HIPAA NOTICE OF PRIVACY PRACTICE
You will be asked to sign a copy of this Notice as required by law. “ I” and “My” in this Notice refer to your therapist.
I. 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 CARE FULLY .
II. IT IS MY LEGAL DUTY TO SAFEGUARD YOUR PROTECTED
HEALTH INFORMATION (PHI).
By law I am required to insure that your PHI is kept private. The PHI co nstitutes information created or noted by me that can be used to identify you. It contains dat a about your past, present, or future health or condition, the provision of health care ser vices to you, or the payment for such health care. I am required to provide you with this Not ice about my privacy procedures. This Notice must explain when, why, and how I would use and/ or disclose your PHI. Use of PHI means when I share, apply, utilize, examine, or analyze information within my practice; PHI is disclosed when I release, transfer, give, or otherwi se reveal it to a third party outside my practice.
With some exceptions, I may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, I am always legally required to follow the privacy practices described in this Notic e.
Please note that I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI already on file with me. Befo re I make any important changes to my policies, I will immediately change this Notice and post a new copy of it in my office and on my website. You may also request a copy of thi s Notice from me, or you can view a copy of it in my office or on my website, which is locate d at www. renewalcounseling.com.
III. HOW I WILL USE AND DISCLOSE YOUR PHI.
I will use and disclose your PHI for many different reasons. Some of the uses or disclosures will require your prior written authorization; others, however, will not . Below you will find the different categories of my uses and disclosures, with some examples.
A. Uses and Disclosures Related to Treatment, Payment, or Health Care
Operations Do Not Require Your Prior Written Consent. I may use and disc lose your PHI without your consent for the following reasons:
I. For treatment. I may disclose your PHI to physicians, psychiatrists, psychologists, ant other licensed health care providers who provide you with health care
Privacy Policy continued page 2
