Request appointment

HIPAA Notice of Privacy Practices

Thriving Center of Psychology (Thriving Mind Psychology, PLLC (Massachusetts, Minnesota, Nevada, New York Psychology Services,Oregon, Washington D.C, Illinois), LA Performance Psychology, PC (Nebraska, Texas, Washington, California Psychology Services), Thriving Center of Psychology, LLC (Florida), Thriving Center for Psychology NJ, LLC (New Jersey), Thriving Center of Psychology NM, LLC (New Mexico), Thriving Mind Psychiatry, PLLC (New York Psychiatry), Thriving Center of Psychiatry, PC (California Psychiatry)

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I 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 by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of my legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in the diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

  • Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
    a. For my use in treating you.
    b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
    c. For my use in defending myself in legal proceedings instituted by you.
    d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
    e. Required by law and the use or disclosure is limited to the requirements of such law.
    f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
    g. Required by a coroner who is performing duties authorized by law.
    h. Required to help avert a serious threat to the health and safety of others.
  • Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
  • Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

  • When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
  • For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
  • For health oversight activities, including audits and investigations.
  • For judicial and administrative proceedings, including responding to a court or administrative order, my preference is to obtain Authorization from you before doing so.
  • For law enforcement purposes, including reporting crimes occurring on my premises.
  • To coroners or medical examiners, when such individuals are performing duties authorized by law.
  • For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
  • Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
  • For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
  • Appointment reminders and health-related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

  • Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or another person that you indicate is involved in your care or the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

  • The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
  • The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
  • The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.
  • The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
  • The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
  • The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on September 20, 2017

Acknowledgment of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

Patient Rights

YOUR PATIENT RIGHTS

Welcome to our Practice. We respect our patients’ dignity and pride.

This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan. If you have any questions, please contact the Practice/Clinic leadership.

Our commitment to you, our patient, includes the following rights. We comply with applicable Federal civil rights laws and affirm that we will deliver high-quality health care to every patient without regard to:

age, gender, disability, race, color, ancestry, citizenship, religion, pregnancy, sexual orientation, gender identity or expression, national origin, health condition, marital status, veteran status, payment source or ability, or any other basis prohibited by federal, state, or local law

Considerate and Respectful Care

  • Fair, high-quality, safe and professional care
  • Care regardless of color, race, religion, creed, etc.
  • Consideration, respect, and recognition of you and your individuality
  • Treatment privacy
  • Safe environment
  • Private and discreet consultation, exam, and care.

Health Status and Care

  • Be informed of your health status in terms and / or language that you, your family, and caregivers can be expected to understand
  • Take part and be active in your care and treatment plan
  • Participate in decisions in your care, unless your doctors or others believe it is harmful to you
  • Know, be told, and understand:
  • the names, roles, and qualifications of your health care experts that provide your care
  • your follow-up care
  • risks, benefits and side effects of all medicines and treatment procedures for your diagnoses
  • innovative or experimental medicines and treatment procedures of diagnosis offered
  • alternative treatment options offered
  • your procedure and to “give informed consent” before it begins
  • possible outcomes of your care and treatment
  • When and if the Practice recommends other health care institutions:
  • to participate in your care
  • to know who these other health care places are and what they will do
  • to refuse their care
  • Get help from the doctor and others for follow-up care, if available
  • To change providers or get a second opinion, including specialists at your request and expense

Decision Making and Notification

  • Choose a person to be your health care representative or decision-maker
  • Exclude those you do not want help from or to join in your care or decisions
  • Ask for, but not have the right to demand, services the Practice does not think are needed or appropriate
  • Refuse treatment
  • Be included in experimental research only with your written consent
  • Refuse experimental research including new drug and medical device investigations
  • Receive the information necessary to approve a treatment or procedure
  • Give consent to a procedure or treatment

Access to Services

  • Have access to our facility buildings and grounds in compliance with The Americans with Disabilities Act, a law that stops discrimination against people with disabilities.  The ADA policy is available upon request
  • Prompt and reasonable response to questions and requests for service

Protective Service

  • Receive available protective and advocacy services
  • Receive, as offered by state law:
  • care and treatment for mental illness or development disability
  • all legal and civil rights as a citizen
  • Understand and expect emergency procedures without unneeded delay within Practice scope
  • Get needed information to approve a treatment or procedure
  • Be given the Practice’s policies and procedures for:
  • Initiation, review, resolution of patient complaints, including the address and phone number to file complaints
  • Discuss complaints, issues, or problems regarding discrimination in access to services with your doctor and/or the Practice management team/ Equity Compliance Coordinator at (352) 332-0902. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Equity Compliance Coordinator is available to help you.
  • File a complaint with the Ethics Line (1-800-994-6610), the Department of Health and Human Services*, Office of Civil Rights* or others with your concerns about patient abuse, neglect, misuse of your property at the Practice, other unresolved complaints, patient safety, and quality concerns
  • Have a fair review of alleged patient right violations

*Contact information for HHS or OCR: US. Department U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html or https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

YOUR PATIENT RESPONSIBILITIES

You are an important and active member of your care plan. You have certain responsibilities to yourself and to your care team.

In the spirit of shared trust and respect, we ask you to:

  • Give true and complete information about your:
  • Health status
  • Medical history
  • Hospitalizations
  • Medicines
  • Other matters about your health
  • Contact information, family members and caregivers and other needed information
  • Let us know

o any risks about your care

o Changes in your care, illness, or injury

o Safety concerns

o Violation of your patient rights

o If you understand your care plan and what we expect from you

o If you don’t understand your care plan or its information

o If you have or need to ask questions

Please:

  • Follow your care plan and instructions created by your doctor, nurses or other health care team members
  • Keep appointments and, if you cannot make your appointments, let us know at a minimum 24 hours before your appointment
  • Be responsible for your actions if you refuse care or don’t follow doctor’s orders
  • Pay your health care bills in a timely manner
  • Follow practice procedures, rules and regulations
  • Be respectful of yourself and our staff
  • Treat the doctor and our health care staff with respect and consideration
  • Accept that bad language or behavior is not tolerated and may be grounds for dismissal
  • Accept we may end our relationship if you do not follow your doctor’s orders or care plan