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Terms and Policy

HIPAA Notice of Privacy Practices

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.

( Type Full Name )
( Full Name )
Appointment Policy

SCHEDULED APPOINTMENTS

You are responsible for attending your scheduled appointments. With your permission, you will be sent an appointment reminder 24 to 48 hours prior to your appointment. It is your responsibility to provide accurate contact information so that these messages can reach you. You may update your contact information via the client portal or at any scheduled session.

MISSED OR LATE CANCELLATIONS

In order to guarantee you a regular time and keep my practice efficiently organized, I typically schedule a single weekly (or biweekly) time slot for you. Missed sessions are not billable to insurance and will be charged directly to your debit/credit card on file. A charge of $100 is applied when appointments are missed or cancelled with less than 24 hours notice. Please remember that you can cancel or reschedule your appointments via my online client portal. Missed sessions or late cancellation fees will only be waived for emergent issues.

LATE APPOINTMENT ARRIVAL

Your appointment times are reserved just for you, so it is important to be on time to make full use of the session. However, I understand that life events may interfere with punctual attendance, so please call or email if you anticipate arriving late to your appointment. If you arrive late for your appointment, we will still finish at your scheduled end time as if we started our session on time. This is to ensure that I am fair to my other clients who show up on time for their scheduled session. 

TERMINATION DUE TO MISSED SESSIONS

If you miss more than 2 sessions in a row and I do not hear from you within three days after the second missed session, I will assume that you have terminated services with me and will remove you from my schedule to make your appointment time available to other clients. Should this take place, you are welcome to contact me about resuming work with me, but I can guarantee neither current availability nor the availability of your previously held appointment time.

MINORS

It is the policy of New Perspectives Counseling and Consulting that a responsible adult must accompany a minor (a child under the age of 18) to every appointment and that a parent or guardian must remain on the premises during that child's entire appointment. If you are unable to remain on site during your child's appointment, you must make arrangements to have a responsible adult stay on the premises while your child attends his/her appointment. In addition, if you bring minors with you to your own appointment, you must make arrangements to have a reliable adult remain in the waiting room with your child during your appointment.

ACCEPTANCE OF TERMS

Your signature or electronic signature below indicates that you agree to be legally bound to the polices herein described.

( Type Full Name )
( Full Name )