KAI SHIN CLINIC
ALANA SASAKI MD
NOTICE OF PRIVACY PRACTICES
EFFECTIVE JUNE 1, 2016
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your provider is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of your privacy rights and my legal duties and privacy practices with respect to your PHI. He/she is required to abide by the terms of this notice with respect to your PHI but reserve the right to change the terms of this notice and make the new notice provisions effective for all PHI that we maintain.
UNDERSTANDING YOUR PERSONAL HEALTH INFORMATION
Each time you visit a hospital, physician, mental health professional or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and in the case of a mental health professional, can include psychotherapy notes. This information, often referred to as your health or medical record, serves as a:
Understanding what is in your record and how your health information is used helps you to:
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of the provider that compiled it, the information belongs to you. You have the following privacy rights:
USES AND DISCLOSURES
Your written authorization is required before your provider can use or disclose psychotherapy notes, which are defined as notes documenting or analyzing the contents of your conversations during counseling sessions and that are separated from the rest of your clinical file.
Psychotherapy notes do not include medication prescription and monitoring, session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis and progress to date.
It is our policy to protect the confidentiality of your PHI to the best of our ability and to the extent permitted by law. There are times however, when use or disclosure of your PHI including psychotherapy notes, is permitted or mandated by law even without your authorization.
Situations where your provider is not required to obtain your consent or authorization for use or disclosure of your PHI include the following circumstances:
For example: Information obtained by your provider will be recorded in your record and used to determine the course of treatment that should work best for you. Your provider will document in your record your work together and when appropriate he/she will provide a subsequent counselor or health care provider with copies of various reports that should assist him or her in treating you once your current therapeutic relationship is terminated.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. (Your PHI may also be provided to business associates, such as billing companies, claims processing companies, and others that process health care claims for your provider.)
For example: Quality control – Your provider might use your PHI in the evaluation of the quality of health care services that you have received or to evaluate the performance of the health care professionals who provided you with these services. He/she may also provide your PHI to attorneys, accountants, consultants, or others to make sure that he/she is in compliance with applicable laws.
For example: Child custody cases and other legal proceedings in which your mental health or condition is an issue are the kinds of suits in which your PHI may be requested.
Your provider or office staff may contact you with appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
If you have any questions or would like additional information you should bring this to your provider’s attention at the first opportunity. Questions or requests may be directed to your provider at: 2233 North Hamline Ave Roseville, MN 55113 Telephone 651 447 3755 Fax 651-444-8923