The Health Insurance Portability and Accountability Act of 1996, otherwise known as
HIPAA, has generated several new sets of federal regulations applicable to health care
practitioners, including social workers. These regulations went into effect on April 14,
THE FOLLOWING INFORMATION DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This
information about you (that may identify you and that relates to your past, present or
future health care, mental health or condition, and related health care services) is referred
to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes
how I may use and disclose your PHI in accordance with applicable law and the National
Association of Social Workers (my professional association) Code of Ethics. It also
describes your rights regarding how you may gain access to and control your PHI.
I am required by law to maintain the privacy of PHI and to provide you with notice of my
legal duties and privacy practices with respect to PHI. I am required to abide by the terms
of this Notice of Privacy Practices. If the terms of my Notice of Privacy Practices change,
any new Notice of Privacy Practices will be effective for all PHI that I maintain at that
time. I will provide you with a copy of the revised Notice of Privacy Practices by posting
a copy on my website, sending a copy to you in the mail upon request, or providing a
copy to you at your next appointment.
HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment. Your PHI may be used and disclosed by those who are involved in your
care for the purpose of providing, coordinating, or managing your health care treatment
and related services. This includes consultation with clinical supervisors or other
treatment team members. I may disclose PHI to any other consultant only with your
For Payment. I may use and disclose PHI so that I can receive payment for the treatment
services provided to you. This will only be done with your authorization. Examples of
payment-related activities are: making a determination of eligibility or coverage for
insurance benefits, processing claims with your insurance company, reviewing services
provided to you to determine medical necessity, or undertaking utilization review
activities. If it becomes necessary to use collection processes due to lack of payment for
services, I will only disclose the minimum amount of PHI necessary for purposes of
For Health Care Operations. I may use or disclose, as needed, your PHI in order to
support my business activities including, but not limited to, licensing, and conducting or
arranging for other business activities. For example, I may share your PHI with third
parties that perform various business activities (e.g., billing services) provided I have a
written contract with the business that requires it to safeguard the privacy of your PHI.
For training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law. Under the law, I must make disclosures of your PHI to you upon your
request. In addition, I must make disclosures to the Secretary of the Department of Health
and Human Services for the purpose of investigating or determining my compliance with
the requirements of the Privacy Rule.
Without Authorization. Applicable law and ethical standards permit me to disclose
information about you without your authorization only in a limited number of other
situations. The types of uses and disclosures that may be made without your authorization
are those that are:
Required by Law, such as the mandatory reporting of child abuse or neglect or mandatory
government agency audits or investigations (such as the social work licensing board or
the health department)
Required by Court Order
Necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. If information is disclosed to prevent or lessen a serious threat it will
be disclosed to a person or persons reasonably able to prevent or lessen the threat,
including the target of the threat.
I may disclose your information to family members that are directly involved in your
treatment only with your written permission.
Uses and disclosures not specifically permitted by applicable law will be made only with
your written authorization, which may be revoked.
YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding PHI I maintain about you. To exercise any of
these rights, please submit your request in writing:
Right of Access to Inspect and Copy. You have the right, which may be restricted only in
exceptional circumstances, to inspect and copy PHI that may be used to make decisions
about your care. Your right to inspect and copy PHI will be restricted only in those
situations where there is compelling evidence that access would cause serious harm to
you. I may charge a reasonable, cost-based fee for copies.
Right to Amend. If you feel that the PHI I have about you is incorrect or incomplete, you
may ask me to amend the information although I am not required to agree to the
Right to an Accounting of Disclosures. You have the right to request an accounting of
certain of the disclosures that I make of your PHI. I may charge you a reasonable fee if
you request more than one accounting in any 12-month period.
Right to Request Restrictions. You have the right to request a restriction or limitation on
the use or disclosure of your PHI for treatment, payment, or health care operations. I am
not required to agree to your request.
Right to Request Confidential Communication. You have the right to request that I
communicate with you about medical matters in a certain way or at a certain location.
Right to a Copy of this Notice. You have the right to a copy of this notice.