HIPAA Notice

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information

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

I. Disclosures for Treatment, Payment, and Health Care Operations

Compass CBT Psychology, PC (hereafter “the Practice”) may use or disclose your protected health information (PHI), for certain treatment, payment, and health care operations purposes without your authorization. In certain circumstances the Practice can only do so when the person or business requesting your PHI provides a written request that includes certain promises regarding protecting the confidentiality of your PHI. To help clarify these terms, here are some definitions:

“PHI” refers to protected health information, which is information that identifies or could be used to identify you.

“EHR” and “e-PHI” refer to health records in electronic form and format.

“Treatment, Payment and Health Care Operations”

Treatment is when a healthcare provider diagnoses or treats you. An example of treatment would be when consulting with another health care provider, such as your family physician or another psychologist, regarding your treatment.

Payment is when the Practice obtains reimbursement for your healthcare. Examples of payment are when your PHI is disclosed to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

Health Care Operations is when your PHI is disclosed to your health care service plan (for example your health insurer), or to other health care providers contracting with your plan, or administering the plan, such as case management and care coordination.

“Use” applies only to activities within the Practice office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

“Disclosure” applies to activities outside of the Practice office, such as releasing, transferring, or providing access to information about you to other parties.

“Authorization” means written permission for specific uses or disclosures.

II. Uses and Disclosures Requiring Authorization

The Practice may use or disclose minimum necessary PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. In those instances when the Practice is asked for information for purposes outside of treatment and payment operations, the Practice will obtain an authorization from you before releasing this information. The Practice will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes about conversation during a private, group, joint, or family therapy session, which are kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke or modify all such authorizations (of PHI or psychotherapy notes) at any time; however, the revocation or modification is not effective until the Practice receives it. When the state (California or New York) laws are more protective than HIPAA, the more stringent requirements will apply.

III. Uses and Disclosures with Neither Consent nor Authorization

The Practice may use or disclose the minimum necessary PHI without your consent or authorization in the following circumstances:

Child Abuse: Whenever, in a professional capacity, the Practice has knowledge of or observes a child that is known or reasonably suspected to have been the victim of child abuse or neglect, the Practice must immediately report such abuse to a police department or sheriff’s department, county probation department, or county welfare department. Also, if the Practice has knowledge of or reasonably suspects that mental suffering has been inflicted upon a child or that his or her emotional well-being is endangered in any other way, the Practice may report such to the above agencies.

Elder and Dependent Adult Abuse: If, in a professional capacity, the Practice has observed or has knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if the Practice is informed by an elder or dependent adult that he or she has experienced these or if the Practice reasonably suspects such, the Practice must report the known or suspected abuse immediately to the adult protective services agency or the local law enforcement agency.

The Practice does not have to report such an incident if:

1) The practice has been told by an elder or dependent adult that they have experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse or neglect;

2) The Practice is not aware of any independent evidence that corroborates the statement that the abuse has occurred;

3) The elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia; and

4) In the exercise of clinical judgment, the Practice reasonably believes that the abuse did not occur.

Health Oversight: If a complaint is filed against members of the Practice with the California Board of Psychology or the New York Board of Psychology, the Board has the authority to subpoena confidential mental health information from the Practice relevant to that complaint.

Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made about the professional services that the Practice has provided you, the Practice must not release your information without 1) your written authorization or the authorization of your attorney or personal representative; 2) a court order; or 3) a subpoena duces tecum (a subpoena to produce records) where the party seeking your records provides the Practice with a showing that you or your attorney have been served with a copy of the subpoena, affidavit and the appropriate notice, and you have not notified the Practice that you are bringing a motion in the court to quash (block) or modify the subpoena. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. Members of the Practice will inform you in advance if this is the case.

Serious Threat to Health or Safety: If you or your family member communicate to the Practice that you pose a serious threat of physical violence against an identifiable victim, the Practice must make reasonable efforts to communicate that information to the potential victim and the police. If the Practice has reasonable cause to believe that you are in such a condition as to be dangerous to yourself or others, the Practice may release relevant information as necessary to prevent the threatened danger.

Worker’s Compensation: If you file a worker’s compensation claim, the Practice may disclose to your employer your medical information created as a result of employment-related health care services provided to you at the specific prior written consent and expense of your employer so long as the requested information is relevant to your claim, provided that is only used or disclosed in connection with your claim and describes your functional limitations provided that no statement of medical cause is included.

IV. Client's Rights and Psychologist's Duties

Client’s Rights:

Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of PHI about you. However, the Practice is not required to agree to all restrictions you request. An important exception is your right to request nondisclosure to your health plan for which you pay out-of-pocket unless the disclosure is for treatment purposes or in the rare event disclosure is required by law.

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.

Right to Inspect and Copy – You have the right with your written request to inspect or obtain a copy (or both) of PHI and/or psychotherapy notes in the Practice’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. The Practice may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, the Practice will have 30 days to respond to your request with one 30-day extension and will discuss with you the details of the request and denial process. There will be a small charge to cover the cost of paper copies and labor. The Practice must provide you access to EHR and other electronic records in the electronic form and format requested by the individual if the records are readily reproducible in that format. Otherwise, the Practice must provide the records in another mutually agreeable electronic format. Hard copies are permitted only when you reject all readily reproducible electronic formats.

Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. The Practice may deny your request. On your request, the Practice 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 for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, the Practice will discuss with you the details of the accounting process.

Right to Prohibit Sale of PHI – Your absence of a written authorization means you are prohibiting the sale of your PHI. Marketing or research uses would be examples of reasons to sell PHI.

Right to a Paper Copy – You have the right to obtain a paper copy of the HIPAA Notice upon request, even if you have agreed to receive the Notice electronically.

Psychologist’s Duties:

The Practice 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.

The Practice must notify you if unsecured PHI is breached. Because your PHI will be encrypted, no notification will be required. No risk assessment of unsecured PHI will need to be conducted if notification of a breach is made.

The Practice reserves the right to change the privacy policies and practices described in this notice. Unless the Practice notifies you of such changes, however, the Practice is required to abide by the terms currently in effect.

The Practice is allowed to send unencrypted emails if you are advised of the risk and still request that form of transmission.

The Practice is allowed to make relevant disclosures to your family after death under essentially the same circumstances such disclosures were permitted before death.

The Practice is allowed to tell you about a third-party product or service without your written authorization when: the Practice receives no compensation for that product or service, the communication with you is face to face, it involves general health promotion, and/or it involves government or government-sponsored programs.

If the Practice revises this HIPAA Notice, it will provide current clients with a revised notice, at their request, by email or by mail to their home address. All new clients will receive an electronic copy prior to their first session. A copy of this Notice is posted on the Practice website, www.compasscbt.com.

V. Questions and Complaints

If you have questions about this notice, disagree with a decision the Practice made about access to your records, or have other concerns about your privacy rights, you may contact Dr. Regina Lazarovich, PhD, at (347) 735-9740 or drlazarovich@compasscbt.com. If you believe that your privacy rights have been violated and wish to file a complaint, you may send your written complaint to Compass CBT at 216-E Mount Hermon Rd, #316, Scotts Valley, CA 95066-4009. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. You have specific rights under the Privacy Rule. The Practice and its members will not retaliate against you for exercising your right to file a complaint.

VI. Effective Date, Restrictions, and Changes to Privacy Policy

This notice went into effect on June 6, 2023.

The Practice reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI maintained by the Practice. The Practice will provide you with a revised electronic notice. If you are no longer in therapy, the Practice will provide a revised notice only at your written request.