Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This
information, which may identify you and relates to your past, present or future physical or
mental health or condition and related health care services, is referred to as Protected
Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and
disclose your PHI in accordance with applicable law. It also describes your rights regarding
how you may gain access to and control your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of our
legal duties and privacy practices with respect to PHI. We are required to abide by the
terms of this Notice of Privacy Practices. We reserve the right to change the terms of our
Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective
for all PHI that we maintain at that time. We will provide you with a copy of the revised
Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the
mail upon request, or providing one to you at your next appointment.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
For Treatment. Your PHI may be used and disclosed by those who are involved in your
care for the purpose of providing, coordinating, or managing your health care treatment
and related services. This includes consultation with clinical supervisors or other
treatment team members. We may disclose PHI to any other consultant only with your
authorization.
For Payment. We may use or disclose PHI so that we can receive payment for the
treatment services provided to you. This will only be done with your authorization.
Examples of payment-related activities are: making a determination of eligibility or coverage
for insurance benefits, processing claims with your insurance company, reviewing services
provided to you to determine medical necessity, or undertaking utilization review activities.
If it becomes necessary to use collection processes due to lack of payment for services, we
will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations. We may use or disclose, as needed, your PHI in order to
support our business activities including, but not limited to, quality assessment activities,
employee review activities, reminding you of appointments, to provide information about
treatment alternatives or other health related benefits and services, licensing, and
conducting or arranging for other business activities. For example, we may share your PHI
with third parties that perform various business activities (e.g., billing or typing services)
provided we have a written contract with the business that requires it to safeguard the
privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your
authorization.
Required by Law. Under the law, we must make disclosures of your PHI to you upon your
request. In addition, we must make disclosures to the Secretary of the Department of
Health and Human Services for the purpose of investigating or determining our compliance
with the requirements of the Privacy Rule.
Following is a list of the categories of uses and disclosures permitted by HIPAA
without an authorization.
Abuse and Neglect Judicial and Administrative Proceedings
Emergencies Law Enforcement
National Security Public Safety (Duty to Warn)
Without Authorization. Applicable law and ethical standards permit us to disclose
information about you without your authorization only in a limited number of other
situations.
The types of uses and disclosures that may be made without your authorization
are those that are:
• Required by law, such as the mandatory reporting of child abuse or neglect or
mandatory government agency audits or investigations (such as state licensing
boards or health department)
• Required by Court Order
• Necessary to prevent or lessen a serious and imminent threat to the health or safety
of a person or the public. If information is disclosed to prevent or lessen a serious
threat, it will be disclosed to a person or persons reasonably able to prevent or lessen
the threat, including the target of the threat.
Verbal Permission. We may use or disclose your information to family members that are
directly involved in your treatment with your verbal permission.
With Authorization. Uses and disclosures not specifically permitted by applicable law will
be made only with your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding your personal PHI maintained by our office. To
exercise any of these rights, please submit your request in writing to our Privacy Officer,
Sara J. Demetry LICSW, at 1097 Main Street, St Johnsbury VT 05819:
• Right of Access to Inspect and Copy. You have the right, which may be restricted
only in exceptional circumstances, to inspect and copy PHI that may be used to make
decisions about your care. Your right to inspect and copy PHI will be restricted only
in those situations where there is compelling evidence that access would cause
serious harm to you. We may charge a reasonable, cost-based fee for copies and
have 30 days to fulfill your request which must be made in writing.