Notice of Health Information Privacy Practices (NPP)

On this page:

• My Pledge Regarding Health Information
• Understanding Protected Health Information (PHI)
• How I May Use and Disclose Health Information About You
• Certain Uses and Disclosures Require Your Authorization
• Certain Uses and Disclosures Do Not Require Your Authorization
• Certain Uses and Disclosures Require You to Have the Opportunity to Object
• Your Rights With Respect to Your PHI
• Filing a Complaint

My Pledge Regarding Health Information

I understand that health information about your mental health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I 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 Jennifer Roy Therapy. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.

Understanding Protected Health Information (PHI)

What is PHI?

Protected Health Information (PHI) refers to any individually identifiable information related to your past, present, or future physical or mental health or condition, health care services you receive, and payment for your health care. This includes demographic details like your name, social security number, address, and date of birth. PHI can be in oral, written, or electronic form.

Examples of PHI:

• Treatment records
• Claims records
• Communications between you and your health care provider

PHI ceases to be PHI if it is de-identified in accordance with HIPAA standards.

My commitment to protect your PHI

I am required by law to:

• Make sure that protected health information ("PHI") that identifies you is kept private and secure.
• Give you this notice of my legal duties and privacy practices with respect to protected health information.
• Notify you if there is a breach of your PHI.
• Follow the terms of the notice that is currently in effect.

I can change the terms of this notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

Safeguards in place

Administrative

Privacy and security training, policies, and procedures.

Technical

Encryption and password protection.

Physical

Locked areas and cabinets.

Marketing or fundraising purposes. As a psychotherapist, I will not use or disclose your PHI for marketing or fundraising purposes.

Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

How I May Use and Disclose Health Information About You

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For treatment, appointment reminders, payment, or health care operations

Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the client/patient 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 diagnosis, treatment, billing/payment, and health care operations such as appointment reminders and to improve practice services. I may also disclose your protected health information for the coordination of care with any health care providers. This too can be done without your written authorization. For example, if I were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist me in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard, because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.

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 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.

Certain Uses and Disclosures Require Your Authorization

Psychotherapy notes

I do keep "psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

1. For my use in treating you.
2. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
3. For my use in defending myself in legal proceedings instituted by you.
4. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
5. Required by law and the use or disclosure is limited to the requirements of such law.
6. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
7. Required by a coroner who is performing duties authorized by law.
8. Required to help avert a serious threat to the health and safety of others.

Special protections for substance use disorder records

The confidentiality of substance use disorder (SUD) client records maintained by this practice is protected by federal law (42 CFR Part 2) and HIPAA. Generally, I may not disclose information identifying you as having or having had a substance use disorder unless you consent in writing, the disclosure is allowed by a court order, or the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Federal law prohibits the use of your SUD records to initiate or substantiate any criminal charges against you or to conduct any investigation of you, unless a specific, specialized court order is issued.

Potential for redisclosure

Information disclosed pursuant to your authorization may be subject to redisclosure by the recipient. Once disclosed, the information may no longer be protected by HIPAA federal privacy regulations.

Certain Uses and Disclosures Do Not Require Your Authorization

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

• 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.
• 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.
• For health oversight activities, including audits and investigations.
• 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.
• For law enforcement purposes, including reporting crimes occurring on my premises.
• To coroners or medical examiners, when such individuals are performing duties authorized by law.
• 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.
• 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.
• For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.
• Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

Certain Uses and Disclosures Require You to Have the Opportunity to Object

Disclosures to family, friends, or others. I 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 or disaster relief efforts.

Your Rights With Respect to Your PHI

Right to request limits on uses and disclosures

You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say "no" if I believe it would affect your health care.

Right to request restrictions for out-of-pocket expenses paid in full

You have the right to request restrictions on disclosures of your PHI to health plans for treatment, 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. While I am not required to agree, I will consider all requests.

Right to choose how I send PHI to you

You have the right to request for me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will accommodate all reasonable requests.

Right to see and get copies of your PHI

Other than "psychotherapy notes," you have the right to see or obtain an electronic or paper copy of your medical record and other information that I have about you. I will provide access within 5 business days of receiving a written request for viewing, provide you with copies of your record within 15 days of receiving a written request, or a summary of it within 30 days of receiving your written request. I may charge a reasonable, cost-based fee for doing so. Access may be denied if it poses a danger to your physical safety. Parents requesting access to a minor's records may be denied if it is detrimental to the therapeutic relationship or the minor's treatment and mental health.

Right to get a list of the disclosures I have made

You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.

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 I correct the existing information or add the missing information. I may say "no" to your request, but I will tell you why in writing within 60 days of receiving your request.

Right to get a paper or electronic copy of this notice

You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

Filing a Complaint

If you feel your rights have been violated, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6775, or www.hhs.gov/ocr/privacy/hipaa/complaints. I will not retaliate against you for filing a complaint.

If you have given someone medical power of attorney or if someone is your legal guardian, they can exercise your rights and make decisions about your health information. I will verify their authority before taking action.

Questions About This Notice

Practice

Jennifer Roy, MS, LMFT (she/her) — Licensed Marriage and Family Therapist, CA LMFT #161735

Phone

(415) 763-5780

Website

jenniferroytherapy.com

The Hobart Building

582 Market Street, San Francisco, CA 94104

Marin County Office

822 D St, San Rafael, CA 94901