This Notice describes how health information about you may be used and disclosed and how you can get access to this information. This Notice provides you with information to protect the privacy of your confidential health care information, hereafter referred to as protected health information (PHI). The Notice also describes the privacy rights you have and how you can exercise those rights. Please review it carefully.
You can download this information by clicking here.
If you have any questions about this Notice, please contact Dr. Garman for more information or clarification
My COMMITMENT REGARDING YOUR PERSONAL HEALTH INFORMATION:
Dr. Garman is committed to maintaining and protecting the confidentiality of Protected Health Information (PHI). Psychologists are required by federal and state law to protect the privacy of your individually identifiable health information and other personal information. PHI is information in any format (electronic, paper, or verbal), about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition or the payment or provision of related health care services.
I am required by law to provide you with this Notice about policies, safeguards and practices.
If you have any questions about this notice, please contact Dr. Garman.
Psychologists are required by law to:
Maintain the privacy of protected health information,Give you this notice of my legal duties and privacy practices regarding health information about you, Follow the terms of this notice that is currently in effect
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION:
The following describes the ways I may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, I will use and disclose Health Information only with your written permission. You may revoke such permission at any time by notifying me of your wish to do so.
For Treatment: I may use and disclose Health Information for your treatment and to provide you with treatmentrelated health care services. For example, I may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside my office, who are involved in your health care and need the information to provide you with health care.
For Payment: I may use and disclose Health Information so that I or others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, I may give your health plan information about you so that they will pay for your treatment.
For Health Care Operations: I may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of my patients receive quality care and to operate and manage my office. For example, I may use and disclose information to make sure the mental health care you receive is of the highest quality. I also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services: I may use and disclose Health Information to contact you to remind you that you have an appointment with me. I also may use and disclose Health Information to tell you about treatment alternatives or healthrelated benefits and services that may be of interest to you.
On Your Authorization: You may give written authorization to use your PHI or to disclose it to another person for the purpose you designate. If you give an authorization, you may withdraw it in writing at any time. Your withdrawal will not affect any use or disclosures permitted by your authorization while it was in effect. I will make disclosures of any psychotherapy notes only if you provide a specific written authorization or when disclosure is required by law.
Personal Representatives: I will disclose your PHI to your personal representative when the personal representative has been properly designated by you and the existence of your personal representative is documented to us in writing through a written authorization.
Disaster Relief: With your consent, I may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. I will provide you with an opportunity to agree or object to such a disclosure whenever I practically can do so.
As Required by Law: I will disclose Health Information when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety: I may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates: I may disclose Health Information to my business associates that perform functions on my behalf or provide me with services if the information is necessary for such functions or services. For example, I may use another company to perform billing services on my behalf. All of my business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Workers’ Compensation: I may release Health Information for workers’ compensation or similar programs. These programs provide benefits for workrelated injuries or illness.
Public Health Risks: I may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if I believe a patient has been the victim of abuse, neglect or domestic violence. I will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities: I may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Data Breach Notification Purposes: I may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, I may disclose Health Information in response to a court or administrative order. I also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Coroners, Medical Examiners and Funeral Directors: I may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities: I may release Health Information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others: I may disclose Health Information to authorized federal officials so they may provide protection to the President.
USES AND DISCLOSURES THAT REQUIRE ME TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT
Individuals Involved in Your Care or Payment for Your Care: Unless you object, I may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, I may disclose such information as necessary if I determine that it is in your best interest based on my professional judgment.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
1. Uses and disclosures of Protected Health Information for marketing purposes; and 2. Disclosures that constitute a sale of your Protected Health Information. Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do give an authorization, you may revoke it at any time by submitting a written revocation to me and I will no longer disclose Protected Health Information under the authorization.
You have the following rights regarding Health Information we have about you:
Right to Access: You have a right, with limited exceptions, to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request in writing. I have up to 30 days to make your Protected Health Information available to you and I may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. I may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needsbased benefit program. I may deny your request in certain limited circumstances. If I do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and I will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records: If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. I will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either a standard electronic format or if you do not want this form or format, a readable hard copy form. I may charge you a reasonable, costbased fee for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Breach: You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
Right to Amend: If you feel that Health Information I have is incorrect or incomplete, you may ask me to amend the information. You have the right to request an amendment for as long as the information is kept by or for my office. To request an amendment, you must make your request in writing.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures I made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization.
Right to Request Restrictions: You have the right to request a restriction or limitation on the Health Information I use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information I disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that I not share information about a particular diagnosis or treatment with your spouse. I am not required to agree to your request unless you are asking me to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid me “outofpocket” in full. If I agree, I will comply with your request unless the information is needed to provide you with emergency treatment.
OutofPocketPayments: If you paid outofpocket (or in other words, you have requested that I not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and I will honor that request.
Right to Request Confidential Communications: You have the right to request that I communicate with you about health matters in a certain way or at a certain location. For example, you can ask that I only contact you by mail or at work. To request confidential communications, you must make your request known to me. Your request must specify how or where you wish to be contacted. I will accommodate reasonable requests.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask me to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at my web site, www.drstevegarman.com.
CHANGES TO THIS NOTICE:
I reserve the right to change this notice and make the new notice apply to Health Information I already have as well as any information I receive in the future. I will make a copy of my current notice available at my office or website.
If you believe your privacy rights have been violated, you may file a complaint with my office or with the Secretary of the Department of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.