NOTICE OF PRIVACY PRACTICES

This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information.

The following information provides details about the provisions of the Health Insurance Portability and Accountability Act (HIPAA) and your rights concerning privacy and your psychological records. HIPAA requires that we provide you with a Notice of Privacy Practices for treatment, payment, and health care operations. The law requires that we obtain your signature acknowledging that we have provided or offered you this information.

Disclosures for treatment, payment, and healthcare operation

We may use or disclose your protected health information (PHI), for certain treatment, payment, and health care operations purposes without your authorization. In certain circumstances, we can only do so when the person or business requesting your PHI gives us a written request that includes certain promises regarding protecting the confidentiality of your PHI.

Uses/disclosures requiring authorization

We may use or disclose the minimum necessary PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. In those instances when we asked for information for purposes outside of treatment and payment operations, we will obtain authorization from you before releasing this information. We will also need to obtain authorization before releasing your psychotherapy & medication management notes. These are notes we have made about our conversation during a private, group, joint, or family therapy session, which we have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.

You may revoke or modify all such authorizations (of PHI or psychotherapy notes) at any time; however, the revocation or modification is not effective until we receive it. When the state laws are more protective than HIPAA, more stringent requirements will apply.

Confidentiality is the legal right to privacy for all patients who receive psychiatric and psychological services. Such as, all personal information presented to this office will not be discussed with persons or agents outside of this office except as authorized by a written release or as required by law. However, there are exceptions to confidentiality. Please be advised, all information discussed in this office will remain confidential except under the following conditions set forth in this agreement:

Possible uses with neither consent nor authorization

We may use or disclose the minimum necessary PHI without your consent or authorization in the following circumstances:

o When you consent in writing for Nu Leaf Mental Health Group to release and disclose information to another entity or person (as detailed on the authorization to release PHI). 

o Child Abuse: Whenever we, in our professional capacity, have knowledge of or observe a child, or reasonably suspect, a child under age 18 has been the victim of abuse or neglect, we must immediately report such to a police department or sheriff’s department, county probation department, or county welfare department. Also, if we have knowledge of or reasonably suspect that mental suffering has been inflicted upon a child or that his or her emotional well-being is endangered in any other way, we may report such to the above agencies.

 o Elder and Dependent Adult Abuse: If we, in our professional capacity, have observed or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, or if we are told by an elder or dependent adult that he or she has experienced these or if we reasonably suspect such, we must report the known or suspected abuse immediately to the adult protective services agency or the local law enforcement agency.

For Elder or Dependent Adult Abuse, we do not have to report such an incident if:

1) We have been told by an elder or dependent adult that he or she has experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse, or neglect;

2) We are not aware of any independent evidence that corroborates the statement that the abuse has occurred;

3) the elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia;

4) in the exercise of clinical judgment, we reasonably believe that the abuse did not occur.

o Serious Threat to Health or Safety: If you or your family member communicate to me that you pose a serious threat of physical violence against an identifiable victim, we must make reasonable efforts to communicate that information to the potential victim and the police. If we have reasonable cause to believe that you are in such a condition, as to be dangerous to yourself or others, we may release relevant information as necessary to prevent the threatened danger.

o Health Oversight: If a complaint is filed against us with California and Nevada Nursing Board, the Board has the authority to subpoena confidential mental health information from us relevant to that complaint.

o Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made about the professional services that we have provided you, we must not release your information without 1) your written authorization or the authorization of your attorney or personal representative; 2) a court order; or 3) a subpoena duces tecum (a subpoena to produce records) where the party seeking your records provides us with a showing that you or your attorney have been served with a copy of the subpoena, affidavit and the appropriate notice, and you have not notified us that you are bringing a motion in the court to quash (block) or modify the subpoena. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. We will inform you in advance if this is the case.

o Worker’s Compensation: If you file a worker’s compensation claim, we may disclose to your employer your medical information created as a result of employment-related health care services provided to you at the specific prior written consent and expense of your employer so long as the requested information is relevant to your claim provided that is only used or disclosed in connection with your claim and describes your functional limitations provided that no statement of medical cause is included.

o You fail to make regular payments on your outstanding bill, which can result in your billing being turned over to a collection agency or submitted to small claims court.

o Upon notification of a social service agency case, wherein all information shared with Nu Leaf Mental Health Group and its affiliates will be conveyed to the assigned social worker and/or other SSA representative and agents.

o If you are a party in litigation, including divorce litigation, and you tender your mental condition as an issue, your privilege may be waived. In custody case you may be required to waive your privilege to facilitate an evaluation by a court ordered evaluator. Nu Leaf Mental Health Group and its affiliates may be required to produce your records and/or testify at deposition or trial if we are served with subpoenas or court orders. We cannot give you legal advice as to what action may or may not waive your privilege.

o Please be aware that under California’s Family Code, a parent without custody may still be entitled to information about his or her child’s treatment.

NOTE TO PARENTS ABOUT CHILDREN’S CONFIDENTIALITY: If your child participated in treatment, it is important to allow him/her to develop a confidential relationship with his/her psychiatrist/provider and/or therapist. As such, you understand that most personal information that your child discusses with his/her therapist will not ordinarily be shared with you. Rather your child’s provider will provide you with general summaries of your child’s progress without private details. This office is committed to informing you about unusual or dangerous symptoms or behaviors (such as violence, child abuse, self-abuse, suicidality, or intentions to harm others, harm oneself, drive while intoxicated, etc.) 

Your rights regarding your protected health information (PHI)

Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of PHI about you. However, we are not required to agree to all restrictions you request. An important exception is your right to request non-disclosure to your health plan for which you pay out-of-pocket unless the disclosure is for treatment purposes or in the rare event disclosure is required by law.

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 me. Upon your request, we will send your bills to another address.) You authorize to allow us to transmit to you by non-secure media the following types of Protected Health Information related to your health records and health care treatment: Information related to scheduling of meetings or other appointments and information related to billing and payment.

Right to Inspect and Copy – You have the right with your written request to inspect or obtain a copy (or both) of PHI and/or psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, we will have 30 days to respond to your request with one 30-day extension and will discuss with you the details of the request and denial process. There will be a small charge to cover the cost of paper copies and labor. We must provide you access to electronic health records and other electronic records in the electronic form and format requested by the individual if the records are readily reproducible in that format. Otherwise, we must provide the records in another mutually agreeable electronic format. Hard copies are permitted only when you reject all readily reproducible e- formats.

Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we 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 for which you have neither provided consent nor authorization. On your request, we will discuss with you the details of the accounting process.

Right to Prohibit the Sale of PHI – Your absence of a written authorization means you are prohibiting the sale of your PHI. Marketing or research uses would be examples of reasons to sell PHI.

Right to a Paper Copy – You have the right to obtain a paper copy of the HIPAA Notice from our team upon request, even if you have agreed to receive the Notice electronically.

Provider/Clinician Duties and Important Information

– We are 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.

– We must notify you if unsecured PHI is breached. Because your PHI will be encrypted, no notification will be required. No risk assessment of unsecured PHI will need to be conducted if notification of a breach is made.

– We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect. – We are allowed to make relevant disclosures to your family after death under essentially the same circumstances such disclosures were permitted before death.

– Our Providers are Master’s Prepared Board Certified – Psychiatric Mental Health Nurse Practitioners (PMHNP) supervised by Board Certified Psychiatrists. Our providers are licensed to assess, diagnose, and treat psychiatric disorders across the lifespan including children, adolescents, adults, and older adults. In California only, our providers practice psychiatry/psychiatric-mental health according to the requirements and regulations of the board of nursing under a collaborative agreement and Standardized Procedures with a California Licensed Psychiatrist. Although we work closely with psychiatrists, our providers are not physicians or psychiatrists.

– Our Clinicians are Doctorate or Master’s Prepared Psychologists, Licensed Marriage and Family Therapists (LMFT), Licensed Clinical Social Workers (ACSW), Associate Marriage and Family Therapists (AMFT) or Associate Clinical Social Workers (ACSW). Our licensed clinicians are licensed to diagnose and treat mental health disorders across the lifespan including children, adolescents, adults, and older adults through counseling, treatment and adjusting treatment plans. Our associate clinicians are registered in the state and have completed their respected programs, however they are still accumulating hours under the supervision of a licensed clinician to become independently licensed. Just like our licensed clinicians, our associates, under the supervision of licensed clinicians, may diagnose and treat mental health disorders across the lifespan including children, adolescents, adults, and older adults through counseling, treatment and adjusting treatment plans.

– You have the right to terminate care at any time and for any reason. We reserve the right to terminate our provider-patient relationship and discharge you from our practice at any time for any reason without sacrificing patient safety.

Examples of reasons we may terminate treatment include: If we suspect prescription medication abuse or undisclosed substance abuse; If a prescription drug contract is violated at any time during your treatment; If we believe that our services are no longer beneficial to you; If we believe that you would be better served by a higher level of care or by a different provider; If there is a pattern of frequent cancellations or 2 or more no-shows; if you cancel or miss an appointment and do not reschedule within 30 days of the missed appointment; if we deem interpersonal dynamics are not conducive to a therapeutic relationship; If you or a family member are hostile or aggressive towards providers, support staff, or other clients. We will do our best to provide you with a discharge letter upon discharge, along with a 30 day supply of medications and a list of providers.

– We are allowed to send unencrypted emails if you are advised of the risk and still request that form of transmission.

– While our providers may share an office with other mental health professionals, our providers are in no part associated with the other licensed professionals besides ourselves. Our records are kept secure and separate from theirs. Only our providers operating in our office suite will have access to your records without your written consent. We are fully responsible for the services we provide you. If you do see one of our office-mates for psychotherapy, or if we refer you to another community therapist/psychologist, we may find it helpful to collaborate and coordinate your care, and this will require your written consent. Any clinician to whom we refer you will be responsible for the care they provide to you.

– We are allowed to tell you about a third-party product or service without your written authorization when: we receive no compensation for that product or service, our communication with you is face to face or via tele health, it involves general health promotion, and/or it involves government or government-sponsored programs.

– If we revise my policies and practices (indicated in the HIPAA Notice), we will provide current clients with a revised notice, at their request, in person, or by mail to their home address. We reserve the right to amend this Notice of Privacy Practices at any time in the future.  Until such amendment is made, we are required by law to comply with this Notice of Privacy Practices.  After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information that we maintain, regardless of when it was created or received.  We will keep a copy of the current Notice of Privacy Practices posted in our reception area.  We will also post the current Notice of Privacy Practices on our website. All new clients receive a copy during their first session.

Questions and Complaints

If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, you may contact Nu Leaf Mental Health Group at (562) 541-8950. Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.  You will not be penalized for filing a complaint. If you are not satisfied with the manner, you may submit a formal complaint to Department of Health and Human Services at 200 Independence Ave, S.W. Washington, DC 20201.