privacy

HIPAA PRIVACY POLICY

HIPAA NOTICE OF PSYCHOLOGIST’S POLICIES AND PRIVACY PRACTICES OF YOUR HEALTH INFORMATION THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN HAVE ACCESS TO THIS INFORMATION. 

PLEASE REVIEW IT CAREFULLY. 

The terms of this HIPAA Notice of Psychologist’s Policies and Privacy Practices of Your Health Information (“Notice”) applies to me (Renèe Y. Moore, Psy.D.), my affiliates and administrative staff. I create and maintain treatment records that contain individually identifiable health information about you. These records are generally referred to as “medical records” or “mental health records,” and this notice, among other things, concerns the privacy and confidentiality of those records and the information contained therein.  

The term “medical Information” is synonymous with the terms “protected health information” and “personal health information” for purposes of this notice. This can be any individually identifiable health information, (either directly or indirectly identifiable), whether oral or recorded in any form or medium, that is created or received by a health care provider (me), health plan, or others, and relates to the past, present, or future physical or mental health or condition of a patient (you); the provision of health care (e.g., mental health) to you; or the past, present, or future payment for the provision of health care to you. 

I may use and/or share protected health information (PHI) of patients as necessary to carry out “Treatment, Payment, and Health Care Operations.” 
  •  “Treatment” is when I provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, such as a primary care physician, psychiatrist, or another psychologist. 
  •  “Payment” is when I obtain reimbursement for your health care. Examples of payment are when I 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 my 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. 
  • “Use” applies only to activities within my office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. 
  • “Disclosure” applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties. 
 
PSYCHOLOGIST’S DUTIES 
I am required by law to maintain the privacy of my patients' PHI and to provide patients with notice of my legal duties and privacy practices with respect to PHI. I also am required to inform you that there may be a provision of state law that relates to the PHI that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act (“HIPAA”). I am required to abide by the terms of this Notice for as long as it remains in effect. I reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all protected health information maintained. If I revise my policies and procedures, I will post the Notice in my office as well as on my website (www.reneeymoore.com). Copies are also available upon request.  

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION 
Authorization and Consent: I may use or disclose your protected health information (“PHI”) for treatment, payment or health care operations purposes with your consent. The “consent” is given when you sign the Psychotherapist-Patient Agreement Consent form. You have the right to revoke such authorization in writing, with such revocation being effective once I actually receive it in writing; however, such revocation shall not be effective to the extent that I have taken any action in reliance on the authorization, or if the authorization was obtained as a condition of obtaining insurance coverage, or if law provides the insurer with the right to contest a claim under the policy or the policy itself.  

Uses and Disclosures for Treatment: I will make uses and disclosures of your PHI as necessary for your treatment. I will limit the uses or disclosures that I make to the minimum necessary.  

Uses and Disclosures for Payment: I will make uses and disclosures of your PHI as necessary for payment purposes. During the normal course of business operations, I may forward information regarding your mental health treatment to your insurance company to arrange payment for the services provided to you. I may also use your information to prepare a bill to send to you or to the person responsible for your payment. 

Uses and Disclosures for Health Care Operations: I will make uses and disclosures of your PHI as necessary, and as permitted by law, for my health care operations, which may include clinical improvement, professional peer review, business management, licensing, etc. For instance, I may use and disclose your PHI for purposes of improving clinical treatment and patient care.  

Business Associates: Certain aspects and components of my services are performed through contracts with outside persons or organizations, such as insurance auditing, etc. At times it may be necessary for me to provide your protected health information to one or more of these outside persons or organizations who assist me with my health care operations. In all cases, I require these associates to appropriately safeguard the privacy of your information.  

Appointments and Services: I may contact you to provide appointment updates or information about your treatment. You have the right to request and I will accommodate reasonable requests by you to receive communications regarding your protected health information from me by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, I will accommodate reasonable requests. With such request, you must provide an appropriate alternative address or method of contact.  

DISCLOSURES REQUIRING AUTHORIZATION 
I may disclose PHI for purposes of treatment, payment, or health care operations with your Authorization. I may also disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An “authorization” is written permission for specific disclosures, above and beyond the general “consent.” In those instances, when I am asked for information for purposes outside of treatment, payment or health care operations, I will obtain an authorization from you before releasing this information. I will also need to obtain an authorization before releasing your Psychotherapy Notes. “Psychotherapy Notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all 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 I have relied on that authorization; or if the authorization was obtained as a condition of obtaining insurance coverage, or if law provides the insurer the right to contest the claim under the policy.  

OTHER USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION 
I may use or disclose PHI without your consent or authorization in the following circumstances: 
  • Child Abuse or Neglect – If I know or suspect that a child is a victim of child abuse or neglect, or has been subjected to physical, sexual or emotional abuse, I am required to report the abuse or neglect to a duly constituted authority. 
  • Adult and Domestic Abuse or Neglect – If I have reasonable cause to believe that an adult, who is unable to take care of himself or herself, and/or has been subjected to physical abuse, neglect, exploitation, sexual abuse, or emotional abuse, I must report this belief to the appropriate authorities.  
  • Serious Threat to Health or Safety – I may disclose PHI to the appropriate individuals if I believe in good faith that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another identifiable person(s).  
  • Health Oversight Activities – If the Alabama Board of Examiners in Psychology is conducting an investigation into my practice, then I am required to disclose PHI upon receipt of a subpoena from the Board. 
  • Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information about your diagnosis, treatment, and/or the records thereof, such information is privileged under state law, and I will not release information without the written authorization from you or your 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. You will be informed in advance if this is the case.  
  •  Worker’s Compensation – I may disclose PHI as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work related injuries or illness without regard to fault.  

RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION 
Access to Your Protected Health Information: You have the right to request in writing a copy of and/or to inspect PHI in the mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. You may inspect and copy Psychotherapy Notes unless I make a clinical determination that access would be detrimental to your health. On your request, I will discuss with you the details of the request and denial process. 

Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. You have the right to request in writing that protected health information that we maintain about you be amended or corrected. I may deny your request to make requested amendments, but I will give each request careful consideration. 

All amendment requests, must be in writing, signed by you or legal representative, and must state the reasons for the amendment/correction request. You may obtain an “Amendment of Protected Health Information Form” in my office.  

Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request in writing restrictions on certain uses and disclosures of your PHI. However, I am not required to agree to a restriction that you request. If I agree to any discretionary restrictions, I reserve the right to remove such restrictions as I see appropriate. I will notify you if I remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw any restriction by communicating your desire to do so to me in writing.  

Paper Copy of this Notice: You have a right to request in writing, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice.
  
Right to Notice of Breach: I take very seriously the confidentiality of my patients’ information, and I am required by law to protect the privacy and security of your protected health information through appropriate safeguards. I will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to take to protect yourself.  

Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI. On your request, I will discuss with you the details of the accounting process. Requests must be made in writing and signed by you or your legal representative. "Accounting of Disclosures Request Forms" are available in my office. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12- month period. You will be notified of the fee at the time of your request.  

Complaints: If you believe your privacy rights have been violated, you may contact me (Privacy Officer/Contact Person) by filing a complaint in writing that specifies the manner in which you believe the violation occurred, the approximate date of such occurrence, and any details that you believe will be helpful to me. I will not retaliate against you in any way for filing a complaint with me or with the Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights. Complaints with the Secretary must be filed in writing and sent to: Secretary of the U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Ave., S.W., Room 509F, HHH Building, Washington, D.C. 20201. 

For Further Information: If you need further information or have questions related to this Notice or its contents, please feel free to contact me. As the Privacy Office/Contact Person for my practice, I will do my best to answer any questions, you may have. This HIPAA Notice of Psychologist’s Policies and Privacy Practices of your Health Information is available on my website (www.reneeymoore.com). This Notice is also available upon request.  
This Notice first became effective on January 20, 2023. 
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