THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice is provided on behalf of the Anxiety Center of Annapolis, LLC (“Clinic”). The Clinic provides psychological services to the community. 

PURPOSE OF THIS NOTICE

This Notice of Privacy Practices describes how I may use and disclose your Protected Health Information (“PHI”) to carry out treatment, payment or health care operations, and for other purposes permitted or required by law. This Notice will also describe your rights and certain obligations I have prior to using or disclosing your PHI. “Protected Health Information” or “PHI” refers to information about you or your minor child, including demographic data such as name, address, phone numbers, etc., that may identify you or your minor child and that relates to you or your minor child’s past, present, or future physical or mental health and related health care services. 

I understand that PHI about you is personal and confidential, and I am committed to protecting its confidentiality. I create a record of the care and services you receive at the Clinic to enable myself to provide such services and to comply with legal requirements. I am required by law to provide this Notice regarding I) the use and disclosure of your health information, II) my legal responsibilities, and III) your rights concerning your health information and to abide by the terms of the most current version of this Notice. I reserve the right to change the privacy practices described in it, with such changes to be effective for all PHI that I maintain. This Notice, including any updates, may be viewed on the website at: https://annapolisanxiety.com. You may request a paper copy of this Notice at any time by contacting the Clinic at: info@annapolisanxiety.com or (540) 808-7006. 

I.   Uses and Disclosures for Treatment, Payment, and Operations

I will use and disclose your PHI as described in each category below. For each category, I will explain in general terms, but not describe all specific uses or disclosures of PHI.

A.   For Treatment

I will use and disclose your PHI without your authorization to provide your health care and any related services. I will also use and disclose your PHI to coordinate and manage your health care and related services. For example, I may need to disclose information to a case manager who is responsible for coordinating your care. I may also disclose your PHI among other staff (e.g., billing specialist who works at the Clinic).

B.   For Payment

I may use or disclose your PHI without your authorization so that the treatment and services you receive are billed to and payment is collected from your health care plan or other third party payer. By way of example, I may disclose your PHI to permit your health care plan or other health insurer to take certain actions before your health care plan or insurer approves or pays for your services. These actions may include:

  • making a determination of eligibility or coverage for health insurance;

  • reviewing your services to determine if they were medically necessary;

  • reviewing your services to determine if they were appropriately authorized or certified in advance of your care; or

  • reviewing your services for purposes of utilization review, to ensure appropriateness of your care, or justify charges for your care.

For example, your health care plan or insurer may ask me to share your PHI in order to determine if the plan will approve additional visits to your therapist.

C.   For Health Care Operations

I may use and disclose PHI about you without your authorization for our health care operations. These uses and disclosures are necessary to run the Clinic and make sure that our clients receive quality care. These activities may include, for example, quality assessment and improvement, reviewing and performance or qualifications of our clinicians, training students in clinical activities, licensing, accreditation, business planning and development, and general administrative activities. I may combine PHI of many of our clients to decide what additional services I should offer, what services are no longer needed, and whether certain treatments are effective. I may also use and disclose your PHI to contact you to remind you of your appointment. Finally, I may use and disclose your PHI to inform you about possible treatment options or alternatives that may be of interest to you.  

D.   Health-Related Benefits and Services

I may use and disclose PHI to tell you about health-related benefits or services that may be of interest to you. If you do not want me to provide you with information about health-related benefits or services, you must notify me in writing at: Anxiety Center of Annapolis, LLC 1125 West Street, Suite 200, Annapolis, Maryland 21401. Please state clearly that you do not want to receive materials about health-related benefits or services. 

II.   Uses and Disclosures That May be Made Without Your Authorization, But For Which You Will Have an Opportunity to Object

A.   Persons Involved in Your Care 

I may provide PHI about you to someone who helps pay for your care. I may use or disclose your PHI to notify or assist in notifying a family member, personal representative, public guardian or conservator, or any other person that is responsible for your care of your location, general condition, or death. If you are physically present and have the capacity to make health care decisions, your PHI may only be disclosed with your agreement to persons you designate to be involved in your care. If you are in an emergency situation, I may disclose your PHI to a spouse, a family member, or a friend so that such person may assist in your care. In this case, I will determine whether the disclosure is in your best interest and, if so, only disclose information that is directly relevant to participation in your care. And, if you are not in an emergency situation but are unable to make health care decisions, I will disclose your PHI to:

  • a person designated to participate in your care in accordance with an advance directive   validly executed under state law;

  • your guardian or other fiduciary, if one has been appointed by a court; or

  • if applicable, the state agency responsible for consenting to your care.

II.   Uses and Disclosures That May be Made Without Your Authorization or Opportunity to Object

A.   Emergencies

I may use and disclose your PHI in an emergency treatment situation. By way of example, I may provide your PHI to a paramedic who is transporting you in an ambulance.

B.   Research

I may disclose your PHI to researchers when their research has been approved by an Institutional Review Board or a similar Privacy Board that has reviewed the research proposal and established protocols to protect the privacy of your PHI. 

C.   As Required By Law

I disclose PHI about you when required to do so by local, state, or Federal law. 

D.   To Advert a Serious Threat to Health or Safety

I may use and disclose PHI about you when necessary to prevent a serious and imminent threat to your health or safety, or to the health or safety of the public or another person. Under these circumstances, I will only disclose PHI to someone who is able to help prevent or lessen the threat.

E.   Organ and Tissue Donation

If you are an organ door, I may release your PHI to an organ procurement organization or to an entity that conducts organ, eye, or tissue transplantation, or serves as an organ donation bank, as necessary to facilitate organ, eye, or tissue donation and transplantation. 

F.   Public Health Activities

I may disclose PHI about you as necessary for public health activities including, by way of example, disclosures to:

  • report to public health authorities for the purpose of preventing or controlling disease, injury, or disability;

  • report vital events, such as birth or death;

  • conduct public health surveillance or investigations;

  • report child abuse or neglect;

  • report certain events to the Food and Drug Administration (FDA) or to a person subject to the jurisdiction of the FDA, including information about defective products or problems with medications;

  • notify clients about FDA-initiated product recalls;

  • notify a person who may have been exposed to a communicable disease or who is at risk of contracting or spreading a disease or condition; 

  • notify appropriate government agency if I believe you have been a victim of abuse or neglect or domestic violence. I will only notify an agency if I obtain your agreement or if I am required or authorized by law to report such abuse, neglect or domestic violence.

G.   Health Oversight Activities

I may disclose PHI about you to a health oversight agency for activities authorized by law. Oversight agencies include government agencies that oversee the health care system, government benefit programs (such as Medicare or Medicaid), other government programs regulating health care, and civil rights laws.

H.   Disclosure in Legal Proceedings

I may disclose PHI about you to a court or administrative agency when a judge or administrative agency orders me to do so. I also may disclose PHI about you in legal proceedings without your permission or without a judge or administrative agency’s order when I receive a subpoena for your PHI. I will not provide this information in response to a subpoena without your authorization if the request is for records of a federally-assisted substance abuse program.

I.   Law Enforcement Activities

I may disclose PHI to a law enforcement official for law enforcement purposes when:

  • a court order, subpoena, warrant, summons, or similar process requires me to do so; 

  • the information is needed to identify or locate a suspect, fugitive, material witness, or missing person;

  • I report a death that I believe may be the result of criminal conduct;

  • I report criminal conduct occurring on the premises of our facilities;

  • I determine that the law enforcement purpose is to respond to a threat of an imminently dangerous activity by you against yourself or another person; or 

  • the disclosure is otherwise required by law.

I may also disclose PHI about a client who is a victim of a crime, without a court order or without being required to do so by law. However, I will do so only if law enforcement officials have requested the disclosure and the victim agrees to the disclosure or, in the case of the victim’s incapacity, the following occurs:

  • the law enforcement official represents to me that (i) the victim is not the subject of the investigation and (ii) an immediate law enforcement activity to meet a serious danger to the victim or others depends upon the disclosure; and

  • I determine that the disclosure is in the victim’s best interest.

J.   Medical Examiners

I may provide PHI about our clients to a medical examiner. Medical examiners are appointed by law to assist in identifying deceased persons and to determine the cause of death in certain circumstances.

K.   Military and Veterans

If you a member of the armed forces, I may disclose your PHI, as required by military command authorities. I may also disclose your PHI for the purpose of determining your eligibility for benefits provided by the Department of Veterans Affairs. Finally, if you are a member of a foreign military service, I may disclose your PHI to that foreign military authority.

L.   National Security and Protective Services for the President and Others

I may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities as authorized by law. I may also disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.

M.   Inmates

If you are an inmate of a correctional institution or under the custody of a law enforcement official, I may disclose PHI about you to the correctional institution or law enforcement official.

N.   Workers’ Compensation

I may disclose PHI about you to comply with Maryland’s Workers’ Compensation law.

III.   Uses and Disclosures Requiring Your Written Authorization

Except as otherwise described in this Notice of Privacy Practices or otherwise permitted under the Health Insurance Portability and Accountability Act (“HIPAA”), uses and disclosures of your PHI will be made only with your written authorization and subject to your right to revoke such authorization at any time. Your written authorization is generally required before I will use or disclose your psychotherapy notes. Psychotherapy notes are notes about your conversations with a mental health professional during a counseling session. I may use and disclose such notes, when needed, to defend against litigation filed by you.

IV.   Your Rights Regarding Your Protected Health Information

A.   Right to Inspect and Copy

You have the right to request an opportunity to inspect or copy PHI used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. You must submit your request in writing to: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401. If you request a copy of the information, I may charge a fee for the cost of copying, mailing, and supplies associated with your request. I may deny your request to inspect or copy your PHI in certain limited circumstances. In some cases, you will have the right to have the denial reviewed by a licensed health care professional not directly involved in the original decision to deny access. I will inform you in writing if the denial of your request may be reviewed. Once the review is completed, I will honor the decision made by the licensed health care professional reviewer. I must provide you with access to your PHI in the form and format requested by you, if the PHI is readily producible in that form and format. If the PHI cannot be provided to you in the form and format that you request, I must provide the information to you in a readable hard copy or in such other form as is mutually agreed is acceptable.

B.   Right to Amend

For as long as I keep records about you, you have the right to request that I amend any PHI used to make decisions about your care – whether they are decisions about your treatment or payment of your care. Usually, this would include clinical and billing records, but not psychotherapy notes. To request an amendment, you must submit a written document to: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401 and describe why you believe the information is incorrect or inaccurate. I may deny your request for an amendment if it is not in writing or does not include a reason to support the request. I may also deny your request if you ask me to amend PHI that:

  • was not created by me, unless the person or entity that created the PHI is no longer available to make the amendment;

  • is not part of the PHI I maintain to make decisions about your care;

  • is not part of the PHI that you would be permitted to inspect or copy; or

  • is accurate and complete.

If I deny your request to amend, I will send you a written notice of the denial stating the basis for the denial and offering you the opportunity to provide a written statement disagreeing with the denial. If you do not wish to prepare a written statement of disagreement, you may ask that the requested amendment and our denial be attached to all future disclosures of the PHI that is the subject of your request. If you choose to submit a written statement of disagreement, I have the right to prepare a written rebuttal to your statement of disagreement. In this case, I will attach the written request and the rebuttal (as well as the original request and denial) to all future disclosures of PHI that is the subject of your request. 

C.   Right to an Accounting of Disclosures

You have the right to request that I provide you with an accounting of disclosures I have made of your PHI. An accounting is a list of disclosures. This list will not include certain disclosures of your PHI (for example, those I have made for purposes of treatment, payment, and health care operations). To request an accounting of disclosures, you must submit your request in writing to: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401. The request should state the time period for which you wish to receive an accounting. This time period should not be longer than six years and not include dates before February 9th, 2019.

D.   Right to Request Restrictions

You have the right to request that I limit uses and disclosures of PHI in relation to treatment, payment, and health care operations or not use or disclose your PHI for these reasons at all. You also have the right to request that I restrict the use or disclosure of your PHI to family members or personal representatives. Any such request must be made in writing to: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401. You must state the specific restriction requested and to whom that restriction would apply.

E.   Right to Request Confidential Communications

You have the right to request that I communicate with you about your health care only in a certain location or through a certain method. For example, you may request that I contact you only at work or by e-mail. To request such a confidential communication, you must make your request in writing to: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401. I will accommodate all reasonable requests. You do not need to give a reason for the request; but your request must specify how or where you wish to be contacted.

F.   Right to a Paper Copy of this Notice

You have the right to obtain a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this Notice of Privacy Practices electronically, you may still obtain a paper copy. To obtain a paper copy, contact the Clinic at: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401.

G.   Right to Receive Notice of a Breach

If your unsecured PHI is acquired, used or disclosed in a manner that is impermissible under the Privacy Rules, then I must notify you of the breach within 60 days following the date that I learn of such breach. The exception to this requirement is if I determine that there is a low probability that your PHI has been compromised by the unauthorized disclosure. For more information on this rule, please contact the Clinic at: Anxiety Center of Annapolis, LLC, 1125 West Street, Suite 200, Annapolis, Maryland 21401. Unsecured PHI is PHI that has not been encrypted or destroyed.

V.   Confidentiality of Substance Abuse Records

For individuals who have received treatment, diagnosis or referral for treatment from our drug or alcohol abuse programs, federal law and regulations protect the confidentiality of drug or alcohol abuse records. As a general rule, I may not tell a person outside the programs that you attend any of these programs, or disclose any information identifying you as an alcohol or drug abuser, unless:

  • you authorize the disclosure in writing;

  • the disclosure is permitted by a court order;

  • the disclosure is made to medical personnel in a medical emergency or to a qualified personnel for research, audit, or program evaluation purposes; or

  • you threaten to commit a crime either at the drug abuse or alcohol program or against any person who works for our drug abuse or alcohol programs.

Please see 42 USC § 290dd-2 for federal law and 42 C.F.R., Part 2 for federal regulations governing confidentiality of alcohol and drug abuse patient records.

VI.   Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Clinic or with the Secretary of the U.S. Dept. of Health and Human Services. I will not retaliate against you for filing a complaint.

VII.   Effective Date of Privacy Policy

This Notice will go into effect on January 1, 2019.