This notice involves your privacy rights and describes how information about you may be disclosed, and how you can obtain access to this information. Please review it carefully.
I. Confidentiality: Uses and Disclosures of Information Requiring Your Authorization or Consent We use and disclose your health information for the normal business activities the law sees as falling in the categories of treatment and health care operations. We continuously seek to safeguard your information through administrative, physical, and technical means, and we otherwise abide by applicable federal and state guidelines.
II. “Limits of Confidentiality:” Possible Uses and Disclosures of Health Records without Consent or Authorization We may use or disclose records or other information about you without your consent or authorization in the following circumstances, either by policy, or because legally required (Virginia laws are referenced where applicable): · Emergency If you are involved in in a life-threatening emergency and we cannot ask your permission, we will share information if we believe you would have wanted us to do so, or if we believe it will be helpful to you. · Child Abuse Reporting: If we have reason to suspect a child is abused or neglected, we are required by Virginia law to report the matter immediately to the Virginia Department of Social Services ( § 63.2-1509 ). · Adult Abuse Reporting: If we have reason to suspect an elderly or incapacitated adult is abused, neglected or exploited, we are required by Virginia law to immediately make a report and provide relevant information to the Virginia Department of Welfare or Social Services ( § 63.2-1606 ). · Court Proceedings: Respond to law enforcement officials or to judicial orders, subpoenas or other processes. ( § 32.1-127.1:03 ). · Deceased: Inform coroners, medical examiners, and funeral directors of information so they may fulfill their duties. · Correctional facilities: Inform a correctional institution to share your health records if you are an inmate. · Serious Threat to Health or Safety: Under Virginia law, if we are engaged in our professional duties and you communicate to us a specific and immediate threat to cause serious bodily injury or death, to yourself or to an identified or to an identifiable person, and we believe you have the intent and ability to carry out that threat immediately or imminently, we are legally required to take steps to protect you or third parties ( § 54.1-2400.1 ). · Workers Compensation: If you file a worker’s compensation claim, we are required by law, upon request, to submit your relevant mental health information to you, your employer, the insurer, or a certified rehabilitation provider. · Treatment: Communicate with other health care providers for your treatment. Other uses and disclosures of information not covered by this notice or by the laws that apply will be made only with your written permission. You may revoke you authorization in writing at any time; however, this will not affect prior uses and disclosures.
III. Patient’s Rights and Provider’s Duties: · Right to Request Restrictions-You have the right to request restrictions on certain uses and disclosures of protected health information about you. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care. If you ask us to disclose information to another party, you may request we limit the information we disclose. However, we are not required to agree to a restriction you request. To request restrictions, you must make your request in writing, and tell us: 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply. · Right to Receive Confidential Communications by Alternative Means and at Alternative Locations — You have the right to request and receive confidential communications of PHI (protected health information) by alternative means and at alternative locations. To request alternative communication, you must make your request in writing, specifying how or where you wish to be contacted. · Right to an Accounting of Disclosures – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in section III of this Notice). On your written request, we will discuss with you the details of the accounting process · Right to Inspect and Copy – In most cases, you have the right to inspect and copy your medical records. To do this, you must submit your request in writing. If you request a copy of the information, we may charge a fee for costs of copying and mailing. · Right to Amend – If you feel protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing, and submitted to us. In addition, you must provide a reason to supports your request. We may deny your request if you ask us to amend information that: 1) was not created by us; we will add your request to the information record; 2) is not part of the medical information kept by us; 3) is not part of the information which you would be permitted to inspect and copy; 4) is accurate and complete. · Right to a copy of this notice – You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Changes to this notice: we reserve the right to change our policies and/or to change this notice, and to make the changed notice effective for medical information we already have about you as well as any information we receive in the future. The notice will contain the effective date. A new copy will be given to you or posted in the waiting room. we will have copies of the current notice available on request. Complaints: If you believe your privacy rights have been violated, you may file a complaint. To do this, you must submit your request in writing to our office.
