Notice of Policies & Practices to Protect the Privacy of Your Health Information
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
PHI—refers to information in your health record that could identify you.
Treatment and Payment
Treatment is when your therapist provides, coordinates, or manages your health care and other services related to your health care. For example, when consulting with another health care provider to discuss your care, information would be shared. Payment is when Amy L. Kopel, LLC is reimbursed for your healthcare.
The information would be shared with your insurance company in order to obtain reimbursement for your health care or to determine eligibility, coverage, and/or obtain treatment authorization. Use applies to those activities within Amy L. Kopel, LLC practice, such as sharing, employing, applying, examining, and analyzing information that identifies you. Disclosure applies to activities outside of Amy L. Kopel, LLC’s practice, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
Amy L. Kopel, LLC may use or disclose PHI for purposes outside of treatment or payment when your appropriate authorization is obtained. An authorization is written permission signed by you or your legal guardian, which gives consent for specific disclosures. You would be contacted in advance if a request is made for information about information, and consent would be obtained prior to any information being released.
Ms. Kopel will also need to obtain written authorization before releasing your psycho counseling notes. “Psycho counseling notes” are notes that your therapist has made about your conversations during your private individual, couples, or family counseling session, which your therapist will have kept separate from the medical record.
Once authorization to release information is obtained, it can only be revoked in writing, and it is understood that the treating therapist cannot be held responsible for information that was released prior to permission being revoked.
III. Uses and Disclosures Where Neither Consent nor Authorization is Required
Amy L. Kopel, LLC is legally bound to take action without your consent or authorization under these circumstances:
You should also be aware that I sometimes consult with other mental health professionals who are all bound by the same rules of confidentiality and are obligated to protect your privacy. I never reveal names or so much information that the client is easily identifiable.
IV. Client’s Rights
V. Ms. Kopel’s Duties
If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may contact me at (410) 878-7490 for further information. We can discuss what, if any, action is to be taken, and I will provide you with the appropriate agency to file a written grievance. This notice goes into effect immediately.