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HIPAA Policy
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Notice
of Jeffrey Zimmerman, Ph.D.’s (Dr. Zimmerman’s) Policies and Practices to
Protect the Privacy of Your Health Information THIS NOTICE DESCRIBES HOW
PSYCHOLOGICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. I.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
DR. ZIMMERMAN (and his
professional and administrative staff) may use
or disclose your protected health information (PHI),
for treatment, payment, and health care
operations purposes with your consent.
To help clarify these terms, here are some definitions: ·
“PHI”
refers to information in your health record that could identify you. ·
“Treatment,
Payment and Health Care Operations” – Treatment
is when DR. ZIMMERMAN provides, coordinate or manage your health care and other
services related to your health care. An
example of treatment would be when a DR. ZIMMERMAN
consults with another health care provider, such as your family physician
or another psychologist. – Payment
is when DR. ZIMMERMAN obtains reimbursement for your healthcare.
Examples of payment are when DR. ZIMMERMAN discloses your PHI to your
health insurer to obtain reimbursement for your health care or to determine
eligibility or coverage. – Health
Care Operations are activities that relate to the performance and operation
of DR. ZIMMERMAN’s professional practice.
Examples of health care operations are quality assessment and improvement
activities, business-related matters such as audits and administrative services,
and case management and care coordination. ·
“Use”
applies only to activities within our practice such as sharing, employing,
applying, utilizing, examining, and analyzing information that identifies you. ·
“Disclosure”
applies to activities outside of our practice, such as releasing, transferring,
or providing access to information about you to other parties. II. Uses and Disclosures
Requiring Authorization
DR. ZIMMERMAN may use or
disclose PHI for purposes outside of treatment, payment, or health care
operations when your appropriate authorization is obtained.
An “authorization” is
written permission above and beyond the general consent that permits only
specific disclosures. In those
instances when DR. ZIMMERMAN is asked for information for purposes outside of
treatment, payment or health care operations, DR. ZIMMERMAN will obtain an
authorization from you before releasing this information. You may revoke all such
authorizations of PHI at any time, provided each revocation is in writing.
You may not revoke an authorization to the extent that (1) DR. ZIMMERMAN
has already relied on that authorization; or (2) if the authorization was
obtained as a condition of obtaining insurance coverage, law provides the
insurer the right to contest the claim under the policy. III.
Uses and Disclosures with Neither Consent nor Authorization
DR. ZIMMERMAN may use or
disclose PHI without your consent or authorization in the following
circumstances: ·
Child
Abuse – If, in the ordinary course of our
work DR. ZIMMERMAN, has reasonable cause to suspect or believe that any child
under the age of eighteen years (1) has been abused or neglected, (2) has had
nonaccidental physical injury, or injury which is at variance with the history
given of such injury, inflicted upon such child, or (3) is placed at imminent
risk of serious harm, then DR. ZIMMERMAN must report this suspicion or belief to
the appropriate authority. ·
Adult
and Domestic Abuse – If DR. ZIMMERMAN knows or
in good faith suspects that an elderly individual or an individual, who is
disabled or incompetent, has been abused, DR. ZIMMERMAN may disclose the
appropriate information as permitted by law. ·
Health
Oversight Activities – If a State of ·
Judicial
and Administrative Proceedings – If you
are involved in a court proceeding and a request is made for information about
your diagnosis and treatment and the records thereof, such information is
privileged under state law, and DR. ZIMMERMAN will not release information
without the written authorization of you or your legally appointed
representative or a court order. The
privilege does not apply when you are being evaluated for a third party or where
the evaluation or release of information is court ordered. ·
Serious
Threat to Health or Safety – ·
Worker’s
Compensation – DR. ZIMMERMAN may disclose
protected health information regarding you as authorized by and to the extent
necessary to comply with laws relating to worker’s compensation or other
similar programs, established by law, that provide benefits for work-related
injuries or illness without regard to fault. IV. Patient’s Rights and
DR. ZIMMERMAN’ Duties
Patient’s Rights: ·
Right
to Request Restrictions – You have the right to
request restrictions on certain uses and disclosures of protected health
information. However, DR. ZIMMERMAN
is not required to agree to a restriction you request. ·
Right
to Receive Confidential
Communications by Alternative Means and at Alternative Locations –
You have the right to request and receive confidential communications of PHI
by alternative means and at alternative locations.
(For example, you may not want a family member to know that you are a
patient or client of the office. On
your request, DR. ZIMMERMAN will send your bills to another address.)
·
Right
to Inspect and Copy – You have the right to
inspect or obtain a copy (or both) of PHI in our mental health and billing
records used to make decisions about you for as long as the PHI is maintained in
the record. DR. ZIMMERMAN may deny
your access to PHI under certain circumstances, but in some cases you may have
this decision reviewed. On your
request, DR. ZIMMERMAN will discuss with you the details of the request and
denial process. ·
Right
to Amend – You have the right to request an
amendment of PHI for as long as the PHI is maintained in the record.
DR. ZIMMERMAN may deny your request.
On your request, DR. ZIMMERMAN will discuss with you the details of the
amendment process. ·
Right
to an Accounting – You generally have the
right to receive an accounting of disclosures of PHI.
On your request, DR. ZIMMERMAN will discuss with you the details of the
accounting process. ·
Right
to a Paper Copy – You have the right to obtain
a paper copy of the notice upon request, even if you have agreed to receive the
notice electronically. DR. ZIMMERMAN’s Duties: ·
DR. ZIMMERMAN is required by law
to maintain the privacy of PHI and to provide you with a notice of its legal
duties and privacy practices with respect to PHI. ·
DR. ZIMMERMAN reserves the right
to change the privacy policies and practices described in this notice. Unless
DR. ZIMMERMAN notifies you of such changes, however, DR. ZIMMERMAN is required
to abide by the terms currently in effect. ·
If DR. ZIMMERMAN revises his
policies and procedures (for which he reserves the right to do), DR. ZIMMERMAN
will provide you with a revised notice by directly handing it to you if you are
actively seen in his office at that time. V.
Complaints
If you are concerned that DR.
ZIMMERMAN may have violated your privacy rights, or you disagree with a decision
DR. ZIMMERMAN made about access to your records, you may contact him to discuss
this matter further. You may also
send a written complaint to the Secretary of the U.S. Department of Health and
Human Services. VI.
Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect
on August 15, 2007.
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© 2008, Jeffrey Zimmerman, Ph.D. |