PHI for certain public health activities as permitted or required by law, including reporting suspected child abuse, elder abuse, or dependent adult abuse, and taking appropriate action to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. 

  3. Health Oversight Activities. I may use or disclose your PHI for health oversight activities authorized by law, including audits, investigations, inspections, licensure proceedings, and other activities necessary for appropriate oversight of the health care system. 

  4. Judicial and Administrative Proceedings. I may use or disclose your PHI in the course of a judicial or administrative proceeding when permitted or required by applicable law, including in response to a court or administrative order, subpoena, discovery request, or other lawful process. When permitted by law, I will make reasonable efforts to obtain your written Authorization before making such a disclosure. 

  5. Law Enforcement Purposes. I may use or disclose your PHI for certain law enforcement purposes when permitted or required by applicable law, including disclosures necessary to report certain crimes or criminal activity. 

  6. Coroners and Medical Examiners. I may disclose your PHI to a coroner or medical examiner when necessary for the performance of duties authorized by law, including determining the cause of death or other responsibilities authorized by law. 

  7. Research. I may use or disclose your PHI for research purposes when permitted by applicable law and when the applicable legal requirements for the use or disclosure of PHI for research have been satisfied. For example, research may involve studying and comparing the mental health outcomes of individuals who received different forms of therapy for the same condition. 

  8. Specialized Government Functions. I may use or disclose your PHI for certain specialized government functions as authorized by law, including activities related to military and veterans’ affairs, national security and intelligence activities, protective services for the President and other authorized persons, and the safety and security of correctional institutions. 

  9. Workers’ Compensation. I may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs established by law that provide benefits for work-related injuries or illnesses. When permitted by law, I will make reasonable efforts to obtain your written Authorization before making such a disclosure. 

  10. Appointment Reminders and Health-Related Benefits and Services. I may use and disclose your PHI to contact you regarding your appointments, including sending appointment reminders. I may also use and disclose your PHI to provide information about treatment alternatives or other health-related services and benefits that may be of interest to you, as permitted by applicable law.

 

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

I may disclose your Protected Health Information (PHI) to a family member, close personal friend, or other person whom you identify as being involved in your health care or in the payment for your health care, unless you object to the disclosure, either in whole or in part.

When appropriate and permitted by law, I may provide such information based on your agreement or, when circumstances require, may reasonably infer from the circumstances that you do not object. In emergency situations, I may disclose relevant PHI based on the circumstances, and, when appropriate, may obtain your consent or provide you with an opportunity to object as soon as reasonably practicable after the emergency.

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

 1. The Right to Request Restrictions on Uses and Disclosures of Your PHI

You have the right to request that I restrict the use or disclosure of your Protected Health Information (PHI) for purposes of treatment, payment, or health care operations. I am not required to agree to your request and may deny it if I determine that the restriction could adversely affect the quality or effectiveness of your health care.

2. The Right to Request Restrictions for Services Paid in Full Out-of-Pocket

You have the right to request that I restrict the disclosure of your PHI to a health plan for purposes of payment or health care operations when the PHI relates solely to a health care item or service that you have paid for in full out-of-pocket.

3. The Right to Request Your Preferred Method of Communication

You have the right to request that I communicate with you in a specific manner or at a specific location. For example, you may request that I contact you by telephone at your home or office or send correspondence to an alternative mailing address. I will accommodate all reasonable requests.

4. The Right to Inspect and Obtain Copies of Your PHI

Except for psychotherapy notes and other information excluded by law, you have the right to inspect and obtain an electronic or paper copy of your medical record and other PHI that I maintain about you.

Upon receiving your written request, I will provide you with a copy of your records or, if you agree to receive one, a summary of your records within 30 days. A reasonable, cost-based fee may apply for providing copies or summaries, as permitted by applicable law.

5. The Right to Receive an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI that I have made for purposes other than treatment, payment, or health care operations, or disclosures for which you have provided written authorization.

I will respond to your request within 60 days of receiving it. The accounting will generally include disclosures made during the preceding six years, unless you request a shorter period.

The first accounting requested within a 12-month period will be provided at no charge. If you request additional accountings during the same 12-month period, I may charge a reasonable, cost-based fee as permitted by law.

6. The Right to Request an Amendment of Your PHI

If you believe that the PHI I maintain about you is incorrect or incomplete, you have the right to request that I amend the existing information or add information that you believe is missing.

I may deny your request under certain circumstances. If I deny your request, I will provide you with a written explanation of the reason for the denial within 60 days of receiving your request, as required by applicable law.

7. The Right to Receive a Paper or Electronic Copy of This Notice

You have the right to receive a paper copy of this Notice of Privacy Practices at any time. You may also request to receive a copy electronically, including by email. Even if you have previously agreed to receive this Notice electronically, you may request a paper copy at any time.

Acknowledgement of Receipt of Privacy Notice 

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your Protected Health Information (PHI).

By checking the box below, you acknowledge that you have received and reviewed a copy of the HIPAA Notice of Privacy Practices and understand that it describes how your PHI may be used and disclosed, as well as your rights regarding your health information.