Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES
for
Melinda Moore, Ph.D.
2365 Harrodsburg Rd, Suite B225
Lextington, KY 40504

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

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

Your therapist may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes. To help clarify these terms, here are some definitions:

“PHI” refers to information in your health record that could identify you.

“Treatment, Payment, and Health Care Operations”

“Treatment” is when your therapist provides, coordinate or manage your health care and other services related to your health care. An example of treatment would be when your therapist consults with another health care provider, such as your family physician or another psychologist.

“Payment” is when your therapist obtains reimbursement for your healthcare. Examples of payment are when your therapist discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage. Health Care Operations are activities that relate to the performance and operation of therapist’ practice. Examples of health care operations are quality assessment and improvement activities, business-related matters, such as audits and administrative services, and case management and care coordination.

“Use” applies only to activities within the therapist’s office & practice group, such as sharing, applying, utilizing, examining, and analyzing information that identifies you.

“Disclosure” applies to activities outside of therapist’s office & practice group, such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

Your therapist may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your therapist asks for information for purposes outside of treatment, payment or health care operations, your therapist will obtain an authorization from you before releasing this information. Your therapist will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes your therapist may have made about your conversation during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that your therapist has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent nor Authorization

Your therapist may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse: If your therapist has reasonable cause to believe that a child is dependent, neglected or abused, therapist must report this belief to the appropriate authorities, which may include the Kentucky Cabinet for Families and Children or its designated representative; the commonwealth’s attorney or the county attorney; or local law enforcement agency or the Kentucky state police. “Dependent child” means any child, other than an abused or neglected child, who is under improper care, custody, control, or guardianship that is not due to an intentional act of the parent, guardian, or person exercising custodial control or supervision of the child.

Adult and Domestic Abuse: If your therapist has reasonable cause to believe that an adult has suffered abuse, neglect, or exploitation, your therapist must report this belief to the Kentucky Cabinet for Families and Children.

Health Oversight Activities: The Kentucky Board of Examiners of Psychology may subpoena records from me relevant to its disciplinary proceedings and investigations.

Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and records thereof, such information is privileged under state law, and your therapist will not release information without the written authorization of you or your personal or legally- appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.

Serious Threat to Health or Safety: If you communicate to your therapist an actual threat of physical violence against a clearly identified or reasonably identifiable victim or an actual threat of some specific violent act, therapist has a duty to notify the victim and law enforcement authorities.

Workers’ Compensation: If you file a claim for workers’ compensation, you waive the psychotherapist-patient privilege and consent to disclosure of your health information reasonably related to your injury or disease to your employer, workers’ compensation insurer, special fund, uninsured employers’ fund or the administrative law judge.

There may be additional disclosures of PHI that your therapist is required or permitted by law to make without your consent or authorization, however the disclosures listed above are the most common.

IV. Patient’s Rights and Psychologist’s Duties

Patient’s Rights:

Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information. However, your therapist is not required to agree to a restriction you request.

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. (For example, you may not want a family member to know that you are seeing your therapist. On your request, your therapist will send your bills to another address.)

Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in the therapist’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your therapist may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, your therapist will discuss with you the details of the request and denial process.

Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your therapist may deny your request. On your request, your therapist 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. On your request, your therapist will discuss with you the details of the accounting process.

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

Have the Right to Restrict certain disclosures of Protected Health Information (PHI) to a health plan if you pay out-of-pocket in full for the healthcare service.

Have the right to be notified if there is breach of your unsecured PHI.

Must sign an authorization before your therapist can release your PHI for any uses and disclosures not described in this Privacy Notice

Psychologist’s Duties:
Your therapist is required by law to maintain the privacy of PHI and to provide you with a notice of your therapist’s legal duties and privacy practices with respect to PHI.
Your therapist reserve the right to change the privacy policies and practices described in this notice. Unless your therapist notifies you of such changes, however, your therapist is required to abide by the terms currently in effect.

If your therapist revises their policies and procedures, they will notify you in person or by mail.

V. Questions and Complaints
If you have questions about this notice, disagree with a decision your therapist has made about access to your records, or have other concerns about your privacy rights, you may call Dr. Moore at 859-457-1210.

If you believe that your privacy rights have been violated and wish to file a complaint, you may send your written complaint to Dr. Melinda Moore at 2365 Harrodsburg Rd, Suite B225, Lexington, KY 40504.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Your therapist can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule. Your therapist will not retaliate against you for exercising your right to file a complaint.

VI. Effective Date, Restrictions, and Changes to Privacy Policy
This notice is in effect on January 20, 2015.