Policies & Fees

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. 

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Relevant codes include: HIPAA, House Bill 300, Health and Safety Code 181

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Policy Officer is Susan Henderson PhD., LPC, LMFT Associate, NCC

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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 physical or mental health or condition and related health care services is referred to as PROTECTED HEALTH INFORMATION (PHI). The notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law and the rules and regulations of the LPC and LMFT Boards in Texas. It also describes your rights regarding how you main gain access to and control your PHI.

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I am required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. I am required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. I will provide you with a copy of the revised Notice of Privacy Practices by sending you a copy through the secure Simple Practice portal. upon request or providing the opportunity to review a copy at your appointment.

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This office will follow all relevant policy including updates with appropriate training for which certificates will be kept on file for the mandated 7 years. I will complete appropriate training in these requirements necessary to maintain client/patient confidentiality and to protect their medical health records and their personal identifying data.

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Records

• All official records will be kept electronically behind two “locks”. The computer in which records are accessed is password protected. The platform (Simple Practice) on which the records are stored is password protected. And the Simple Practice platform is HIPAA compliant. Paper records such as billing receipts, payments, and all correspondence from insurance companies (if applicable) will be scanned and stored in the HIPAA compliant platform. All paper copies will be shredded following the requirements of state licensure and of insurance companies. After termination of services, records will be maintained 7 years for adults or 5 years past the majority (18 years) or 7 years, whichever is greater. If I cancel with Simple Practice or retire prior to the destruction of your records, then your records will be downloaded and stored on an encrypted external hard drive. The hard drive will be destroyed once records are erased from the external hard drive - this will happen 7 years after your last session or for minors, 5 years past the date of majority or 7 years (whichever is greater).

• All correspondence between the therapist and client will be through the HIPAA compliant Simple Practice portal or by telephone. Any texts will only be for appointment reminders and cancellations. 

• Clients/patients may receive a copy of their electronic or paper records within 15 days of the written request. A form is available for requesting records.

• All client financial records for billing purposes is maintained on a secure HIPAA compliant portal, Simple Practice.

• Any breach of medial records or protected personal information will be documented in the log and the client/patient will be notified ASAP.

• Your therapist is fully licensed as a Licensed Professional Counselor but continues to receive supervision for her Associate license as a Marriage and Family Therapist by Mary Nichter, LMFT Approved Supervisor. PHI is not disclosed in these supervision sessions, but Mary Nichter has the right to receive any information necessary for the treatment of services. She is bound by the same confidentiality as your therapist.

• Your therapist will follow the appropriate ethical requirements of their licenses regarding records upon retirement or death. In summary, upon the death or incapacitation of your therapist, your records will be in the custody of Craig Henderson, Ph.D., a licensed Psychologist in the state of Texas or his designee. Craig Henderson is knowledgeable regarding records and needs of clients/patients as well as confidentiality requirements.

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I. MY PLEDGE REGARDING HEALTH INFORMATION:

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I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

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II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

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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 professional clinical consultants or other treatment team members. We may disclose your PHI to any other consultant only with your authorization.

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For Payment:

Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the PHI without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will be done with your authorization. Examples of payment-related activities are: 1) making a determination of eligibility or coverage for insurance benefits, 2) processing claims with your insurance company, 3) reviewing services provided to you to determine medical necessity, or 4) undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount PHI necessary for purposes of collection.

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Lawsuits and Disputes:

If you are involved in a lawsuit, We may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

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III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

2. Sale of PHI. As a psychotherapist, I will not sell your PHI in the regular course of my business.

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IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

9. For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws.

10. Appointment reminders and health-related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. However, it is my practice to not include PHI in these contacts. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

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V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or another person that you indicate is involved in your care or the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

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VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 15 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.

5. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.

6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.

7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

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EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on January 1, 2020