NOTICE OF PRIVACY PRACTICES
Effective Date: June 3, 2017
THIS NOTICE DESCRIBES HOW HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.
This notice covers the policies and procedures regarding information about you that is known to Psychology Everywhere. Psychology Everywhere will only know your name and contact details (your profile). If appointments are made through Psychology Everywhere, dates of appointments will be known to Psychology Everywhere. Details of your treatment are known only to your therapist. No notes or other records of your treatment are stored in the Psychology Everywhere system.
PERMITTED USES AND DISCLOSURES
We, Psychology Everywhere and your therapist, are required by law to maintain the privacy of your protected health information. Protected health information is information that could allow someone to identify you as the subject of the health information. We will not use or disclose your health information without your written authorization, except as explained in this Notice or as required by law. Certain laws may require that we disclose your health information without your written authorization and we are obligated to follow those laws. “Your information” means your protected health information. The term “disclose” means use and disclose.
HOW WE MAY DISCLOSE YOUR HEALTH CARE INFORMATION
Payment: Your information may be used to bill or receive payment for your appointments. This may include communication with credit card companies.
Individuals Involved in Your Care or Payment for Care: We may disclose your information to your family, friends or other persons identified by you when they are involved in your care or payment for your care.
As Required by Law: We will disclose your information as required by law.
To a Government Authority: We can disclose your information if you are the victim of abuse, neglect, or domestic violence under certain circumstances.
To Avert a Serious Threat to Health or Safety: We may disclose your information as necessary to prevent a serious threat to your health and safety or the health and safety of anyone else.
Judicial and Administrative Proceedings: We may disclose your information in response to a court or administrative order or in response to a subpoena, discovery request during litigation, or lawful process.
Law Enforcement: We may release health information if asked by a law enforcement official: (i) in response to a court order, subpoena, warrant, summons or similar process; (ii) to identify or locate a suspect, fugitive, witness, or missing person; (iii) about the victim of a crime under certain circumstances; (iv) about a death we believe may be the result of criminal conduct; (v) about criminal conduct on our premises; and (vi) to report a crime in an emergency.
OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
Other uses and disclosures of your information not covered in the previous sections of this Notice will only be made with your written authorization. You may revoke the authorization any time in writing. After you revoke your authorization, we will not disclose the information under the terms of the authorization. We cannot retrieve information disclosed with your permission.
You have the following rights regarding your information:
Disclosures: You have the right to request, in certain situations, a list of disclosures of your information for purposes other than treatment, payment and health care operations. You must submit your written request to Psychology Everywhere’s Privacy Officer for review. You may be charged the cost of providing the list. Once notified of the cost, you may withdraw or modify your request before costs are incurred.
Complaints: If you believe that your privacy rights have been violated, you may call Psychology Everywhere’s Privacy Officer at the phone number below or file a written complaint with Psychology Everywhere’s Privacy Officer. You may also send your complaint to the Secretary of the U.S. Department of Health and Human Services at the Office of Civil Rights. You will not be penalized for filing a complaint.
CHANGES TO THIS NOTICE We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as information we will receive. We will inform you of a change in this Notice by posting the changes on our website.
PRIVACY OFFICER INFORMATION
If you have any questions or would like additional information about Psychology Everywhere’s privacy practices, you may contact Psychology Everywhere’s Privacy Officer:
Jonathan Perez, Tel. 1-(612) 460-1497, PsychologyEverywhere.com, firstname.lastname@example.org