HIPAA–Notice of Privacy Policy

OUR LEGAL DUTY

I am required by applicable federal and state law to maintain the privacy of your health information. I am also required to give you this Notice about privacy practices, my legal duties, and your rights concerning your health information. I must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect August 1, 2017, and will remain in effect until I replace it.

I reserve the right to change my privacy practices and the terms of the Notice at any time, provided such changes are permitted by applicable law. I reserve the right to make the changes in my privacy practices and the new terms of my Notice effective for all health information that we maintain, including health information I created or received before I made the changes. Before I make a significant change in my privacy practices, I will change this Notice and make a new Notice available upon request.

You may request a copy of our notice at any time. For more information about my practices or for additional copies of this Notice, please contact me.

USES AND DISCLOSURES OF HEALTH INFORMATION

Treatment, Payment, and Healthcare Operations: I may use or disclose your health information to a physician or other healthcare provider providing treatment for you. I may use or disclose your health information for healthcare operations, such as quality assessment and improvement activities, to review the competence or qualifications of healthcare professionals, for evaluation of practitioner and provider performance, for conducting training programs, accreditation, certification, licensing, or credentialing activities. I may use and disclose your health information to obtain payment for services I provide to you.

Your Authorization: You may give me written authorization to use your health information or to disclose it to anyone for any purpose. If you give me authorization, you may revoke it in writing at any time. Your revocation will not affect any use of disclosures permitted by your authorization while it was in effect. Without written authorization, I will not disclose health information unless otherwise described in this notice.

Persons Involved in Care: I may use or disclose health information to notify, or assist in the notification of a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, I will provide you with an opportunity to object to such use or disclosures. In the event of your incapacity or emergency circumstances, I will disclose health information based on a determination using my professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. I will also use my professional judgment and my experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up health information.

Marketing Health Related Services: I will not use your health information for marketing communication.

Required by Law: I may use or disclose your health information when I am required by law to do so, or if a court of law orders your records.

Abuse, Neglect, or Threats of Harm: I may disclose your health information to appropriate authorities if I reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. I may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

National Security: I may disclose military authorities the health information of Armed Forces under certain circumstances. I may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. I may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmates or patients certain circumstances.

Appointment Reminders: I may disclose your health information to provide you with appointment reminders (such as voicemail messages, text messages, email, or letters) as requested.

CLIENT RIGHTS

Access: In most cases, you have the right to inspect and copy your medical and billing records. You must submit your request in writing. You have the right to request your records in electronic form. If you request a copy of information, I may charge a fee for the costs and time of copying. I may deny your request to inspect and copy information in some circumstances.

Disclosure Accounting: You have the right to receive an accounting of disclosures of your health information and may submit a written request for this account.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. I am not required to agree to these additional restrictions, but if I do, I will abide by our agreement (except in an emergency). If paying out of pocket for services, you may restrict the release of information to your insurance provider.

Alternative Communication: You have the right to request in writing that I communicate with you about your health information by alternative means or to alternative locations. You must provide satisfactory explanation of how payments will be handled under the alternative means or locations. Amendment: You have the right to request in writing that I amend your health information. Your request must explain the reason for amendment. I may deny your request under certain circumstances.

Right to a Copy of This Notice: You have a right to a paper copy of this notice and may request this at any time. If you received this notice electronically, you have the right to receive it in writing.

Breach of Private Health Information: You will be notified in the case of any breach of unsecured health information.

Questions and Complaints

If you want more information about my privacy practices or if you have any questions, please contact me. If you are concerned that I may have violated your privacy rights or you disagree with a decision I made about your health information, you may file a complaint in writing using the contact information at the end of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. I support your right to privacy and will not retaliate if you file a complaint.

Contact Information:
Therapist: Kathryn Antolin, LMFT
Phone: 850.889.0929
Address: 7318 W Post Rd Suite 211, Las Vegas, Nevada 89118