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 IT CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
Terra Psychiatry, PLLC is committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) and your rights regarding that information. We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable state laws to maintain the privacy of your PHI, provide you with this Notice, and follow the terms of this Notice.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment: We may use and disclose your PHI to provide, coordinate, or manage your psychiatric care and related services. For example, we may share information with another provider involved in your care, such as your primary care physician or therapist, with your authorization.
Payment: We may use and disclose your PHI to obtain payment for services. For example, we may provide information to your health insurance company when you submit a superbill for out-of-network reimbursement.
Health Care Operations: We may use and disclose your PHI for our internal operations, such as quality assessment, staff training, compliance activities, and business management.
As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law.
To Avert a Serious Threat: We may use and disclose your PHI when necessary to prevent a serious threat to the health or safety of you, another person, or the public.
Public Health Activities: We may disclose your PHI for public health activities, such as reporting certain diseases or conditions to public health authorities.
Abuse or Neglect Reporting: We may disclose your PHI to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence, as required by law.
Judicial and Administrative Proceedings: We may disclose your PHI in response to a court order or subpoena, as permitted by law.
Law Enforcement: We may disclose your PHI to law enforcement officials in certain limited circumstances, as permitted by law.
PSYCHOTHERAPY NOTES
Psychotherapy notes receive special protection under HIPAA. We will not use or disclose your psychotherapy notes without your written authorization, except in limited circumstances permitted by law (e.g., to defend against a legal action brought by you, for certain law enforcement purposes, to avert a serious and imminent threat, or for the provider’s own training or supervision).
USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
Other uses and disclosures of your PHI not covered by this Notice or applicable law will be made only with your written authorization. You may revoke any authorization at any time, in writing. Revocation will not affect disclosures already made in reliance on your prior authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Access: You have the right to inspect and obtain a copy of your PHI maintained by this practice. Requests must be submitted in writing. We may charge a reasonable fee for copies.
Right to Amend: You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. Requests must be submitted in writing with a reason for the amendment. We may deny the request in certain circumstances.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures of your PHI made by this practice.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your request, except in certain circumstances involving self-pay patients.
Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
Right to Be Notified of a Breach: You have the right to be notified if there is a breach of your unsecured PHI.
SELF-PAY PATIENTS
If you pay out of pocket in full for a service, you have the right to request that we not disclose your PHI related to that service to a health plan. We will honor this request unless disclosure is required by law.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice and make new provisions effective for all PHI we maintain. If changes are made, a revised Notice will be made available to you.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with this practice or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue, S.W., Washington, D.C. 20201
Phone: (877) 696-6775 | www.hhs.gov/ocr/privacy
If you have questions about this Notice or wish to exercise any of your rights, please contact me.