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. Our Pledge Regarding Health Information:

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We 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 we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are 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.
  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

II. How We May Use And Disclose Health Information About You:

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed.
Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations.

  1. Treatment: We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services, including with a third party and for treatment activities of another health care provider. This may include talking with and writing to other health care providers, inside and outside of our organization, about your treatment, and coordinating and managing your health care with others.
  2. Payment: We may use and disclose your protected health information to get or give reimbursement for the provision of health care to you. This means we may use and disclose your protected health information to get paid (including determining eligibility, preparing bills and managing accounts). We may also give your protected health information to others (such as insurers, utilization reviewers, collection agencies, consumer reporting agencies, and lawyers) for payment purposes, and to a health plan covered by the Privacy Rule or a health care clearinghouse or another health care provider for that provider’s payment activities. Sometimes we may give your protected health information to an insurance plan before you receive certain health care services, because we need to know whether the insurance plan will pay for a service.
  3. Health care operations: We may use and disclose your protected health information in performing many business activities, called health care operations. For example, we may use or disclose your protected health information while conducting quality assessments, training of new clinicians, and general administrative activities.
  4. Required by law: We will use or disclose your protected health information if our use or disclosure is required by and is limited to the relevant requirements of law. There are many Massachusetts and other state and federal laws that may require the use or disclosure of protected health information. For example, Massachusetts law requires us to report known or suspected abuse or neglect to the Department of Public Health. National and other priority use and disclosure: When required or permitted by law, we may use or disclose protected health information about you without your permission for some activities that are recognized as national priorities. Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child 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.

III. Certain Uses and Disclosures Require Your Authorization:

In general, Massachusetts or federal laws require that we obtain your written authorization before using or disclosing your information about genetic testing or genetic test results, HIV testing or test results, drug, alcohol and other substance abuse rehabilitation treatment programs, treatment for venereal or other sexually transmitted diseases (except legally required disclosures to public health officials), certain information that is legally privileged, psychotherapy notes (except sharing with your therapist), marketing and the sale of protected health information.

    1.  Medical Record Notes. We keep progress notes, psychotherapy notes and chart notes regarding your medical care. Any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

a. For our use in treating you.
b. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c.  For use in defense in legal proceedings instituted by you.
d.  For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
e.  Required by law and the use or disclosure is limited to the requirements of such law.
f.  Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g.  Required by a coroner who is performing duties authorized by law.
h.  Required to help avert a serious threat to the health and safety of others.1.  Medical Record Notes. We keep progress notes, psychotherapy notes and chart notes regarding your medical care. Any use or disclosure of such notes requires your Authorization unless the use or disclosure is:a.  For our use in treating you.

    2.  Marketing Purposes. We will not use or disclose your PHI for marketing purposes.
    3.  Sale of PHI. We will not sell your PHI in the regular course of my business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization.

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

  1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
  2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
  3. For health oversight activities, including audits and investigations.
  4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
  5. For law enforcement purposes, including reporting crimes occurring on my premises.
  6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
  7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
  8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

V. Certain Uses and Disclosures Require You to Have The Opportunity to Object.

  1. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. 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 us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request.
  2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to 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.
  3. The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way or to send mail to a different address.
  4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and may charge a reasonable, cost based fee for doing so.
  5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request.
  6. 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 we correct the existing information or add the missing information. We have the right to reject your request, but will provide explanation in writing within 60 days of receiving your request.
  7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail.
  8. Right to Receive Notice of a Breach: We are required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breaches of Unsecured Protected Health Information as soon as possible, but in any event, no later than sixty (60) days following the discovery of the breach.

How you may file a privacy-related complaint if you believe that your privacy rights set out in this Notice have been violated or you believe we are not complying with the HIPAA Privacy Rule, we urge you to tell our Director as soon as possible by calling us at 978-999-2165.

You may file a complaint with us or with the federal government. There will be no retaliation for filing a complaint. To file a complaint with us, you may contact us at 978-999-2165 or in writing at 70 Broadway St. Westford, MA 01886. To file a complaint with the federal government, send your complaint to:

Office for Civil Rights U. S. Department Health and Human Services
Government Center
J. F. Kennedy Federal Building – Room 1875
Boston, Massachusetts 02203

Phone (800) 368-1019
Fax (617) 565-3809
TDD (800) 537-7697

Please know that a complaint filed with the Office for Civil Rights must be filed within 180 days of when you knew or should have known of the act or omission believed to be in violation, unless this time limit is waived by the government.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on [4/26/24]