THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires us to ask each of our patients to acknowledge receipt of our Notice of Privacy Practices (the “Notice”). The Notice is published on this page. You acknowledge receipt of this notice by accepting terms and conditions for joining Modern Psychiatry Center PLLC (“Modern Psychiatry Center”).
Modern Psychiatry Center Responsibilities
Under the HIPAA, Modern Psychiatry Center must take steps to protect the privacy of your Protected Health Information (“PHI”). PHI includes information that we have created or received regarding your health or payment for your health. It includes both your medical records and personal information such as your name, social security number, address, and phone number.
Under federal law, we are required to:
Protect the privacy of your PHI. All of our employees and physicians are required to maintain the confidentiality of PHI.
Provide you with this Notice of Privacy Practices explaining our duties and practices regarding your PHI
Follow the practices and procedures set forth in the Notice
Uses and Disclosures of Your Protected Health Information That Do Not Require Your Authorization
Modern Psychiatry Center uses and discloses PHI in several ways in connection to your treatment, payment for your care, and our health care operations. Some examples of how we may use or disclose your PHI without your authorization are listed below.
Treatment:
To provide, coordinate, or manage health care and related services by one or more health care provider
Payment:
To obtain reimbursement for services, confirm coverage, billing or collection activities, and utilization review
Healthcare Operations:
To run aspects of our practice, such as conducting quality assessment and improvement activities, auditing functions, cost -management analysis, and customer service
Others:
Required by law – When we are required to do so by state and federal law, including workers’ compensation laws.
Public health and safety – To an authorized public health authority or individual to:
Protect public health and safety.
Prevent or control disease, injury, or disability.
Report vital statistics such as births or deaths.
Investigate or track problems with prescription drugs and medical devices. (Food and Drug Administration.)
Abuse or neglect – To government entities authorized to receive reports regarding abuse, neglect, or domestic violence.
Oversight agencies – To health oversight agencies for certain activities such as audits, examinations, investigations, inspections, and licensures.
Legal proceedings – In the course of any legal proceeding in response to an order of a court or administrative agency and, in certain cases, in response to a subpoena, discovery request, or other lawful process.
Law enforcement – To law enforcement officials in limited circumstances for law enforcement purposes. For example disclosures may be made to identify or locate a suspect, witness, or missing person; to report a crime; or to provide information concerning victims of crimes.
Military activity and national security – To the military and to authorized federal officials for national security and intelligence purposes or in connection with providing protective services to the President of the United States.
De-identify information—If information is removed from your PHI so that you can’t be identified, as authorized by law.
Threat to health or safety—To avoid a serious threat to the health or safety of yourself and others.
Correctional facilities—If you are an inmate in a correctional facility we may disclose your PHI to the correctional facility for certain purposes, such as providing health care to you or protecting your health and safety or that of others.
Except in the situations listed in the sections above, we use and disclose your PHI only with your written authorization. You may revoke such authorization in writing at any time.
Your Rights Regarding Your Protected Health Information
You have the right to:
The right to request restrictions by asking that we limit the way we use or disclose your PHI for treatment, payment, or health care operations. Please note that we are not required to agree to your request except when a restriction has been requested regarding a disclosure to a health plan in situations where the patient has paid for services in full and where the purpose of the disclosure is for payment or healthcare operations. If we do agree, we will honor your limits unless it is an emergency.
The right to reasonable requests to receive confidential communications of protected health information from us by alternative mean.
The right to request an electronic or paper copy of your PHI. We may ask you to make this request in writing and we may charge a reasonable fee for the cost of producing and mailing the copies.
The right to amend your PHI. Your request for an amendment must be in writing and provide the reason for your request.
The right to seek an accounting of disclosures of PHI. Your request must be in writing and give us the specific information we need in order to respond to your request.
The right to request a paper copy of this Notice.
The right to receive written notification of any breach of your unsecured PHI.
The right to file a complaint if you believe your privacy rights have been violated. You can file a written complaint with us at the address below, or 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.
Changes to Privacy Practices
Modern Psychiatry Center may change the terms of this Notice at any time. The revised Notice would apply to all PHI that we maintain. We will make any such changes to our website.