Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I. OUR PLEDGE REGARDING HEALTH INFORMATION

PRT (“we”) understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated while you are a client of PRT. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private and secure. This includes maintaining reasonable and appropriate administrative, technical, and physical safeguards to protect the unauthorized use or disclosure of your protected information.

  • Give you this notice of our privacy practices with respect to your protected health information.

  • Follow the terms of the notice that is currently in effect. This includes alerting your promptly if a breach occurs that may have compromised the privacy or security of your information. Additionally, we will mitigate, to the extent practicable, any harmful effect we learn was caused by a breach of privacy or security. We will not share or use your information, other than as described here, without your express written permission. If you authorize a use or disclosure of your information, you may revoke that authorization in writing at any time.

  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our online client portal.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe the most common ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category is listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

To provide you with care

We can use your health information to provide psychotherapy services and may share your information with other professionals who are providing you with healthcare services, assuming you have provided our consent to do so. This may include the sharing of information to covered entities that are not part of your direct treatment team. Example: A psychiatrist speaks with your licensed clinical social worker about your overall mood in therapy sessions.

To run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use your health information to coordinate services between an individual and group therapist.

To bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. Example: We provide healthcare information to your health insurance plan so that they will reimburse for your sessions.

III. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

How else can we use or share your health information?

We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

To help with public health and safety issues

We can share health information about you for certain situations such as: preventing disease, reporting adverse reactions to medications, reporting suspected child or elder abuse, neglect, or domestic violence, or preventing or reducing a serious threat to anyone’s health or safety.

To conduct research

We can use or share your information for health research. (This practice does not currently participate in research.)

To comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

To address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, or for special government functions such as military, national security, and presidential protective services.

To respond to lawsuits and legal actions

We can share your health information in response to a court or administrative order or subpoena.

IV. YOUR CHOICES

For certain health information, you can tell us your choice about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory

If you are unable to tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In all other cases, we never share your information unless you give us written permission.

V. YOUR RIGHTS

When it comes to your health information, you have certain rights., This section explains your rights and some of our responsibilities to help you.

Receive a copy of your medical record

You can ask for an electronic or paper copy of your record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may refuse your request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will agree to all reasonable requests.

Ask us to limit the information we share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may refuse if it would affect your care. If you pay for a service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or operations with your health insurer. We will agree unless the law requires us to share that information.

Get a list of those with whom we’ve shared information

You can request a detailed accounting of when, with whom, and why we have shared your health information for up to six years prior to the date of your request. We will include all disclosures except for those about treatment, payment, health care operations, and certain other disclosures (such as any you have requested). We will provide one free accounting per year but will charge a reasonable, cost-based fee if you request another within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide this paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will ensure the person has this authority and can act for you before we take any action.

File a complaint if you feel your privacy rights are violated

If you feel we have violated your rights, you can file a complaint by contacting us using the information at the top of this form.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting: https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html

We will not retaliate against you for filing a complaint.

VI. OUR RESPONSIBILITIES

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will advise you promptly if there has been a breach that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described in this notice unless you authorize us in writing to release information. You can revoke your authorization in writing at any time, and to the extent that such release has not already occurred.

  • For more information: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on December 1, 2019