Privacy Notice

Center for Integrative Health, LLC, Waltham, MA

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of my legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• I can change the terms of this Notice, and such changes will apply to all information I have about you. I will provide you with a copy of the revised Notice of Privacy Practices at your next appointment. The new Notice will also be available upon request, and if applicable, in my office, and on my website.

II. USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS, REQUIRING CONSENT

For Treatment: I may disclose your PHI with your consent, to those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes a consultation with a clinical supervisor or other treatment team member. An example of treatment would be a consult with a family physician or another mental health provider. I may disclose PHI to any other consultant only with your authorization.

For Payment: I may disclose your PHI, with your consent, to carry out payment-related activities. An example of payment-related activities would be processing of claims with your insurance company.

For Healthcare Operations: I may disclose PHI, with your consent, for the purpose of health care operations, provided I have a written contract with the business that requires it to safeguard the privacy of your PHI. An example of healthcare operations would be a billing or typing service.

III. CERTAIN USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that I have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization:

1. Most uses and disclosures of psychotherapy notes, which are separated from the rest of your medical record.
2. Uses and disclosures of PHI for marketing purposes.
3. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.
4. Other uses and disclosures not described in this Notice of Privacy Practices.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR CONSENT OR AUTHORIZATION.

Subject to certain limitations in the law, I can use and disclose your PHI without your authorization for the following reasons:

1. Child Abuse: If, in my professional capacity, I have reasonable cause to believe that a minor child is suffering physical or emotional injury resulting from abuse inflicted upon him or her, I must immediately report such condition to the Massachusetts Department of Children and Families.
2. Elder Abuse: If I have reasonable cause to believe that an elderly person (age 60 or older) is suffering from or has died as a result of abuse I must immediately make a report to Department of Elder Affairs.
3. Abuse of a Disabled Person: If I have reasonable cause to suspect abuse of an adult(ages 18-59) with mental or physical disabilities, I must immediately make a report to the Massachusetts Disabled Persons Protection Commission.
4. Serious Threat to Health or Safety: If you communicate to me an explicit threat to kill or inflict serious bodily injury upon an identified person and you have the apparent intent and ability to carry out the threat, I must make reasonable precautions. Reasonable precautions may include warning the potential victims, notifying law-enforcement, or arranging for your hospitalization. I must also do so if I know you have a history of physical violence and I believe there is a clear and present danger that you will attempt to kill or inflict bodily injury upon an identified person. Furthermore, if you present a clear and present danger to yourself and refuse to accept further appropriate treatment, and I have a reasonable basis to believe that you can be committed to a hospital, I must seek said commitment and may contact members of your family or other individuals if it would assist in protecting you.
5. Health Oversight: The Board of Registration of Psychologists has the power, when necessary, to subpoena relevant records should I be the focus of an inquiry.
6. Judicial or Administrative proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law and we will not release information without written authorization from 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.
7. For Specialized Government Functions such as fitness for military duties, eligibility for benefits, and for national security and intelligence reasons.
8. Workers' Compensation purposes. If you file a workers’ compensation claim, your records relevant to that claim will not be confidential to entities such as your employer, the insurer and the Division of Workers Compensation.
9. Public Health: If required, I may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
10. Appointment reminders and health related benefits for services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives for other healthcare services or benefits that I offer.
11. There may be additional disclosures of PHI that I am required or permitted by law to make without your consent or authorization. These include those for complying with State and Federal laws, for helping with product recalls, for law enforcement purposes (when certain narrowly-defined disclosures are permitted by law,) or for coroner or medical examination purposes, when such individuals are performing duties authorized by law.

V. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care, except if you request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. 
2. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
3. The Right to See and Get Copies of Your PHI. You have the right to see or obtain a copy (or both) of your PHI and psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your access may be denied in certain circumstances, but in some cases, you may be able to have this decision reviewed. On your request, I will discuss with you the details of the request and denial process. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request a copy of your PHI be provided to another person. I will provide a copy or a summary of your PHI. I may charge a reasonable, cost-based fee.
4. The Right to Get a List of the Disclosures I Have Made. You have the right to request an accounting of PHI, for which you have neither provided authorization nor consent. On request, I will discuss with you the details of the accounting process. I may charge a reasonable, cost-based fee if you request more than one accounting within 12 months.
5. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but you have the right to file a statement of disagreement with me. I may prepare a rebuttal to your statement and will provide you with a copy. On your request, I will provide you with the details of the amendment process.
6. The Right to Get a Paper Copy of this Notice. You have the right to get a paper copy of this notice promptly upon request, even if you have agreed to receive the notice electronically.
7. The Right to be notified if there is a breach of your unsecured PHI. If there is a breach of unsecured PHI concerning you, I may be required to notify you of this breach, including what happened and what you can do to protect yourself.

VI. PSYCHOLOGIST’S DUTIES

1. 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.
2. 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.
3. If I revise my policies and procedures, I will notify you at our next therapy session.

VII. QUESTIONS AND COMPLAINTS

If you have any questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at (617)812-2232. If you believe that your privacy rights have been violated and wish to file a complaint with me or my practice, you may send your written complaint to Kimberlie King, Ph.D., 231 Lowell St. #1, Waltham, MA 02453. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201, call (877)696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints/. I will not retaliate against you for exercising your right to file a complaint.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on 1/10/22.