Laurie Pryor, MA, LPCC

HIPAA NOTICE OF PRIVACY PRACTICES & CLIENT RIGHTS 

EFFECTIVE 06/30/2014: 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.

 As your therapist, I am committed to maintaining your confidentiality. I will abide by New Mexico state and local laws as well as federal HIPAA policies.

 Uses and Disclosures of Protected Health Information

Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow me to use and disclose your protected healthcare information for these purposes.

 Treatment

I may need to use or disclose your protected health information to provide, manage or coordinate your care or related services; this could include consultations and potential referral sources.

 Payment

Your protected health information will be used, as needed to verify insurance coverage and/or benefits with your insurance carrier, to process your claims as well as information needed for billing and collection purposes. I may bill the person in your family who pays for your insurance.

 Healthcare Operations

I may need to use or disclose, as needed, your protected health information in order to review treatment procedures and conduct business activity. Information may be used for certification, compliance, and licensing activities.

 Other Uses or Disclosures of Your Protected Information Not Requiring Your Consent

There are some instances I may be required to use and disclose your protected health information without your consent. These situations include: 1) a client is believed to be in danger of harming self or others; 2) suspected child physical or sexual abuse, neglect, or abandonment; then New Mexico State Law mandates I report this to the New Mexico Children, Youth, and Families Department; 3) a medical emergency where client has unexpectedly become unable to give permission to release appropriate information; 4) when required by law.

 Other Permitted and Required Uses and Disclosures

These will be made only with your consent, or opportunity to object, unless required by law.

 Right to Request How I Contact You

It is my normal practice to communicate with you at the address and phone number provided when you scheduled your appointment. Sometimes I may leave messages on your voicemail. You have the right to request that I communicate with you in a different way.

 Right to Release Your Medical Records

You may consent in writing to release your records to others. You have the right to revoke this authorization, in writing, at any time.

 Right to Inspect and Copy Your Medical and Billing Records

You have the right to inspect and obtain a copy of your clinical record. Your request must be submitted in writing and state the reason for the request. Under limited circumstances I may release that information to you within two business days. I may also deny your request to inspect or copy your clinical chart in the event I decide this action would interfere with or negatively impact your treatment. If I agree to your request, the administrative fee for copying and supplies is $60.00 plus estimated postage costs via certified mail.

 Right to Add Information or Amend Your Medical Records

You have the right to add or amend your clinical record. This request must be in writing, with an explanation for the requested change. I may deny your request to add or amend your information based on clinical judgment. If I deny your request, you have a right to file a statement of disagreement. Your statement and my response will be added to your clinical record.

 Right to an Accounting of Disclosures

You may request an accounting of any disclosures I have made related to your medical information, except for information used for treatment and treatment planning, payment or health care operational purposes, information that you gave specific consent to release, or that I am required to release by law.

 Right to Request Restrictions on Uses and Disclosures of Your Health Information

You have the right to ask for restrictions on certain uses and disclosures of your health information. This request must be submitted in writing. However, I am not required to agree to such a request.

 Right to Complain

If you believe your privacy rights have been violated, please contact me personally and discuss your concerns. If you are not satisfied with the outcome, you may file a written complaint with the U.S. Department of Health and Human Services.

 Right to Receive Changes in Policy

You have the right to receive any future policy changes secondary to changes in state and federal laws.

I have received a copy of the HIPAA Notice of Privacy Practices and have had an opportunity to ask any questions.