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HIPAA Privacy Policy

It is the intent of this office to be in compliance with the Privacy Standards for Private Health Information (PHI) covered under Health Insurance Portability and Accountability Act (HIPAA).

 

I understand that I have the right to request that certain information be excluded from my record unless the information is related to my diagnosis or is related to one of the exceptions listed on the next page.

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I understand that I have the right to amend information but not expunge (“erase”) information from my record.

 

I understand that I have the right to inspect and/or receive a copy of my Private Health Information (PHI) i.e. record unless it is legally determined that it would adversely affect my well-being or I am a minor. My request must be fulfilled by this office within 60 days of my written request. There will be a charge for copies.

 

As additional HIPAA regulations are mandated and clarified, this office will be altering its policies and procedures to be in compliance.

 

If this office is found to be in violation of the Primary Standards put forth in HIPAA, I am urged to speak with my therapist and if not resolved, I have a right to file a formal complaint with the Office of Civil Liberties.

 

Statement Regarding Confidentiality:

 

All information shared in this office is confidential unless a specific release of information is signed by you with the following exceptions:

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  • You express your planned intention of harming yourself or your emotional/mental state is observed by me to put you at risk.

  • You express that you intend to do bodily harm to another person. (In that event, I am obligated by law to take reasonable precautions to ensure others’ safety.)

  • You share that you have in the past and/or present emotionally, physically, or sexually abused a minor.

  • You are a minor and you share that you are currently, or have been, physically or sexually abused, or I determine that you are at significant risk.

  • Your insurance company requests information relative to payment of your claim, or another process is required to collect unpaid fees, or any legal defense is required by your therapist.

  • I receive a signed order by a judge to testify in court, or to provide records.

 

In the above instances, I will take appropriate action to ensure your safety.

 

Otherwise, I will not reveal any information about you without your written permission.

 

I have no control over the confidentiality of any information once it is disclosed outside this office. If you have any questions about who has access to your information, please contact others to whom you have authorized information to be released.

 

I have read and received a copy of the above Privacy Standards for Private Health Information covered under HIPAA.

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By entering your contact information, you are opting in to The Misiph Center contacting you via phone or email. 

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