Braving Motherhood Privacy Practices

This notice describes how health information may be used and disclosed and how you can get access to this information.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

I understand that health information about you and your health care is personal. I am committed to protecting that information. I create a record of the care and services you receive from me, and I need this record to provide you with quality care and to comply with certain legal requirements.

This notice applies to all the records of your care generated by this practice. It describes how I may use and disclose your protected health information (PHI), your rights regarding that information, and my legal obligations.

I am required by law to:

  • Keep your PHI private.

  • Provide you with this Notice of Privacy Practices.

  • Follow the terms of this Notice.

I may change the terms of this Notice, and such changes will apply to all information I have about you. A new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:

For Treatment, Payment, and Health Care Operations:

I may use and disclose your PHI for treatment, payment, or health care operations without your written authorization. Examples include:

  • Sharing information with other health professionals to coordinate care.

  • Consulting with other providers for diagnosis or treatment.

  • Billing your insurance provider.

Disclosures for treatment are not limited to the minimum necessary standard because therapists need access to full information to provide effective care.

Lawsuits and Disputes:

If you are involved in a legal proceeding, I may disclose PHI in response to a court or administrative order, or in response to a subpoena or discovery request if efforts have been made to notify you or obtain a protective order.

III. USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

Psychotherapy Notes:

I keep “psychotherapy notes” as defined under HIPAA. These are given extra protection. I will not use or disclose these notes without your explicit written authorization unless:

  • They are used for your treatment;

  • They are used for supervision or training purposes;

  • They are needed for my defense in legal proceedings initiated by you;

  • They are required by law or government oversight;

  • They are used to prevent a serious threat to health or safety.

Marketing Purposes:

I will not use your PHI for marketing purposes.

Sale of PHI:

I will not sell your PHI under any circumstance.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION:

I may use or disclose your PHI without your authorization in certain situations, including:

  • As required by law.

  • For public health reporting (e.g., child, elder, or dependent adult abuse).

  • For health oversight activities (e.g., audits, inspections).

  • In judicial or administrative proceedings.

  • To law enforcement for crimes occurring on the premises.

  • To medical examiners or coroners performing authorized duties.

  • For research approved by an Institutional Review Board (IRB).

  • For national security or military purposes.

  • For workers’ compensation claims.

  • To provide appointment reminders or inform you of services or treatment alternatives.

V. DISCLOSURES REQUIRING AN OPPORTUNITY TO OBJECT:

I may disclose your PHI to family members, friends, or others involved in your care or payment for your care unless you object. In emergencies, I may make these disclosures retroactively.

VI. YOUR RIGHTS REGARDING YOUR PHI:

1. Right to Request Restrictions

You may request that I not use or disclose your PHI for certain purposes. I’m not required to agree, but I will consider your request.

2. Right to Restrict Disclosure of Paid-in-Full Services

You can request that PHI not be disclosed to your health plan for services you paid for entirely out-of-pocket.

3. Right to Confidential Communications

You may request that I contact you in a specific way (e.g., only via email, or at work) and I will accommodate reasonable requests.

4. Right to Access Your Records

You may request an electronic or paper copy of your record (excluding psychotherapy notes). I will respond within 30 days and may charge a reasonable fee.

5. Right to an Accounting of Disclosures

You may request a list of disclosures made in the last six years (excluding treatment, payment, and operations). I will respond within 60 days.

6. Right to Amend Your Records

You may request corrections to your records. I may deny the request, but I will explain my reasons in writing.

7. Right to a Copy of This Notice

You have the right to a paper or electronic copy of this Notice, even if you received it electronically.