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PERSOMA P.C. is concerned about the privacy of each person seeking our services and seeks to protect the confidentiality of each person within the boundaries of the law. PERSOMA P.C. abides by the strict ethical standards of the American Psychological Association (www.apa.org) and all applicable federal and state confidentiality regulations. In 1996, Congress passed The Health Insurance Portability and Accountability Act (HIPAA) with the intention of protecting the privacy of consumers of healthcare services. The “Notice of Privacy Practices” listed below is PERSOMA P.C.’S policy in compliance with the HIPAA regulations. Please feel free to discuss any questions that you may have about privacy of your healthcare information with your therapist.

Notice of Privacy Practices (NPP)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY PERSOMA P.C.(hereafter referred to as “The Practice”) AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Privacy is a very important concern for all those who come to this office. It is also complicated because of the federal and state laws and our professional ethics. Because the rules are so complicated, some parts of this Notice are quite detailed and you probably will have to read them several times to understand them. You may speak with your therapist or contact our privacy officer if you have questions.

A. Introduction

This notice tells you how we handle information about you. It tells how we use this information here in this office, how we share it with other professionals and organizations, and how you can see it. We want you to know all of this so that you can make the best decisions for yourself and your family. We are also required to tell you about this because of the privacy regulations of a federal law, The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Because this law and the laws of this state are very complicated, we have simplified some parts.

B. What we mean by your medical information

Each time you visit The Practice or any doctor’s office, hospital, clinic, or any other “healthcare provider,” information is collected about you and your physical and mental health. It may be information about your past, present or future health or conditions, or the treatment or other services that you received from us or from others, or about the payment for healthcare. The information that we collect from you is called, in the law, PHI, which stands for Protected Health Information. This information goes into your medical or healthcare record or file at the office. In this office, PHI is likely to include the following kinds of information:

  • Your history-childhood, school, work, relationships, marriage, etc.
  • Reasons that you came for treatment
  • Diagnoses
  • Treatment Plan
  • Progress Notes- notes about each session and meeting your treatment goals
  • Records that we receive from others who have treated you
  • School Records
  • Information about medications that you are taking
  • Legal Matters
  • Billing and Insurance Information

This list is just to give you an idea and there may be other kinds of information that go into your healthcare record here.

We use this information for many purposes. For example, we may use it:

  • To plan your care and treatment
  • To decide how well our treatments are working for you
  • When we talk with other healthcare professionals, who are also treating you such as your family doctor or the professional who referred you to us
  • To show that you actually received the services fro us which we billed to you or to your health insurance company
  • For teaching and training other healthcare professionals
  • For medical or psychological research
  • To improve the way we do our job by measuring the results of our work

When you understand what is in your record and how the information is used, you can make better decisions about who, when and why others should have this information.

Although your PERSOMA P.C. health record is the physical property of PERSOMA P.C., the information in the record belongs to you. You can read it. If you want a copy, we can make one for you but may charge you for the costs of copying ( and mailing if you want it mailed to you). In some very unusual situations, you cannot see all of what is in your records. If you find anything in your records that you think is incorrect or missing, you can ask us to amend (add information to) your record. In some instances, we do not have to agree to do that.

C. Privacy and the laws

The HIPAA law requires us to keep your PHI private and to give you this notice of our legal duties and our privacy practices which is called the Notice of Privacy Practices or NPP. We will obey the rules of this notice as long as it is in effect but if we change it, the rules of he new NPP will apply to all the PHI information that we keep. If we change the NPP, we will post the new Notice in our office where everyone can see it. It will also be posted on our website at www.persoma.com.

D. How your protected health information can be used and shared

When your information is read by your therapist or others in The Practice, that is called, in the law, “use.” If the information is shared with or sent to others outside PERSOMA P.C., that is called in the law, “disclosure.” Except in special circumstances, when we use your PHI here or disclose it to others we share only the minimum necessary PHI needed for the purpose. The law gives you the rights to know about your PHI, how it is used and to have a say in how it is disclosed and so we will tell you about what we do with your information.

We use and disclose PHI for several reasons. Mainly, we will use and disclose (share) it for routine purposes and we will explain more about these below. For other uses we must tell you about them and have a written authorization from you unless the law allows or requires us to make the use or disclosure without your authorization. However, the law also says that we are allowed to make some uses and disclosures without your consent or authorization.

1. Uses and disclosures of PHI in healthcare with your consent

After you have read this Notice , you will be asked to sign a separate Consent form to allow us to use and share your PHI. In almost all cases we intend to use your PHI here or share your PHI with other people or organizations to provide treatment to you, arrange for payment for our services, or some other business functions called health care operations. Together these routine purposes are called TPO and the Consent form allows us to use and disclose your PHI for TPO.

1a. For treatment, payment, or healthcare operations

We need information about you and your condition to provide care to you. You have to agree to let us collect the information and to use it and share it as necessary to care for you properly. Therefore, you must sign the Consent form before we begin to treat you because if you do not agree and consent, we cannot treat you.

When you first come to see us, your therapist will collect information about you and all of it may go into your healthcare records at PERSOMA P.C. Generally, we may use or disclose your PHI for three purposes: treatment, obtaining payment, and what are called healthcare operations:

For Treatment

We use your medical information to provide you with psychological treatment or services. These might include individual, marital, family or group therapy, psychological, educational, or vocational testing, treatment planning or measuring the effects of our services.

We may share or disclose your PHI to others who provide treatment to you. We are likely to share your information with your personal physician. If you are being treated by a team, we can share some of your PHI with them so that the services you receive will be coordinated. They will also enter their findings, the actions they took, and their plans into your record and so we all can decide what treatments work best for you and make up a Treatment Plan. We may refer you to other professionals or consultants for services that we can not offer. When we do this, we need to tell them some things about you and your conditions. We will receive their findings and opinions and those will go into your records here. If you receive treatment in the future from other professionals, we can also share your PHI with them. These are some examples of how we share and disclose your PHI for treatment.

For Payment

We may use your information to bill you, your insurance, or others to be paid for the treatment we provide to you. We may contact your insurance company to check on exactly what your insurance covers. We may have to tell them about your diagnoses, what treatments that we propose and those that you have received, and what we expect as we treat you. We will need to tell them information about when we met, your progress and other similar information.

For Healthcare Operations

There are some other ways we may use or disclose your PHI which are called health care operations. For example, we may use your PHI to see where we can make improvements in the care and services we provide. We may be required to supply some information to some government health agencies so they can study disorders and treatment and make plans for services that are needed. If we do, your name and identity will be removed from what we send.

1b. Other uses in healthcare

Appointment Reminders – We may use and disclose medical information to reschedule or remind you of appointments for treatment or other care. If you want us to call or write to you only at your home or work or prefer another way to reach you, we usually can arrange to do that. Just tell us.

Treatment Alternatives – We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of interest to you.

Other Benefits and Services – We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.

Research – We may use or share information to do research to improve treatments. In all cases, your name, address and other information that reveals who you are will be removed from the information given to researchers. If they need to know who you are, we will discuss the research project with you and you will have to sign a special Authorization form before any information is shared.

Business Associates – There are some jobs that we hire other businesses to do. They are called Business Associates in the law. These include accountants, copying services, billing services, etc. These business associates need to receive some of your PHI to do their job properly. To protect your privacy, they have agreed in their contract with us to safeguard your information.

2. Uses and disclosures requiring your Authorization

If we want to use your information for any purpose besides the TPO or those we described above, we need your permission on an Authorization form. We don't expect to need this very often.

If you do authorize us to use or disclose your PHI, you can revoke (cancel) that permission, in writing, at any time. After that time, we will not use or disclose your information for the purposes that we agreed to. Of course, we cannot take back any information that we have already disclosed with your permission or that we had used in our office.

3. Uses and disclosures of PHI from mental health records Not Requiring Consent or Authorization

The law allows or requires us to use and disclose some of your PHI without your consent or authorization in some cases.

a. When required by law

There are some federal, state, or local laws which require us to disclose PHI.

  • We have to report suspected child abuse
  • If you are involved in a lawsuit or legal proceeding and we receive a subpoena, discovery request, or other lawful process, we may have to release some of your PHI. We will only do so after trying to tell you about the request, consulting with your lawyer, or trying to get a court order to protect the information they requested.
  • We have to release (disclose) some information to the government agencies which check on us to see that we are obeying the privacy laws.

b. For Law Enforcement Purposes

We may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.

c. For public health activities

We might disclose some of your PHI to agencies which investigate diseases or injuries.

d. For specific government functions

We may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment, to Workers’ Compensation Programs, to correctional facilities if you are an inmate, and for national security reasons.

e. To prevent a serious threat to health and safety

If we come to believe that there is a serious threat to your health or safety or that of another person or the public we can disclose some of your PHI. We will only do this to persons who can prevent danger.

4. Uses and disclosures requiring you to have an opportunity to object

We can share some information about you and your family or close significant others. We will only share information with those involved in your care and anyone else you choose such as close friends or clergy. We will ask you about who you want us to tell what information about your condition or treatment. You can tell us what you want and we will honor your wishes as long as it is not against the law.

5. An accounting of disclosures

When we disclose your PHI we keep some records of to whom they were sent, when we sent them, and what was sent. You can get an accounting of many of these disclosures.

E. If you have questions or problems

If you need more information or have questions about the privacy practices described above, please speak to your therapist. If your therapist cannot answer your questions, you will be asked to speak to PERSOMA P.C.'s Privacy Officer listed below. If you have a problem with how your PHI is being handled or if you believe your privacy rights have been violated, contact the Privacy Officer. You have the right to file a complaint with us and with the Secretary of the Federal Department of Health and Human Services. We promise that we will not in any way limit your care here or take any actions against you for this complaint.

If you have questions regarding this notice or our health information privacy policies, please contact our Privacy Officer, who is James R. Long Ph.D., and can be reached by telephone at 412-823-5155, extension 612, or by e-mail at jlong@persoma.com.

The effective date of this notice is April 14, 2003.