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Orange County Counseling by Mark Pines. Call (714) 855-2232. |
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Privacy Policy
Your privacy is important to me. If you have any questions about my privacy policy, please feel free to contact me.
Privacy on this website
On this website, no personably identifiable information is collected. The only exception to this, are forms where you explicitly provide your personal information. Your personal information will never be revealed to a third party or used for any purpose other than the reason you provided the information.
HIPAA privacy policy for clients
I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
II. I HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH
lNFORMATION (PHI)
I am legally required to protect the privacy of your PHI, which
includes information that can be used to identify you that I've
created or received about your past, present, or future health or
condition, the provision of health care to you, or the payment of
this health care. I must provide you with this Notice about my
privacy practices, and such Notice must explain how, when, and why I
will "use" and "disclose" your PHI. A "use" of PHI occurs when I
share, examine, utilize, apply, or analyze such information within
my practice; PHI is "disclosed" when it is released, transferred,
has been given to, or is otherwise divulged to a third party outside
of my practice. With some exceptions, I may not use or disclose any
more of your PHI than is necessary to accomplish the purpose for
which the use or disclosure is made. And, I am legally required to
follow the privacy practices described in this Notice.
However, I reserve the right to change the terms of this Notice and
my privacy policies at any time. Any changes will apply to PHI on
file with me already. Before I make any important changes to my
policies, I will promptly change this Notice and post a new copy of
it in my office and on my website (if applicable). You can also
request a copy of this Notice from me, or you can view a copy of it
in my office or at my website, which is located at (insert website
address, if applicable).
III. HOW I MAY USE AND DISCLOSE YOUR PHI.
I will use and disclose your PHI for many different reasons. For
some of these uses or disclosures, I will need your prior
authorization; for others, however, I do not. Listed below are the
different categories of my uses and disclosures along with some
examples of each category.
A. Uses and Disclosures Relating to Treatment, Payment, or Health
Care Operations Do Not Require Your Prior Written Consent. I can use and disclose your PHI
without your consent for the following reasons:
-
For treatment.
I can disclose your PHI to physicians, psychiatrists,
psychologists, and other licensed health care providers who
provide you with health care services or are involved in your
care. For example, if you're being treated by a psychiatrist, I
can disclose your PHI to your psychiatrist in order to
coordinate your care.
-
To obtain payment for
treatment. I can use and disclose your PHI to bill and collect
payment for the treatment and services provided by me to you.
For example, I might send your PHI to your insurance company or
health plan to get paid for the health care services that I have
provided to you. I may also provide your PHI to my business
associates, such as billing companies, claims processing
companies, and others that process my health care claims.
-
For health care
operations.
I can disclose your PHI to operate my practice.
For example, I might use your PHI to evaluate the quality of
health care services that you received or to evaluate the
performance of the health care professionals who provided such
services to you. I may also provide your PHI to our accountants,
attorneys, consultants, and others to make sure I’m com-plying
with applicable laws.
-
Other disclosures.
I may also disclose your PHI to others with-out your consent in
certain situations. For example, your consent isn't required if
you need emergency treatment, as long as I try to get your
consent after treatment is rendered, or if I try to get your
consent but you are unable to communicate with me (for example,
if you are unconscious or in severe pain) and I think that you
would consent to such treatment if you were able to do so.
B. Certain Uses and Disclosures Do Not Require Your Consent.
I can use and disclose your PHI without your consent or
authorization for the following reasons:
-
When disclosure is
required by federal, state or Iocal law; judicial or
administrative proceedings; or, law enforcement. For example, I may make a
disclosure to applicable officials when a law requires me to
report information to government agencies and law enforcement
personnel about victims of abuse or neglect; or when ordered in
a judicial or administrative proceeding.
-
For public health
activities. For example, I may have to report information
about you to the county coroner.
-
For health oversight
activities.
For example, I may have to provide information to
assist the government when it conducts an investigation or
inspection of a health care provider or organization.
-
For research purposes.
In certain circumstances, I may provide PHI in order to conduct
medical research.
-
To avoid harm.
In order to avoid a serious threat to the PHI to law enforcement
personnel or persons able to prevent or lessen such harm.
-
For specific government
functions. I may disclose PHI of military personnel and veterans
in certain situations. And I may disclose PHI for national
security purposes, such as protecting the President of the
-
For workers'
compensation purposes. I may provide PHI in order to comply with
workers' compensation laws.
-
Appointment reminders
and health related benefits or services. I may use PHI to
provide appointment reminders or give you information about
treatment alternatives, or other health care services or
benefits I offer.
C. Certain Uses and Disclosures Require You to Have the
Disclosures to family, friends, or others.
I may provide your PHI to a family member, friend, or other 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.
D. Other Uses and Disclosures Require Your Prior Written
Authorization.
In any other situation not described in sections III A, B, and C
above, I will ask for your written authorization before using or
disclosing any of your PHI. If you choose to sign an authorization
to disclose your PHI, you can later revoke such authorization in
writing to stop any future uses and disclosures (to the extent that
I haven't taken any action in reliance on such authorization) of
your PHI by me.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect to your PHI:
A. The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to ask that I limit how I use and disclose your
PHI. I will consider your request, but I am not legally required to
accept it. If I accept your request, I will put any limits in
writing and abide by them except in emergency situations. You may
not limit the uses and disclosures that I am legally required or
allowed to make.
B. The Right to Choose How I Send PHI to You.
You have the right to ask
that I send information to you to at an alternate address (for
example, sending information to your work address rather than your
home address) or by alternate means (for example, e-mail instead of
regular mail) I must agree to your request so long as I can easily
provide the PHI to you in the format you requested.
C. The Right to See and Get Copies of Your PHI. In most cases, you have the
right to look at or get copies of your PHI that I have, but you must
make the request in writing. If I don't have your PHI but I know who
does, I will tell you how to get it. I will respond to you within 30
days of receiving your written request. In certain situations, I may
deny your request. If I do, I will tell you, in writing, my reasons
for the denial and explain your right to have my denial reviewed. If
you request copies of your PHI, I will charge you not more than $.25
for each page. Instead of providing the PHI you requested, I may
provide you with a summary or explanation of the PHI as long as you
agree to that and to the cost in advance.
D. The Right to Get a List of the Disclosures I Have Made.
You have the right to get a list of instances in which I have
disclosed your PHI. The list will not include uses or disclosures
that you have already consented to, such as those made for
treatment, payment, or health care operations, directly to you, or
to your family. The list also won't include uses and disclosures
made for national security purposes, to corrections or law
enforcement personnel, or disclosures made before April 15, 2003.
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. The list will include the date of the
disclosure, to whom PHI was disclosed (including their address, if
known), a description of the information disclosed, and the reason
for the disclosure. 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.
E. 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, you have the right to request that I correct the existing
information or add the missing information. You must provide the
request and your reason for the request in writing. I will respond
within 60 days of receiving your request to correct or update your
PHI. I may deny your request in writing if the PHI is (i) correct
and complete, (ii) not created by me, (iii) not allowed to be
disclosed, or (iv) not part of my records. My written denial will
state the reasons for the denial and explain your right to file a
written statement of disagreement with the denial. If you don't file
one, you have the right to request that your request and my denial
be attached to all future disclosures of your PHI. If I approve your
request, I will make the change to your PHI, tell you that I have
done it, and tell others that need to know about the change to your
PHI.
F. The Right to Get This Notice by E-Mail. You have the right to get a copy
of this notice by e-mail. Even if you have agreed to receive notice
via e-mail, you also have the right to request a paper copy of it.
V. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If you think that I may have violated your privacy rights, or you
disagree with a decision I made about access to your PHI, you may
file a complaint with the person listed in Section VI below. You
also may send a written complaint to the Secretary of the Department
of Health and Human Services at
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO
COMPLAIN ABOUT MY PRIVACY PRACTICES
If you have any questions about this notice or any com-plaints about
my privacy practices, or would like to know how to file a complaint
with the Secretary of the Department of Health and Human Services,
please contact me at: Mark Pines, 2900 Bristol St., Suite G-202,
Costa Mesa, CA 92626 (714) 855-2232
VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on April 14, 2003.