NOTICE OF CONFIDENTIALITY AND PRIVACY PRACTICES
Notice of Psychologist's 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
New Perspectives Counseling and Consulting - The named private
practice and its owner, Dr. Robert Buzan. Unless otherwise
specified, the term "New Perspectives Counseling and Consulting,"
"New Perspectives," "NPCC," or "I" refers to this company and the
named psychologist owner.
I 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:
"PHI" refers to information in your health record that
concerns your condition or treatment, how your care is paid for
and demographic information, if such information can be used to
identify you.
Treatment is when I provide, coordinate, or manage
your health care and other services related to your health care.
An example of disclosure for treatment purposes would be when I
consult with another health care provider, such as your family
physician or another psychologist.
Payment is when I obtain reimbursement for your
healthcare. An example of disclosure for purposes of payment
would be to 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
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. Please note that,
while federal law does not require that I obtain
written authorization to use or disclose your PHI for treatment,
payment, or health care operations, my professional code of
ethics states that I do. I will therefore ask for your written
authorization, even though it is not legally required.
II. Uses and Disclosures Requiring
Authorization
I may use or disclose PHI for purposes outside of treatment,
payment, or health care operations with your specific
authorization. An "authorization" is written permission above and
beyond the general consent that permits only specific
disclosures. 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 we may 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. In all cases, I will only disclose the
minimum amount of PHI necessary to satisfy requests for PHI.
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) I have relied on that authorization; or (2)
if the authorization was obtained as a condition of obtaining
insurance coverage, law provides the insurer the right to contest
the claim under the policy.
III. 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 - I am required to report PHI to the
appropriate authorities when I have reasonable grounds to believe
that a minor is or has been the victim of neglect or physical
and/or sexual abuse.
Adult and Domestic Abuse - If I have the
responsibility for the care of an incapacitated or vulnerable
adult, I am required to disclose PHI when I have a reasonable
basis to believe that abuse or neglect of the adult has occurred
or that exploitation of the adult's property has occurred.
Health Oversight Activities - If the North Carolina
Board of Psychology is conducting an investigation, 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 the professional services I provided you and/or
the records thereof, such information is privileged under state
law, and I will not release information without the written
authorization of 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.
Serious Threat to Health or Safety - If you
communicate to me an explicit threat of imminent serious physical
harm or death to a clearly identified or identifiable victim(s)
and I believe you have the intent and ability to carry out such a
threat, I have a duty to take reasonable precautions to prevent
the harm from occurring, including disclosing information to the
potential victim and the police and in order to initiate
hospitalization procedures. If I believe there is an imminent
risk that you will inflict serious harm on yourself, I may
disclose information in order to protect you.
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.
Insurance Reimbursement- If you are using a mental health
insurance policy to pay for your visits, I may be required to
provide certain diagnostic and treatment information in order to
obtain payment for services.
Care Coordination - To coordinate services with your
primary care provider, your psychiatrist, your referring doctor
and/or other relevant providers as stated in the HIPAA
regulations.
Other uses and disclosures not described in this Privacy
Notice will be made only with your authorization.
IV. Patient's Rights and Psychologist's
Duties
Patient's Rights:
Right to Request Restrictions - You have the right to
request restrictions on certain uses and disclosures of protected
health information; however, I am not required to agree to all
requested restrictions. You have the right to restrict certain
disclosures of PHI to health plans/insurance companies if you
pay/paid out of pocket in full for the health care services. I am
required to abide by such requests.
Right to be Notified of a Breach: You have the right
to be notified following a breach of unsecured PHI, if a risk
assessment fails to demonstrate that there is a low probability
that your information has been compromised.
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 me. On
your request, I will send correspondence to another address.)
Right to Inspect and Copy - You have the right to
inspect and copy your PHI. This includes medical and billing
records, but does not include psychotherapy notes, which are kept
separate and are given greater protection than PHI. To inspect
your PHI, you will need to make a separate appointment. If you
wish a copy of your PHI, if appropriate, this will be provided
for you at no charge while you are in treatment. After treatment,
copies of PHI are provided for the cost of $25.00 plus 10 cents
per page, paid in advance of receiving the copy. I may deny your
access to PHI under certain circumstances, but in some cases you
may have this decision reviewed.
Right to Amend - You have the right to request an
amendment of PHI for as long as the PHI is maintained in the
record. I may deny your request. On your request, I 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,
I 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 me upon request, even if you have
agreed to receive the notice electronically.
Psychologist's Duties:
I am required by law to maintain the privacy of PHI and to
provide you with a notice of my legal duties and privacy
practices with respect to PHI.
I am required to notify you following a breach of your PHI, if a
thorough risk assessment fails to demonstrate a low probability
that your information has been compromised. The risk assessment
considers the following factors:
1. Nature and extent of PHI
involved;
2. To whom the PHI may have been
disclosed;
3. Whether that PHI was actually
acquired or viewed; and
4. The extent to which the risk to
the PHI has been mitigated (for example, assurances from
recipient that information has been destroyed or will not be
further used or disclosed).
I reserve the right to change the privacy policies and practices
described in this notice. Unless I notify you of such changes,
however, I am required to abide by the terms currently in effect.
I may change the terms of this notice, and the changes will apply
to all information I have about you. The new notice will be
available upon request, in my office, and on my web site.
V. Complaints
If you are concerned that I have violated your privacy rights, or
you disagree with a decision I made about access to your records,
you may contact me, Robert F. Buzan, Ph.D., (828)
278-3722. You may also send a written complaint to the
Secretary of the U.S. Department of Health and Human Services at
200 Independence Ave., S.W.; Washington, D.C. 20201.
VI. Effective Date
This notice is in effect as of August 1, 2018. New
Perspectives Counseling and Consulting, PLLC reserves the right
to change the privacy policies and practices described in this
notice. If we revise our policies and procedures, we will post a
copy of our current Notice in our office or on our website. You
may request, and we will provide, a copy of our most current
Notice at any time.
CONFIDENTIALITY
The confidentiality of any material discussed in therapy with be
upheld at all times. As a general rule, New Perspectives
Counseling and Consulting, PLLC will not release any information
without your written consent.
THERE ARE SOME EXCEPTIONS TO THE CONFIDENTIALITY RULE:
If a child whose parents are divorced and have joint custody is
in therapy, the N.C. Attorney General's Office has advised that
psychotherapists are obligated to
inform both parents that the child of this and
to explain the nature and course of treatment.
If a therapist suspects that child abuse or neglect has occurred,
the law requires that it be reported to the proper authorities.
Child abuse includes sexual exploitation, physical abuse, and
mental/emotional injuries resulting in impaired functioning.
Child neglect includes failure to provide for the basic needs of
the child (including medical care) and inappropriate
discipline.
If a therapist believes a client is a clear and imminent danger
to themselves or another person, that therapist must take steps
to prevent that occurrence. These steps may require breaking
confidentiality.
In a legal proceeding, client-therapist communications are
privileged. A judge can, however, order the therapist to divulge
confidential information if this information is deemed necessary
for the proper administration of justice. However, N.C. law
states that a marriage counselor is incompetent to testify in any
subsequent legal action regarding divorce.
Your records can be released without your consent to prove to the
appropriate agencies that New Perspectives Counseling and
Consulting, PLLC is in compliance with federally mandated HIPAA
privacy laws.
Your records can be released without your consent upon request
from the military for purposes of national security.
North Carolina Law stipulates that when necessary to coordinate
care and treatment, mental health and medical providers may share
client information with one another without obtaining the
client's written consent. This applies between mental health
providers and other health care providers (such as psychiatrists,
primary care physicians, and pediatricians) regulated by the 1999
Health Insurance Portability and Accountability Act (HIPAA). This
allows a referring psychologist or physician to be informed about
a client they have referred. As a rule, I will request your
authorization prior to releasing such information except under
extenuating circumstances.
Filing insurance always requires giving the insurance company, or
third party payor, a diagnosis and the date of service. This
information could come back to an insurance administrator at the
place of employment if you are covered by an employee group
health plan. Insurance companies or third party payors sometimes
require more extensive information before processing claims,
which usually come back to the employer. If you are concerned
about this, please check to see how your company protects
insurance information.
If the use of a collection agency or attorney becomes necessary
to collect a past due balance, your right to confidentiality is
curtailed. While no clinical information would be revealed, your
name, your employer, etc. and the amount owed becomes available
to the agents.
If you have any concerns regarding confidentiality, please feel
free to discuss them with me.
Acknowledgement
Your signature or electronic signature below signifies that you
have received a copy of this office's Notice of Confidentiality
and Privacy Practices and that you have read and understand the
limits to your confidentiality. In addition, you
hereby consent to the use and disclosure of your and/or your
child's personal health information for the purposes of
treatment, payment, and health care operations.