April 14, 2003
The Health Insurance Portability & Accountability
Act of 1996 (HIPAA) requires all health care records
and other individually identifiable health information
(protected health information) used or disclosed to
us in any form, whether electronically, on paper, or
orally, be kept confidential. This federal law gives
you, the patient, significant new rights to understand
and control how your health information is used. HIPAA
provides penalties for covered entities that misuse
personal health information. As required by HIPAA, we
have prepared this explanation of how we are required
to maintain the privacy of your health information and
how we may use and disclose your health information.
Without specific written authorization, we are permitted
to use and disclose your health care records for the
purposes of treatment, payment and health care operations.
• Treatment means providing,
coordinating, or managing health care and related
services by one or more health care providers. Examples
of treatment would include Psychiatric Services, Individual
Therapy, Group Therapy,etc.
• Payment means such activities
as obtaining reimbursement for services, confirming
coverage, billing or collection activities, and utilization
review. An example of this would be billing Medicaid
or Victim’s Compensation for your therapy services.
• Health Care Operations include
the business aspects of running our practice, such
as conducting quality assessment and improvement activities,
auditing functions, cost-management analysis, and
customer service. An example would include a periodic
assessment of our documentation protocols, etc.
In addition, your confidential information may be used
to remind you of an appointment (by phone or mail) or
provide you with information about treatment options
or other health-related services including release of
information to friends and family members that are directly
involved in your care or who assist in taking care of
you. We will use and disclose your protected health
information when we are required to do so by federal,
state or local law. We may disclose your PROTECTED HEALTH
INFORMATION to public health authorities that are authorized
by law to collect information, to a health oversight
agency for activities authorized by law included but
not limited to: response to a court or administrative
order, if you are involved in a lawsuit or similar proceeding,
response to a discovery request, subpoena, or other
lawful process by another party involved in the dispute,
but only if we have made an effort to inform you of
the request or to obtain an order protecting the information
the party has requested. We will release your PROTECTED
HEALTH INFORMATION if requested by a law enforcement
official for any circumstance required by law. We may
release your PROTECTED HEALTH INFORMATION to a medical
examiner or coroner to identify a deceased individual
or to identify the cause of death. If necessary, we
also may release information in order for funeral directors
to perform their jobs. We may release PROTECTED HEALTH
INFORMATION to organizations that handle organ, eye
or tissue procurement or transplantation, including
organ donation banks, as necessary to facilitate organ
or tissue donation and transplantation if you are an
organ donor. We may use and disclose your PROTECTED
HEALTH INFORMATION when necessary to reduce or prevent
a serious threat to your health and safety or the health
and safety of another individual or the public. Under
these circumstances, we will only make disclosures to
a person or organization able to help prevent the threat.
We may disclose your PROTECTED HEALTH INFORMATION if
you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate
authorities. We may disclose your PROTECTED HEALTH INFORMATION
to federal officials for intelligence and national security
activities authorized by law. We may disclose PROTECTED
HEALTH INFORMATION to federal officials in order to
protect the President, other officials or foreign heads
of state, or to conduct investigations. We may disclose
your PROTECTED HEALTH INFORMATION to correctional institutions
or law enforcement officials if you are an inmate or
under the custody of a law enforcement official. Disclosure
for these purposes would be necessary: (a) for the institution
to provide health care services to you, (b) for the
safety and security of the institution, and/or (c) to
protect your health and safety or the health and safety
of other individuals or the public. We may release your
PROTECTED HEALTH INFORMATION for workers' compensation
and similar programs.
Any other uses and disclosures will be made only with
your written authorization. You may revoke such authorization
in writing and we are required to honor and abide by
that written request, except to the extent that we have
already taken actions relying on your authorization.
You have certain rights in regards to your PROTECTED
HEALTH INFORMATION, which you can exercise by presenting
a written request to our Privacy Officer at the practice
address listed below:
• The right to request restrictions on certain
uses and disclosures of PROTECTED HEALTH INFORMATION,
including those related to disclosures to family members,
other relatives, close personal friends, or any other
person identified by you. We are, however, not required
to agree to a requested restriction. If we do agree
to a restriction, we must abide by it unless you agree
in writing to remove it.
• The right to request to receive confidential
communications of PROTECTED HEALTH INFORMATION from
us by alternative means or at alternative locations.
• The right to access, inspect and copy your
PROTECTED HEALTH INFORMATION.
• The right to request an amendment to your
PROTECTED HEALTH INFORMATION.
• The right to receive an accounting of disclosures
of PROTECTED HEALTH INFORMATION outside of treatment,
payment and health care operations.
• The right to obtain a paper copy of this notice
from us upon request.
We are required to abide by the terms of the Notice
of Privacy Practices currently in effect. We reserve
the right to change the terms of our Notice of Privacy
Practices and to make the new notice provisions effective
for all PROTECTED HEALTH INFORMATION that we maintain.
Revisions to our Notice of Privacy Practices will be
posted on the effective date and you may request a written
copy of the Revised Notice from this office.
You have the right to file a formal, written complaint
with us at the address below, or with the Department
of Health & Human Services, Office of Civil Rights,
in the event you feel your privacy rights have been
violated. We will not retaliate against you for filing
a complaint.
For more information about our Privacy Practices,
please contact:
Therapy Department Supervisor
Xiomara Sanchez
Kristi House, Inc
1265 NW 12th Ave
(305) 547-6800
For more information about HIPAA or to file
a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)
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