HIPAA: Notice of Privacy Practices
I. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
II. It is my legal duty to safeguard and Protect Health Information (PHI).
By law I am required to ensure that your PHI is kept private. PHI constitutes information created or noted by me that can be used to identify you. It contains data about your past, present, or future health or condition, the provision of health care services to you, or the payment for such services.
III. How I will use and disclose your PHI
A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent. I may use and disclose you PHI without your consent for the following reasons:
1. For Treatment. I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are otherwise involved in your care.
2. To obtain payment for treatment. I may use and disclose your PHI to bill and collect payment for the treatment and services I provided you.
3. Emergency Treatment. Your consent is not required if you need emergency treatment provided that I attempt to get consent after treatment is rendered.
B. Certain Other Uses and Disclosures Do NOT Require Your Consent. I may use and/or disclose your PHI without your consent or authorization for the following reasons:
1. When disclosure is required by federal, state, or local law, judicial, board, or administrative proceedings, or law enforcement.
2. If disclosure is compelled by a party to a proceeding before a court of an administrative agency pursuant to its lawful authority.
3. If disclosure is required by a search warrant lawfully issued to a governmental law enforcement agency.
4. If disclosure is compelled by the patient or the patient’s representative pursuant to Massachusetts Health and Safety Codes or to corresponding federal statutes of regulations, such as the Privacy Rules that requires this Notice.
5. To avoid harm. I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety of a person or the public.
6. If disclosure is compelled or permitted by the fact that you are in such mental or emotional condition as to be dangerous to yourself or other person or property of others, and if I determine that disclosure is necessary to prevent the threatened danger.
7. If disclosure is mandated by the Massachusetts Child Abuse and Neglect Reporting law. For example, if I have a reasonable suspicion of child abuse or neglect.
8. If disclosure is mandated by the Massachusetts Elder/Dependent Adult Abuse Reporting law. For example, if I have a reasonable suspicion of elder abuse or dependent adult abuse.
9. If disclosure is compelled or permitted by the fact that you tell me of a serious/imminent threat of physical violence by you against a reasonably identifiable victim or victims.
10. For public health activities.
11. For health oversight activities.
12. For specific government functions.
13. For research purposes. In certain circumstances, I may disclose PHI in order to conduct medical research.
14. For Workers’ Compensation purposes. I may provide PHI in order to comply with Workers’ Compensation laws.
15. For appointment reminders and health related benefits or services.
16. If an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena daces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel.
17. If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law.
18. If disclosure is otherwise specifically required by law.
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C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.
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D. Other Uses and Disclosures Require Your Prior Written Authorization.
In any other situation not described in Section IIIA, IIIB and IIIC above, I will request your written authorization before using or disclosing any of your PHI. Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that I haven’t taken any action subsequent to the original authorization) of your PHI by me.
IV What rights you have regarding your PHI
A. The right to see and get copies of your PHI.
B. The right to request limits on uses and disclosures of your PHI.
C. The right to choose how I send your PHI to you.
D. The right to get a list of the Disclosures I have made. You are entitled to a list of disclosures of your PHI that I have made. The list will not include uses or disclosures to which you have already consented, (for example, those for treatment, payment, or health care operations, sent directly to you, or to your family), neither will the list include disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before April 15, 2003. After April 15, 2003, disclosure records will be held for six years.
E. The right to amend your PHI. If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that I correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. If I find that the PHI is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of my records, or (d) written by someone other than me, I may deny your request that the PHI be corrected. My denial must be made in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and any denial be attached to any future disclosures of your PHI. If I approve your request, I will make the change(s) to your PHI. Additionally, I will tell you that the changes have been made, and I will advise all others who need to know about the change(s) to your PHI.
F. The right to get this notice by email. You have the right to get this notice via email. You have the right to request a paper copy of it as well.
V. How to complain about my privacy practices.
If in your opinion, I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Washington, D.C. 20201. If you file a complaint about my privacy practices, I will take no retaliatory action against you.
VI. Person to contact for information about this Notice or to complain about my privacy practices.
If you have any questions about this Notice or any complaints about my privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact me at: Baker Mental Health, 51 Union Street, Suite 214, Worcester, MA 01608.