HIPAA NOTICE OF PRIVACY PRACTICES
Applied Psychological Solutions in Brandon, Florida
Applied Psychological Solutions LLC
Steven F. Wu, Ph.D., Licensed Psychologist, FL PY4543
Privacy Officer: Steven F. Wu, Ph.D., 813-655-7057
Effective Date: 9/18/2013
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.
I understand the importance of privacy and am committed to maintaining the confidentiality of your medical information. I make a record of the medical care I provide and may receive such records from others. I use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable me to meet my professional and legal obligations to operate this medical practice properly. I am required by law to maintain the privacy of protected health information, to provide individuals with notice of my legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how I may use and disclose your medical information. It also describes your rights and my legal obligations with respect to your medical information. If you have any questions about this Notice, please contact me.
How This Medical Practice May Use or Disclose Your Health Information
This practice collects health information about you and stores it in a paper chart and file. This is your medical record. The medical record is the property of this practice, but the information in the medical record belongs to you. The law permits me to use or disclose your health information with your consent for the following purposes:
1. Treatment. I use medical information about you to provide your medical care. I disclose medical information to my employees and others who are involved in providing the care you need. I may also disclose medical information to members of your family or others who can help you when you are too incapacitated to grant informed consent, or after you die.
2. Payment. I use and disclose medical information about you to obtain payment for the services I provide. For example, I give your health insurance company the information it requires before it will pay me or disclose certain information to my billing company to assist them in obtaining payment for services I have provided to you.
3. Health Care Operations. I may use and disclose medical information about you to operate this medical practice. For example, I may use and disclose this information to review and improve the quality of care I provide, or the competence and qualifications of my professional staff. Or I may use and disclose this information to get your health plan to authorize services or referrals. I may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. I have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information. I may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care-coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
4. Appointment Reminders. I may use and disclose medical information to contact and remind you about appointments. If you are not home, I may leave this information on your answering machine or in a message left with the person answering the phone. If I do this, any information I leave will be vague and discrete.
5. Sign In Sheet. I may use and disclose medical information about you by having you sign in when you arrive at my office. I may also call out your name when I am ready to see you.
6. Notification and Communication With Family. I may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed me otherwise, in the event of your death. In the event of a disaster, I may disclose information to a relief organization so that they may coordinate these notification efforts. I may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, I will give you the opportunity to object prior to making these disclosures, although I may disclose this information in a disaster even over your objection if I believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, I will use my best judgment in communication with your family and others.
7. Marketing. I will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether I receive any compensation for any marketing activity you authorize, and I will stop any future marketing activity to the extent you revoke that authorization.
8. Required by Law. As required by law, I will use and disclose your health information, but I will limit my use or disclosure to the relevant requirements of the law. When the law requires me to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, I will further comply with the requirement set forth below concerning those activities.
9. Public Health. I may, and am sometimes required by law, to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When I report suspected elder or dependent adult abuse or domestic violence, I will inform you or your personal representative promptly unless in my best professional judgment, I believe the notification would place you at risk of serious harm or would require informing a personal representative I believe is responsible for the abuse or harm.
10. Health Oversight Activities. I may, and am sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.
11. Judicial and Administrative Proceedings. I may, and am sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. I may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
12. Law Enforcement. I may, and am sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
13. Coroners. I may, and am required by law, to disclose your health information to coroners in connection with their investigations of deaths.
14. Organ or Tissue Donation. I may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
15. Public Safety. I may, and am sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
16. Specialized Government Functions. I may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
17. Workers’ Compensation. I may disclose your health information as necessary to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, I will make periodic reports to your employer about your condition. I am also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
18. Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another psychologist.
19. Breach Notification. In the case of a breach of unsecured protected health information, I will notify you as required by law. If you have provided me with a current e-mail address, I may use e-mail to communicate information related to the breach. In some circumstances my business associate may provide the notification. I may also provide notification by other methods as appropriate.
20. Psychotherapy Notes. I will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) for training my staff, students and other trainees, 3) to defend myself if you sue me or bring some other legal proceeding, 4) if the law requires me to disclose the information to you or the Secretary of HHS or for some other reason, 5) in response to health oversight activities concerning your psychotherapist, 6) to avert a serious and imminent threat to health or safety, or 7) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, I will stop using or disclosing these notes.