The Health Insurance Portability and Accountability Act of 1996 (“HIPPA”) is a federal program that requires that all health records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or verbally, are kept properly confidential.  This Act gives YOU, the patient, significant new rights to understand and control how your mental health information is used.  “HIPPA” provides penalties for covering entities’ personal health information. 


As required by “HIPPA”, I am providing this explanation to you, the patient, about how I am required to maintain the privacy of your health information and how it may be used and disclosed.


Your mental health records may be disclosed for each of the following purposes:


TreatmentYour Protected Health Information may be used by staff members of disclosed to other health care professionals for the purpose of evaluating your health, diagnosis, medical/mental health conditions, and providing treatment.  For example, your protected records will be available to all health professionals who may provide treatment or who may be consulted by staff members.  For example, results of laboratory tests and procedures, a physical examination, etc. 


Payment:  Your Protected Health Information may be used to seek payment from your health plan, from other sources of coverage such as automobile insurers, or form credit card companies that you may use to pay for services.  For example, your health plan may request and receive information on dates of service, services provided, and the condition being treated.


Health Care Operations: Your Protected Health Information may be used as necessary to support the day-to-day activities and management of this office.  For example, information on the services you received may be used to support budgeting and financial reporting, as well as activities to evaluate and promote quality. 


Law Enforcement: Your Protected Health Information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting. 


Public Health Reporting: Your Protected Health Information may be disclosed to public health agencies, as required by law.  For example, I am required to report certain communicable diseases to the State’s Public Health Department.  There may be a need to share information with the Food and Drug Administration related to adverse events or product defects. I am also required to share information, if requested, with the Department of Health and Human Services to determine my compliance with the federal laws related to health care.


Lawsuits and Similar Proceedings:  Your Protected Health Information may be used and disclosed in response to a Court administrative order, if you are involved in a lawsuit or a similar proceeding, as well as in response to request, subpoena, or by another order protecting another party included in the dispute; but only if I make an effort to inform you of the request, or to obtain an order protecting the information. 


Serious Threats to Health and Safety: This practice may use and disclose Your Protected Health Information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual, or the public in general.


Military:  This practice may disclose Your Protected Health Information if you are a member of the US or foreign military forces (including veterans), and if required by the proper authorities. 


National Security: This practice may disclose Your Protected Health Information to federal officials for intelligence and national security activities authorized by law.  Your Protected Health Information may also be disclosed to federal officials, in order to protect the President, other officials/foreign heads of state, or to conduct investigations. 



Inmates: This practice may disclose Your Protected Health Information to correctional institutions, or law enforcement officials, if you are an inmate under the custody of a law enforcement official.  Disclosure would be necessary for the following purposes:  a) for the institution to provide health care services to you,  b) for the safety and security of the institution,  c)and/or to protect your/other individuals’ health and safety.


Workers’ Compensation: This practice may release Your Protected Health Information for Workers’ Compensation and similar programs. 


Other permitted and required uses and disclosures of protected information


Under state and federal law, your personal protected information may be disclosed without your consent in the following circumstances:


EmergenciesSufficient information may be shared to address emergencies you may be facing to ensure your safety and prevent self-harm.


Follow up Appointment Care: I may be contacting you to remind you of future appointments or give you information about treatment alternatives or other health-related benefits and services that may be of interest to you.


Coroners: I am required to disclose information about the circumstances of your death to a Coroner. 




The following is a statement of your rights under the privacy rule in reference to your personal health records.  Please feel free to discuss any questions with me.  You may contact me at 210.863.6377.


You have the right to receive and I am required to provide you with a copy of this Notice of Privacy Practices:  I am required to follow the terms of this Notice. I reserve the right to change the terms of this Notice, at any time required by the State and/or federal law. Upon your request, I will provide you with a revised Notice of Privacy Practices, if you call my Agent and request that a copy be sent to you by mail.  You may also request a copy of a revised Privacy Practices at the time of your appointment.


You have the right to inspect and obtain a copy of your protected records:  You are entitled to inspect and obtain a copy of your personal protected health information.  I may charge you a fee to cover copying and mailing costs of your records. 


You have the right to authorize other use and disclosure of your protected personal records You may consent in writing, to the release of your records to other parties for the purpose you choose.  This may include your attorney, employer, or others whom you wish to have knowledge of your care.  You may revoke this consent at any time, but only to the extent that no action has been taken in reliance to your previous authorization.


You have the right to choose how I may contact you:  You may request that I send information to another address or by alternative means.  I will honor your request as long as it is reasonable and I am assured it is correct. I have the right to verify that the payment information you are providing is correct. I may provide you information to you via e-mail at your request. 


You have the right to request disclosure of accountability:  You may request a listing of any disclosures I have made related to your protected health information to any parties/persons outside my practice.