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
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 ... Read more
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 ... Read more
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; ... Read more
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 ... Read more
B. When This Psychology Practice May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, this practice will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
C. Your Health Information Rights
1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on my use or disclosure of that information you wish to have imposed. If you tell me not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, I will abide by your request, unless I must disclose the information for treatment or legal reasons. I reserve the right to accept or reject any other request, and will notify you of my decision.
2. Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that I send information to a particular e-mail account or to your work address. I will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications. I will notify you that sending information in this way, however, is not be a secure way of receiving your confidential information.
3. Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. I will provide copies in your requested form and format if it is readily producible, or I will provide you with an alternative format you find acceptable, or if I can’t agree and I maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. I will also send a copy to any other person you designate in writing. I will charge a reasonable fee which covers my costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. I may deny your request under limited circumstances. If I deny your request to access your child's records or the records of an incapacitated adult you are representing because I believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal my decision. If I deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
4. Right to Amend or Supplement. You have a right to request that I amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. I am not required to change your health information, and will provide you with information about this practice's denial and how you can disagree with the denial. I may deny your request if I do not have the information, if I did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If I deny your request, you may submit a written statement of your disagreement with that decision, and I may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 18 (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
6. Right to a Paper or Electronic Copy of this Notice. You have a right to notice of my legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact me.
D. Changes to this Notice of Privacy Practices
I reserve the right to amend this Notice of Privacy Practices at any time in the future pursuant to changes in Federal HIPAA laws. Until such amendment is made, I am required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that I maintain, regardless of when it was created or received. I will keep a copy of the current notice posted in my reception area, and a copy will be available at each appointment. I will also post the current notice on my website.
E. Complaints
Complaints about this Notice of Privacy Practices or how this practice handles your health information should be directed to me. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: the local DHHS Office of Civil Rights The complaint form may be found at /hipaa/complaints/hipcomplaint.pdf.

You will not be penalized in any way for filing a complaint.