Notice of The Psychology Groups Policies and Practices to Protect the Privacy of Your Health Information
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
The Psychology Group (TPG) may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes. To help clarify these terms, here are some definitions:
● "PHI" refers to information in your health record that could identify you.
● "Treatment, Payment, and Health Care Operations"
Treatment is when TPG provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when a clinician consults with another health care provider, such as your family physician or another psychologist.
Payment is when TPG obtains reimbursement for your healthcare. Examples of payment are when TPG discloses 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 this 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 TPG's practice group, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
● "Disclosure" applies to activities outside of TPG's practice group, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
TPG may use or disclose PHI for purposes outside of treatment, payment, or 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 TPG is asked for information for purposes outside of treatment, payment or health care operations, TPG will obtain an authorization from you before releasing this information.
You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) TPG has 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
TPG may use or disclose PHI without your consent or authorization in the following circumstances:
● Child Abuse: If a clinician has reasonable cause to believe that a child is dependent, neglected or abused, the clinician must report this belief to the appropriate authorities, which may include the Kentucky Cabinet for Families and Children or its designated representative; the commonwealth's attorney or the county attorney; or local law enforcement agency or the Kentucky state police.
"Dependent child" means any child, other than an abused or neglected child, who is under improper care, custody, control, or guardianship that is not due to an intentional act of the parent, guardian, or person exercising custodial control or supervision of the child.
● Adult and Domestic Abuse: If a clinician has reasonable cause to believe that an adult has suffered abuse, neglect, or exploitation, the clinician must report this belief to the Kentucky Cabinet for Families and Children.
● Health Oversight Activities: The Kentucky Board of Examiners of Psychology may subpoena records from TPG relevant to its disciplinary proceedings and investigations.
● Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and records thereof, such information is privileged under state law, and TPG will not release information without the written authorization of 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. You will be informed in advance if this is the case.
● Serious Threat to Health or Safety of Others: If you communicate to a clinician an actual threat of physical violence against a clearly identified or reasonably identifiable victim or an actual threat of some specific violent act, the clinician has a duty to notify the victim and law enforcement authorities.
● Serious Threat to Health or Safety of Self: If you communicate to a clinician an actual threat of significant harm against self, the clinician may be obligated to proceed with a hospitalization, and if involuntary may release information in the course of such action.
● Workers' Compensation: If you file a claim for workers' compensation, you waive the psychotherapist-patient privilege and consent to disclosure of your health information reasonably related to your injury or disease to your employer, workers' compensation insurer, special fund, uninsured employers' fund or the administrative law judge.
IV. Patient's Rights and Psychologist's Duties
Clients are afforded the following rights:
● Right to Request Restrictions You have the right to request restrictions on certain uses and disclosures of protected health information. However, TPG is not required to agree to a restriction you request.
● Right 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 a therapist. On your request, TPG will send your bills to another address.)
● Right to Inspect and Copy You have the right to inspect or obtain a copy (or both) of PHI in TPG's mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. TPG may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, TPG 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. TPG may deny your request. On your request, TPG will discuss with you the details of the amendment process.
● Right to an Accounting You generally have the right to receive an accounting of disclosures of PHI. On your request, TPG will discuss with you the details of the accounting process.
● Right to a Paper Copy You have the right to obtain a paper copy of the notice from TPG upon request, even if you have agreed to receive the notice electronically.
Psychologists have the following duties:
● TPG is required by law to maintain the privacy of PHI and to provide you with a notice of legal duties and privacy practices with respect to PHI.
● TPG reserves the right to change the privacy policies and practices described in this notice. Unless TPG notifies you of such changes, however, TPG is required to abide by the terms currently in effect.
TPG revises its policies and procedures, TPG will notify you, if you are an
active client, either by mail or by written copy at the time of your next
session following the changes.
V. Questions and Complaints
If you have questions about this notice, disagree with a decision TPG makes about access to your records, or have other concerns about your privacy rights, you may contact Robert B. Hobson, Psy.D. at The Psychology Group, 1910 S. Virginia St. Ste. 200, Hopkinsville, KY 42240, telephone: 270-889-9200 .
If you believe that your privacy rights have been violated and wish to file a complaint with this office, you may send your written complaint to Robert B. Hobson, Psy.D. at The Psychology Group, 1910 S. Virginia St. Ste. 200, Hopkinsville, KY 42240, telephone: 270-889-9200 .
You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The persons listed above can provide you with the appropriate address upon request.
You have specific rights under the Privacy Rule. TPG will not retaliate against you for exercising your right to file a complaint.
This notice will go into effect on October 25, 2010.
TPG reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that TPG maintains. If an active client, TPG will provide you with a revised notice by mail or written copy during your next visit following the revision.4-2003