1. PURPOSE: Barbara D. Agran, P.A. will follow the privacy practices described in this notice.
The Barbara D. Agran, P.A. keeps your mental health information in records that will be
maintained and protected in a confidential manner, as required by law. Please note that in
order to provide you with the best possible care and treatment all professional staff involved
in your treatment here at the Barbara D. Agran, P.A. offices have access to your records.
2. WHAT ARE THE TREATMENT and HEALTH CARE OPERATIONS?
Your treatment includes sharing
information among mental health providers who are involved in your treatment. For example,
if you are seeing both a physician (psychiatrist) and a psychotherapist, they may share
information in the process of coordinating your care. Treatment records may be reviewed as part
of an on-going process directed toward assuring the quality of my office operations. I will
personally review each patient/client's records to verify that certain standards are met.
3. HOW WILL THE BARBARA D. AGRAN, P.A.USE MY PROTECTED HEALTH INFORMATION?
Your personal mental health record will be retained by the Barbara D. Agran, P.A. for
approximately ten years after your last clinical contact with my office. After that time has
elapsed, the record will be shredded or burned or otherwise destroyed in a way that protects
your privacy.
Until the records are destroyed they may be used, unless you request restrictions on a specific
use or disclosure for the following purposes:
- Appointment reminders;
- Notification when an appointment is cancelled or rescheduled;
- For public health services such as reporting a child or elder abuse or neglect;
reporting reactions to medications; infectious desease control; notifying authorities of
suspected abuse, neglect, or domestic violence (if you agree or As required by law);
- Mental health oversight activities, e.g., Audits, inspections or investigations of
administration and management of Barbara D. Agran, P.A.
- Lawsuits and disputes (We will attempt to provide you advance notice of subpoena
before disclosing information from your record);
- Law enforcement (e.g., in response to a court order or other legal process) to identify
or locate an individual being sought by authorities; about victim of a crime under
restricted circumstances; about a death that may be the result of criminal
conduct; about criminal conduct that occurred in the offices of Barbara D. Agran, P.A.; when
emergency circumstances occur relating to a crime;
- To prevent a serious threat to health or safety;
- To carry out treatment and health care operations functions through transcriptions and
billing services;
- To military command authorities if you are a member of the armed forces or a foreign
military authority;
- National security and intelligence activities;
- Protection of the President or other authorized persons for foreign heads of state, or
to conduct special investigations.
- Psychotherapy Notes that are kept separate from the medical record enjoy special protection
- Psychotherapy Notes excludes medication prescription and monitoring, counseling
session start and stop times, the modalities and frequencies of treatment furnished, results of
clinical tests, and any summary of the following items:
diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date,
Employment, application, utilization, examination, or analysis of such information within
an entity that maintains such information.
- Alcohol and drug abuse information has special privacy protections. The BARBARA D. AGRAN,
P.A. will not disclose any information identifying an individual as being a client or provide
any mental health or medical information relating to a client's substance abuse treatment unless:
(I) the client consents in writing; (II) a court order requires disclosure of the
information; (III) medical personnel need the information to meet a medical emergency;
(IV) qualified personnel use the information for the purpose of conducting research, management
audits, or program evaluation; or (V) it is necessary to report a crime or a threat to commit a
crime or to report abuse or neglect as required by law.
4. YOUR AUTHORIZATION IS REQUIRED FOR OTHER DISCLOSURES.
Except as described previously, we will not use or disclose information from your record unless
you authorize (permit) in writing the Barbara D. Agran, P.A. to do so. You may revoke your
permission, which will be effective only after the date of your written revocation.
5. YOU HAVE RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your health information, provided that you make a
written request to invoke the right on the form provided by Barbara D. Agran, P.A.
- Right to request restriction. You may request limitations on your mental health
information we may disclose, but we are not required to agree to your request. If we agree, we
will comply with your request unless the information is needed to provide you with emergency
treatment.
- Right to confidential communications. You may request communications in a certain way or at
a certain location, but you must specify how or where you wish to be contacted.
- Right to inspect a copy. You have the right to inspect and copy your mental health
information regarding decisions about your care; however, psychotherapy notes may not be
inspected and copied. We may charge a fee for copying, mailing, and supplies. Under limited
circumstances, your request may be denied; you may request review of the denial by another
licensed mental health professional chosen by Barbara D. Agran, P.A. The Barbara D. Agran, P.A.
will comply with the outcome of the review.
- Right to request clarification of the record. If you believe that the information we have
about you is incorrect or incomplete you may ask to add clarifying information. You may ask
for a form for that purpose and the form will require certain specific information. The Barbara
D. Agran, P.A. is not required to accept the information that you propose.
- Right to accounting of disclosures. You may request a list of the disclosures of your mental
health information that have been made to persons or equities other than for treatment or health
care operations in the last six (6) years, but not prior to April 14, 2003.
- Right to copy of this Notice. You may request a paper copy of this Notice at any time, even
if you have been provided with an electronic copy. You may print out a copy of this notice from
any clinical website we provide.
6. REQUIREMENTS REGARDING THIS NOTICEThe Barbara D. Agran, P.A. is required to provide
you with this Notice that governs our privacy practices. The Barbara D. Agran, P.A. may change
its policies or procedures in regard to privacy practices. If and when changes occur, the
changes will be effective for mental health information we have about you as well as any
information we receive in the future. Any time you come in to the Barbara D. Agran, P.A. for an
appointment, you may ask for and receive a copy of the Privacy Notice that is in effect at the
time.
7. COMPLAINTS If you believe your privacy rights have been violated, you may file a
complaint with Barbara D. Agran, P.A. You will not be penalized or retaliated against in any way
for making a complaint.
Contact: Call the Barbara D. Agran, P.A. and ask to speak to Barbara D. Agran, LMHC who
is the person/official responsible for privacy.
If you have a complaint. you have any question about this notice you wish to request
restrictions on uses and disclosure for health care treatment or operations; or you may obtain
any of the forms mentioned to exercise your individual rights described above.
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