of Privacy Practices
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Uses and
Disclosures for Treatment, Payment, and Health Care Operations
providers may use or disclose your protected health
information (PHI), for treatment,
payment, and health care operations purposes with your consent.
To help clarify these terms, here are some definitions:
refers to information in your health record that could identify you.
Payment and Health Care Operations
Treatment is when we provide,
coordinate or manage your health care and other services related to your health
care. An example of treatment would be when we consult with another health care
provider, such as your family physician or another psychologist.
Payment is when we obtain
reimbursement for your healthcare. Examples of payment are when we disclose your PHI
to your health insurer to obtain reimbursement for your health care or to
determine eligibility or coverage.
Health Care Operations are activities
that relate to the performance and operation of our practice.
Examples of health care operations are quality assessment and improvement
activities, business-related matters such as audits and administrative services,
and case management and care coordination.
applies only to activities within practice group such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you.
applies to activities outside of our practice group such as releasing,
transferring, or providing access to information about you to other parties.
Uses and Disclosures Requiring Authorization
may use or disclose PHI for
purposes outside of treatment, payment, and health care operations when your
appropriate authorization is obtained. An authorization
is written permission above and beyond the general consent that permits only
specific disclosures. In those
instances when we are asked for information for purposes outside of treatment,
payment and health care operations, we will obtain an authorization from you
before releasing this information. We
will also need to obtain an authorization before releasing your psychotherapy
notes. Psychotherapy notes are
notes we have made about our conversation during a private, group, joint, or
family counseling session, which we have kept separate from the rest of your
medical record. These notes are
given a greater degree of protection than PHI.
may revoke all such authorizations (of PHI
or psychotherapy notes) at any time, provided each revocation is in
writing. You may not revoke an authorization to the extent that (1) we have
relied on that authorization; or (2) if the authorization was obtained as a
condition of obtaining insurance coverage, and the law provides the insurer the
right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization
may use or disclose PHI without
your consent or authorization in the following circumstances:
Abuse: If we
have cause to believe that a child has been, or may be, abused, neglected, or
sexually abused, we must make a report of such within 48 hours to the Texas
Department of Protective and Regulatory Services, the Texas Youth Commission, or
to any local or state law enforcement agency.
and Domestic Abuse: If
we have cause to believe that an elderly or disabled person is in a state of
abuse, neglect, or exploitation, we must immediately report such to the
Department of Protective and Regulatory Services.
Oversight: If a
complaint is filed against one of our providers with the State Board governing
their license, they have the authority to subpoena confidential mental health
information from us relevant to that complaint.
If you are a parent of an unemancipated minor, and are acting as the minors
personal representative, we may disclose protected health information to you
under certain circumstances. An exception to this is if your child is legally
authorized to consent to treatment (without separate consent from you), consents
to such treatment, and does not request that you be treated as his or her
or Administrative Proceedings: If
you are involved in a court proceeding and a request is made for information
about your diagnosis and treatment and the records thereof, such information is
privileged under state law, and we will not release information, without written
authorization from you or your personal or legally appointed representative, or
a court order. The privilege does
not apply when you are being evaluated for a third party or where the evaluation
is court ordered; in a judicial proceeding affecting the parent-child
relationship; a judicial proceeding relating to a will if the clients
physical or mental condition is relevant to the execution of the will; or in any
criminal proceeding as provided by law.
Threat to Health or Safety: If
we determine that there is a probability of imminent physical injury by you to
yourself or others, or there is a probability of immediate mental or emotional
injury to you, we may disclose relevant confidential mental health information
to family members, medical or law enforcement personnel.
National Security and Intelligence Activities, Protection of the President:
disclose your protected health information for specialized government functions
as authorized by law; determination of veterans benefits; requests as
necessary by appropriate military commanding officers (if you are in the
military); authorized national security and intelligence activities, as well as
authorized activities for the provision of protective services for the President
of the United States, other authorized government officials, or foreign heads of
state; and the health, safety, and security of correctional institutions.
and Drug Administration:
We may disclose health information about you to the
FDA, or to an entity regulated by the FDA, in order to report an adverse event
or a defect related to a drug or medical device.
We may disclose
health information about you for research purposes in accordance with our legal
obligations. We may disclose health information without a written authorization
if an Institutional Review Board (IRB) has reviewed the research study and
determined that the information is necessary for the research and will be
adequately safeguarded. The information may be given to the FDA or other
government agencies as part of applications to gain approval of new medications
or to meet other reporting requirements such as reporting side effects.
Medical Examiners, and Funeral Directors: We
may release your health information to a coroner or medical examiner to identify
a deceased or cause of death. Further,
we may release your health information to a funeral director where such
disclosure is necessary for the director to carry out his duties.
By Law: We
may disclose protected health information about you as required by federal,
state, or other applicable law.
§ Workers Compensation: If you file a worker's compensation claim, we may disclose records relating to your diagnosis and treatment to your employers insurance
Patient's Rights and Providers Duties
to Request Restrictions You
have the right to request restrictions on certain uses and disclosures of
protected health information about you. However, we are not required to agree to
a restriction you request.
to Receive Confidential
Communications by Alternative Means and at Alternative Locations
You have the right to request and receive confidential communications of PHI
by alternative means and at
alternative locations. (For example, you may not want a family member to know
that you are seeing one of our providers. Upon
your request, we will send your bills to another address.)
to Inspect and Copy
You have the right to inspect or obtain a copy or a summary of PHI and
psychotherapy notes in our mental health and billing records used to make
decisions about you for as long as the PHI
is maintained in the record. Texas law requires that requests for copies
be made in writing and we ask that requests for inspection of your health record
also be made in writing. We may deny your access to PHI
under certain circumstances, but in some cases you may have this decision
reviewed. On your request, we will discuss with you the details of the request
and denial process. Please direct all written requests to :
Psychiatry Associates, P.A.
Attn: Karen Ward
17115 Red Oak Drive, Suite 109
Houston, TX 77090
law requires that we provide copies or a summary or a written denial within 15
days of your request. We are allowed to charge a reasonable cost based fee per
You have the right to request an amendment of PHI
for as long as the PHI is
maintained in the record. You must make your request in writing to:
Red Oak Psychiatry Associates, P.A.
Attn: Karen Ward
17115 Red Oak Drive, Suite 109
Houston, TX 77090
will respond within 60 days. We may deny your request if the information
wasnt created by this practice or the physicians here in this practice, if it
is not part of the designated record set, is not available because of an
appropriate denial, or if the information is accurate and complete.
Even if we refuse to allow an amendment you are permitted to include a
patient statement about the information at issue. On your request, we will
discuss with you the details of the amendment process.
to an Accounting
You generally have the right to receive an accounting of disclosures of PHI
for which you have neither provided consent nor authorization (as
described in Section III of this Notice). On
your request, we will discuss with you the details of the accounting process.
to a Paper Copy
You have the right to obtain a paper copy of the notice from us upon request,
even if you have agreed to receive the notice electronically.
required by law to maintain the privacy of PHI
and to provide you with a notice of our legal duties and privacy
practices with respect to PHI.
your privacy we will not discuss your personal or billing information at our front check-in window. Please discuss these issues with
your clinician or our business office located in Suite 101A. All phone calls
regarding these issues will be forwarded to the appropriate individual.
the right to change the privacy policies and practices described in this notice.
Unless we notify you of such changes, however, we are required to abide by the
terms currently in effect.
If we revise
our policies and procedures, we will promptly distribute the revised Notice,
post it in the waiting area of our office, post it to our website, and make
copies available to our patients and others.
you are concerned that we have violated your privacy rights, or you disagree
with a decision we made about access to your records, you may speak to Karen
Ward, ext.172 , available in person or by phone during regular business
hours. A written complaint should be sent to:
Oak Psychiatry Associates, P.A.
Red Oak Drive, Suite 109
may also send a written complaint to the Secretary of the U.S. Department of
Health and Human Services (HHS), Office for Civil Rights, U.S. Department of
Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH
Building, Washington, D.C. 20201: or by calling (800) 368-1019; or by sending an
VI. Psychotherapy Notes
the course of your care with us, you may receive treatment from a mental health
professional who keeps separate notes during the course of your therapy sessions
about your conversations. These notes, known as psychotherapy notes, are
kept apart from the rest of your medical record. They can contain details of
your therapeutic conversation or especially sensitive material, as well as
hunches or impressions about your therapy. Basic information such as your
medication treatment record, counseling session start and stop times, the types
and frequencies of treatment you receive, or your test results must be in your
clinical record. Your clinical record will also include any summary of your
diagnosis, condition, treatment plan, symptoms, prognosis, or treatment
notes may be disclosed by a therapist only after you have given written
authorization to do so. (Limited exceptions exist, e.g. in order for your
therapist to prevent harm to yourself and others, and to report child
abuse/neglect.) You cannot be required to authorize the release of your
psychotherapy notes in order to obtain health insurance benefits for your
treatment, or enroll in a health plan. Psychotherapy notes are also among the
records that you may request to review or copy, unless we judge it would be
harmful to yourself or others. If you have any questions, feel free to discuss
this subject with your therapist.
notice will go into effect on April 14, 2003.
We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. The amended terms shall apply to all health information that we maintain, including information about you collected or obtained before the effective date of the revised information. We will provide you with a revised Notice by posting the revised Notice in the waiting are, on our website, and make copies available to our patients and others.
These pages are solely for public informational purposes. The information cannot be relied on to make diagnoses or prescribe treatment in any individual. Persons who require such services should consult with a licensed professional.
Send mail to firstname.lastname@example.org with questions or comments about this web site.
© 2000 Red Oak Psychiatry Associates, P.A. Updated