Pyol Thompson, LCPC

Privacy Practices

Your Confidentiality Matters

This notice describes how medical information about you may be used, disclosed, and how get access to this information. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your health record contains personal information about you and your health. This information about that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how I may use and disclose you PHI in accordance with applicable laws and the APA code of ethics. It also describes your rights regarding how you may gain access to and control you PHI.

Under the Health Insurance Portability and Accountability Act of 1996 (“HIPPA”), I am required to maintain the privacy of PHI and to provide you with notice of my legal duties and privacy practice at any time. Any new Notice of Privacy Practices will be effective for all PHI that I maintain at that time. I will provide you with a copy of the revised Notice of Privacy Practices by sending you a copy in the mail or e-mail upon request or providing one to you at you next appointment.

How I may use and disclose health information about you:

For Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation  with clinical supervisors or other treatment team members. I may disclose PHI to any other consultant only with your authorization.

For Payment: I may use and disclose PHI so that I can receive payment for the treatment services provided to you. If it becomes necessary to use collection processes due to lack of payment for services, I will only disclose the minimum amount of PHI necessary for the purposes of collection.

For Health Care Operations: I may use or disclose, as needed, you PHI in order to support my business activities including but not limited to quality assessment activities, licensing, and conducting or arranging for other business activities. For example, I may share your PHI with third parties that perform various business activities (e.g. billing or typing services) provided I have a written contract with the businesses that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization. I may use PHI to contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.  

Required by Law: Under the law, I must make disclosures of your PHI to you upon your request. In addition, I must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirement of the Privacy Rule.

Without Authorization: Applicable law and ethical standards permit me to disclose information about you without your authorization only in a limited number of other situations. Types of uses and disclosures that may be made without your authorization are those that are:

• Required by law, such as the mandatory reporting of child abuse or neglect or elder abuse, or mandatory government agency audits or investigations (such as the psychology licensing board or the health department)

• Required by Court Order

• Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of that threat.

• When the use and disclosure without your consent or authorization is allowed under other sections of Section 164.512 of the Privacy Rule and the state’s confidentiality law. This includes certain narrowly defined disclosures to law enfrcement agencies, to a health oversight agency (such as HH5 or state health department), to a coroner or medical examiner, for public health purposes relating to disease or FDA-regulated products, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligience.

Verbal Permission: I may use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked.  

Your Rights Regarding Your PHI

You have the following rights regarding PHI I maintain about you. To exercise any of these rights, please submit your request in writing to me.

Right of Access to Inspect and Copy: You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you. I may charge a reasonable, cost based fee for copies.

Right to Amend: If you feel that the PHI I have about you is incorrect or incomplete, you may ask me to amend the information although I am not required agree to the amendment.

Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures that I make of your PHI. I may charge you a reasonable fee if you request more than one accounting in any 12-month period.

Right to Request Restrictions: You have the right to request a restriction or limitation on the use or disclosure of you PHI for treatment, payment, or health care operations. I am not required to agree to your request.

Right to Request Confidential Communication: You have the right to request that I communicate with you about medical matters in a certain way or at a certain location.

• You have the right to restrict certain disclosures of PHI to a health plan when you pay out of pocket in full for my services.

• You have the right to be notified if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards; and (c) my risk assessment fails to determine that there is a low probability that your PHI has been compromised.

Right to a Copy of this Notice: You have a right to a copy of this notice.

Complaints

If you believe I have violated your privacy rights, you have the right to file a complaint in writing with Pyol Thompson. I will not retaliate against you for filing a complaint.