Notice of Privacy Practices
Notice of Dr. Carol Bouzoukis’ Policies and Practices to Protect the Privacy of Health Information
This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
I am committed to protecting client confidentiality to the full extent of the law. The information below (which I am required by law to give to you) reflects federal regulations that set a minimum standard of privacy. In most instances, my policies (and laws of the state of Delaware) are more stringent. I will continue to ask for written authorization from you before releasing information about psychotherapy or payment.
Patients younger than the age of 18 are usually considered minors. Most of the time, the parents or legal guardians of minor patients make decisions about their children’s medical care and have the privacy rights described in this Notice. However, there are times when minor patients may make decisions about their own care and have the rights described in this Notice. For example, by law, minors may seek help on their own for medical conditions such as mental health issues, sexually transmitted diseases, drug dependencies and pregnancy.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
According to the new guidelines, I may use or disclose your protected health information (PHI) for treatment, payment, and health care operations’ purposes only with your written consent. To help clarify these terms, here are some definitions:
* “PHI” refers to information in your health record that could identify you as well as past and present diagnosis, dates of treatment, treatment interventions, progress, test results, and prognosis.
“Treatment, Payment, and Health Care Operations”
o Treatment is when I provide, coordinate, or manage your health care and other services related to your
o Payment refers to circumstances when you seek to obtain full or partial reimbursement for your health care. An example of payment is: I disclose your PHI to your health insurer so that you may obtain reimbursement for your health care or to determine eligibility or coverage.
o Health Care Operations are activities that relate to the performance and operation of my office. 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 my office, such as employing, applying, utilizing, examining, and analyzing information that identifies you.
* “Disclosure” applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
I may use or disclose PHI for purposes outside of treatment, payment, or health care operations only when your appropriate authorization is obtained. An “authorization” is written permission beyond the general consent that permits only specific disclosures. In those instances when I am asked for information for purposes outside of treatment, payment or health care operations, an authorization will be obtained from you before releasing this information.
Psychotherapy notes, which are notes by me documenting the contents of a counseling session with you, will be used only by me and will not otherwise be used or disclosed without your written authorization. These notes are given a greater degree of protection under the guidelines 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 retroactively. If the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures Where Neither Consent nor Authorization is Required
I may use or disclose PHI without your consent or authorization as required by law in the following circumstances:
Serious Threat to Health or Safety – If I believe in good faith that there is risk of imminent personal injury to you or to other individuals or risk of imminent injury to the property of other individuals, the appropriate information, as permitted by law, may be disclosed.
Child Abuse – If I, in the ordinary course of professional practice, have reasonable cause to suspect or believe that any child under the age of eighteen years (1) has been abused or neglected, (2) has had non accidental physical injury or injury which is at variance with the history given of such injury, inflicted upon such child, or (3) is placed at imminent risk of serious harm, then I must report this suspicion or belief to the appropriate authority.
Adult and Domestic Abuse – If I know or in good faith suspect that an elderly individual or an individual who is disabled or incompetent has been abused, the appropriate information as permitted by law may be disclosed.
Health Oversight Activities – If any government entity is investigating my practice, that entity may subpoena records relevant to such investigation.
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 the records thereof, such information is privileged under state law, and will not be released without the written authorization of you or your legally appointed representative or a court order (subpoena). The privilege does not apply when you are being evaluated for a third party, the evaluation is court ordered, or you gave up the privilege (for example, by initiating court action in a suit claiming damages for mental health reasons).
Workers’ Compensation — I may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
IV. Patient’s Rights and Therapist’s Duties
Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. I will consider seriously any such request, although I am not required to agree to a restriction you request. If I cannot agree, I will discuss my decision with you directly if at all possible
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 a psychotherapist. On your request, I will send your bills/statements to another address or give them to you at your appointment time.
Right to Inspect and Copy – You may request access to your PHI record and billing records maintained by me and my billing representative in order to inspect and request copies of the records. All requests for access must be in writing. Under limited circumstances, I may deny access to your records. I may charge a fee for the administrative costs of copying and sending you any records requested. If you are a parent or legal guardian of a minor, please note that certain portions of the minor’s PHI record will not be accessible to you. For example, Delaware Code, Title 13, permits confidential treatment and disclosure of records related to services for communicable diseases and pregnancy for patients age 12 and over.
Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. This request must be made in writing and given to me. I may deny your request. At your request, I will discuss with you the details of the amendment process.
Right to an Accounting – You have the right to receive an accounting of any disclosures. At your request, your therapist will discuss with you the details of the accounting process.
o I am required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
o I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you
of such changes, however, I am required to abide by the terms currently in effect.
o If I revise my policies and procedures, I will provide you with an updated version.
If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, please discuss it with me directly. You may also send a written complaint to the Secretary of the U.S. Department
of Health and Human Services. I will provide you with the appropriate address upon request.
VI. Effective Date
This notice went into effect on April 14, 2003.