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Notice of Policies and Practices to Protect

the Privacy of Your Health Information

 

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE

USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

 

I.  Uses and Disclosures for Treatment, Payment, and Health Care Operations

 

Scheerbert Psychological, PLLC may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent.  To help clarify, these terms are defined:

• “PHI” refers to information in your health record that could identify you.

• Treatment is when your therapist provides, coordinates, or manages your health care and other services related to your health care.  An example of treatment would include your therapist consulting with another health care provider, such as your family physician or another psychotherapist.

• Payment is when Scheerbert Psychological, PLLC obtains reimbursement for your healthcare.  Examples of payment are when we disclose your PHI to your insurance company to obtain reimbursement for your health care or to determine eligibility for coverage.

• Health Care Operations are activities that relate to the performance and operation of this office.  Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, as well as case management and care coordination.

• Use applies only to activities within this office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

• Disclosure applies to activities outside of this office, such as releasing, transferring, or providing access to information about you to other parties.

 

II.  Uses and Disclosures Requiring Authorization

 

Scheerbert Psychological, PLLC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained.  An “authorization” is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when a request for information for purposes outside of treatment, payment or health care operations is received, an authorization will be obtained from you before releasing this information.  Our office will also need to obtain an authorization before releasing your Psychotherapy Notes.  “Psychotherapy Notes” are notes made about conversations between a therapist and patient during a private, group or family counseling session, which are kept separate from the rest of your professional record.  These notes are given a greater degree of protection than PHI.

 

You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that 1) the office has relied on that authorization, or 2) if the authorization was obtained as a condition of obtaining insurance coverage; law provides the insurer the right to contest the claim under the policy.

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III.  Uses and Disclosures with Neither Consent nor Authorization

 

Scheerbert Psychological, PLLC may use or disclose PHI without your consent or authorization in the following circumstances:

• Child Abuse—if there is reasonable cause to suspect child abuse or neglect, this suspicion must be reported to the appropriate authorities as required by law.

• Adult and Domestic Abuse—if there is reasonable cause to suspect adult/domestic criminal abuse, a report of this suspicion to the appropriate authorities is required by law.

• Health Oversight Activities—if a subpoena is received or other lawful request from the Department of Health, Michigan Board of Psychology, or similar governmental oversight agency, we must disclose the relevant PHI pursuant to that subpoena or lawful request.

• Judicial and Administrative Proceedings—if you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof, such information is privileged under state law, and will not be released without your written authorization or a court order.  The privilege does not apply when you are being evaluated by a third party, or where the evaluation is court-ordered.  You will be informed in advance if this is the case.

• Serious Threat to Health or Safety—if you communicate a threat of physical violence against a reasonably identifiable third person and you have the apparent intent and ability to carry out that threat in the foreseeable future, your therapist may be required to disclose relevant PHI and take the reasonable steps permitted by law to prevent the threatened harm from occurring.  If it is believed that there is an imminent risk that you will inflict serious physical harm on yourself, your therapist may be required to disclose information in order to protect you.

• Workers Compensation—your therapist may disclose PHI regarding you as authorized by and to the extent necessary to comply with laws related to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illnesses without regard to fault.

 

IV.  Patient’s Rights and Psychotherapist’s Duties

 

Patient’s Rights:

• Right to Request Restrictions—you have the right to request restrictions on certain uses and disclosures of PHI.  However, your therapist is not required to agree to a restriction you request.

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations—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 being seen.  On your request, your bills can be sent to another address.

• Right to Inspect and Copy—you have the right to inspect or obtain a copy (or both) of PHI in the mental health and billing records used to make decisions about you, as long as the PHI is maintained in the record.  Your access to PHI under certain circumstances may be denied, but in some cases you may have this decision reviewed.  On your request, you and your therapist can discuss the details of the request and denial process.

• Right to Amend—you have the right to request an amendment of PHI for as long as the PHI is maintained in the record.  Your request may be denied.  On your request, you and your therapist will discuss the details of the amendment process.

• Right to an Accounting—you generally have the right to receive an accounting of disclosures of PHI.  On your request, your therapist will discuss with you the details of the accounting process.

• Right to a Paper copy—you have the right to obtain a paper copy of this Notice from your therapist upon request.

 

Psychotherapist’s Duties:

• Scheerbert Psychological, PLLC is required by law to maintain the privacy of PHI and to provide you with a notice of the legal duties and privacy practices with respect to PHI.

• Scheerbert Psychological, PLLC reserves the right to change the privacy policies and practices described in this notice.  Unless notified of such changes, however, Scheerbert Psychological, PLLC is required to abide by the terms currently in effect.

• If these policies and procedures are revised, Scheerbert Psychological, PLLC will provide notice to patients at their next clinical visit.  Otherwise, patients may call the office to obtain the date of the latest revision.

 

V. Questions and Complaints

 

If you have questions about this notice, disagree with a decision regarding access to your records, or have other concerns about your privacy rights, you may contact Thomas A. Hulbert, Ph.D., who functions as the privacy officer, at 248-415-4471.

 

If you believe that your privacy rights have been violated and wish to file a complaint with this office, you may send your written complaint to the privacy officer listed above.

 

You have specific rights under the Privacy Rule.  Scheerbert Psychological, PLLC will not retaliate against you for exercising your right to file a complaint.

 

VI.  Effective Date, Restrictions, and Changes to Privacy Policy

 

This Notice is in effect as of July 19, 2006. 

 

The Notice was amended January 6, 2013 only to the extent that contact information was changed to reflect a move from 20300 Civic Center Drive, Suite 303 to the current address, which took place in December, 2012.  In July, 2017 it was amended by placing it on a website.