Office Policies
  1. Office Procedures and Policy Statement
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  2. This policy explains how the office may use and disclose information about you.  It also informs you of your rights as a patient/guardian.  Respecting your confidential and private medical/psychiatric information is very important in this office.  We work very hard to protect your privacy and preserve the confidentiality of your personal health information.  Federal rules and regulations are in place to help maintain the privacy of your medical/psychiatric record.  The law requires the office to give you this written notice, follow the terms of this notice, keep your medical/psychiatric information private, and only disclose patient information as is authorized or allowed by federal laws, rules, or regulations.  The office will keep a record of releases of information, and provide it to the patient upon request; in addition, the office must keep copies of all authorizations for at least six years.
    With your consent, the office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations.  Protected health information is the information we create and obtain in providing our services to you.  Such information may include documenting symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment.  It also includes billing documents for those services.  Examples of uses of your health information for treatment purposes are: 

  3. Staff obtains treatment information about you and records it in a health record.  During the course of your treatment, the doctor may determine that you need an EKG, medical procedure, laboratory test, or emergency evaluation.  He/she will share information with the doctor, or assistant, in order to get your tests completed or to permit emergency care in the case of an emergency assessment. 

  4. Examples of uses of your health information for payment purposes: 

  5. Submission of information for payment to your health insurance company.  The health insurance company or business associate helping us obtains payment requests information from us regarding your medical care given.  We will provide information to them about you and the care given. 

  6. Examples of uses of your health information for health care operations: 

  7. We may obtain services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, billing services, mailing services, and insurance. 

  8. We will share information about you with such business associates as necessary to obtain these services. Those business associates must maintain your confidentiality by law as well.


  10. You have the right to have your medical and psychiatric information kept private.

  11. You have the right to limit the release of information to only that information authorized and to only those individuals authorized to receive the information.  Authorizations are required for most all disclosures of psychiatric information including but not limited to general requests for information, transfers of care to another doctor, psychotherapy notes, life and disability insurance policy applications, and workman’s compensation claims.  You may sign a written request in our office.  

  12. You have a right to request that communication of your health information be made by alternative means or at an alternative location.   You may deliver a written request to our office.

  13. While you have the right to revoke any authorization at any time, you must understand that your doctor may have already used or disclosed information about you at the time you revoke authorization. Canceling an authorization would not affect the information already used or disclosed. 

  14. You have the right to a history of all disclosures of your private medical/psychiatric information.  You may deliver a written request to our office.  

  15. You have the right to review, read, and have a copy of your medical/psychiatric record upon request.  (Our office procedures do allow us to bill you for the records, and allow us up to 30 days to copy those records stored on site for you.  Up to 60 days is allowed for those records that are in long-term storage.)  Access to part of the medical record may be denied because psychotherapy records are considered private protected records.  If you have any questions about this possibility, please ask your provider. 

  16. You have the right to complain to us, your health plan, or to the Department of Health and Human Services concerning any violation of privacy. 

  17. You have the right to exercise any of the above rights by contacting the office manager (privacy officer) in person or in writing during normal business hours.  She will provide you with assistance on the steps to take to exercise your rights. 

  18. You have the right to review the Privacy Policies and Procedures before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes. 

  19. You also have the right to request amendments to your record.


  21. We must maintain the privacy of your health information as required by law.

  22. We must provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you. 

  23. We must abide by the terms of this notice. 

  24. We must notify you if we cannot accommodate a requested restriction or request.

  25. We must accommodate your reasonable requests regarding methods to communicate health information with you. 

  26. We must accommodate your request for an accounting or history of disclosures. 

  27. We reserve the right to amend, change, or eliminate provisions in our privacy policy and access practices and to enact new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our notice.  

  28. You are entitled to receive a revised copy of the notice by calling and requesting a copy of our notice or by visiting our office and picking up a copy.  We have the right to apply any new changes for all medical/psychiatric information kept, including information created before the changes. 

  29. We have the right to disclose limited information to protect your well-being and others if we believe you are abusing prescription medications. 

  30. We have the right to disclose limited information to protect your well being should you require emergent hospitalization for psychiatric or other medical reasons. 

  31. We have the right to disclose limited information if national, state, or local governmental security is threatened in any manner. 

Experience is that marvelous thing that enables you recognize a mistake

     when you make it again. -- F. P. Jones