THIS NOTICE DESCRIBES HOW HEALTH INFORMATION PRIVACY MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION: I, Kelly Marker, MS LPC-MH, understand that health information about you and your health care is personal. I am committed to protecting your health information and ensuring HIPAA compliance. I create a record of the care and services you receive from my mental health counseling practice. This record is essential to provide you with quality care and to comply with specific legal requirements. This notice applies to all records of your care generated by my practice. It will explain how I may use and disclose your health information and describe your rights regarding this information, as well as my obligations concerning health information privacy. I am required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices concerning health information.
Follow the terms of the notice that is currently in effect.
I can change the terms of this Notice, which will apply to all information I have about you. The new Notice will be available upon request in my office and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe various ways that I use and disclose your health information. I will explain what I mean for each category of uses or disclosures and provide some examples. Not every use or disclosure in a category will be listed, but all permissible ways I am allowed to use and disclose information will fit within one of these categories.
For Treatment, Payment, or Health Care Operations: Federal privacy rules allow healthcare providers who have a direct treatment relationship with clients to use or disclose personal health information without the patient’s written authorization for payment or healthcare operations, in accordance with HIPAA compliance.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose your health information in response to a court order. I may also disclose health information about your child in response to lawful processes, provided efforts have been made to inform you about the request or to secure an order protecting the requested information.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION: Progress Notes. I keep “progress notes,” and any use or disclosure of such notes requires your Authorization unless it is:
a. For my use in treating you.
b. For my use in defending myself in legal proceedings instituted by you.
c. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
d. Required by law, limited to the requirements of such law.
e. Required by law for specific health oversight activities concerning psychotherapy notes.
f. Required by a coroner authorized by law.
g. Necessary to avert a serious threat to anyone’s health and safety.
Marketing Purposes: As a psychotherapist, I will not use or disclose your PHI for marketing purposes.
Sale of PHI: I will not sell your PHI in the regular course of my mental health counseling business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain legal limitations, I can use and disclose your PHI without your consent for the following reasons:
When disclosure is mandated by state or federal law, and the use or disclosure complies with the relevant laws.
For public health activities, including reporting suspected abuse or preventing serious health threats.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including court order responses, though I prefer obtaining your Authorization beforehand.
For law enforcement purposes, including reporting crimes on my premises.
To coroners or medical examiners when mandated.
For specialized government functions related to military operations, national security, or correctional institutions.
For workers' compensation purposes. Although I prefer your Authorization, I may provide your PHI in compliance with workers' compensation laws.
To remind you of appointments and health-related benefits or services. I may use and disclose your PHI to contact you for appointment reminders or to inform you about treatment alternatives or other healthcare services I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT. Disclosures to family, friends, or others. I may provide your PHI to someone involved in your care or payment unless you object either partially or fully. Your consent may be obtained retroactively in emergencies.
VI. YOU HAVE THE FOLLOWING RIGHTS CONCERNING YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You may ask me not to use or disclose certain PHI for treatment, payment, or healthcare operations purposes. While I am not required to agree, I may refuse if it could affect your healthcare.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for in Full. You can request limits on disclosing your PHI for health plans regarding health care items or services you have fully paid for out of pocket.
3. The Right to Choose How I Send PHI to You. You can request that I contact you a specific way (like at home or work) or send mail to a different address, and I will accommodate reasonable requests.
4. The Right to See and Get Copies of Your PHI. Except for “progress notes,” you have the right to request a paper copy of your medical record and other information I have. I will provide your record or a summary within 30 days of your written request, potentially charging a reasonable fee for this service.
5. The Right to Get a List of Disclosures. You may request a list of instances where I disclosed your PHI for reasons other than treatment or payment. I will respond to such requests within 60 days, and the list will cover the last six years unless you request a shorter period. This will be provided at no charge, but a fee may apply for multiple requests in the same year.
6. The Right to Correct or Update Your PHI. If you believe your PHI contains errors or lacks important information, you may request corrections or additions. While I can say “no,” I will provide you with the reason in writing within 60 days of your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to obtain this Notice in paper format, as well as electronically. Even if you agree to receive it via e-mail, you can still request a paper copy.
Concerns: If you have questions or concerns about health information privacy practices, please discuss them with me. You can also send a written complaint to the South Dakota Board of Counselor Examiners or the Florida Board of Mental Health. I support your right to the confidentiality of your health information.
EFFECTIVE DATE OF THIS NOTICE: This notice came into effect on January 1, 2025.
Acknowledgment of Receipt of Privacy Notice: Under HIPAA, you have specific rights related to the use and disclosure of your protected health information. By checking the box below, you acknowledge receiving a copy of the HIPAA Notice of Privacy Practices.
Kelly Marker MS, LMHC, LPC-MH
2770 Indian River Blvd, Suite 400-G, Vero Beach, FL 32960
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