HIPAA

Your information is very important. We at the Emmada Psychology Center, Inc. do our best to protect it. We utilized safe and secure platforms to make sure your information remains confidential and that is only limited to members of our treatment team and to those who you desire to have it. We encourage ongoing dialogue as it relates to your privacy and ways to protect your information. Please follow up with your therapists or a member of our treatment team if you have any additional comments and/or question.

NOTICE OF PRIVACY PRACTICES

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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

OUR COMMITMENT TO YOUR PRIVACY

We care about our clients’ privacy and strive to protect the confidentiality of your medical information. New federal legislation requires that we give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. You have the right to the confidentiality of your medical information, and we are required by law to maintain the privacy of the protected health information. We are required to abide by the terms of this Notice of Privacy Practices which took effect on April 14, 2003 and will remain in effect until we replace it.

We reserve the right to change our privacy policies and practices, and the terms of this Notice at any time, provided such changes are permitted by applicable law. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain, including protected health information we created or received before we made the changes. 

You may request a printed copy of our Notice at any time. If you have questions about this Notice, please contact our Privacy Officer, Dr. Rick Williamson, at the address and phone number listed below.

After you have read this Notice of Privacy Practices we will ask you to sign a Consent for Use and Disclosure of Protected Health Information Form to let us use and share your information to care for you properly. You must sign the Consent form before we begin to treat you because if you do not agree we cannot treat you.

USES AND DISCLOSURES OF HEALTH INFORMATION

Treatment. We may use and disclose your protected health information to other health care professionals for the purpose of evaluating your mental health, establishing a diagnosis, and providing treatment. For example, we may consult with another health care provider, such as your family physician or another psychologist, regarding your treatment.

Payment. We may use and disclose your protected health information to bill you, your insurance company, your credit card company, or others so we can be paid for the services we provide to you. For example, your health plan may request and receive information on dates of services, services provided, and the condition being treated to determine and process eligibility or coverage.

Healthcare Operations. We may use the disclose your protected health information to support the day-to-day activities and management of our practices such as quality assessment and improvement activities, and accreditation, licensing or credentialing activities.

Other Uses. We may use and disclose your protected health information to reschedule or remind you of appointments, to tell you about or recommend possible treatments that may be of help to you or to inform you of other health-related services and products that may be of interest to you. For example, we may phone you to change the date or time of an appointment, or we may write you to remind you of an upcoming appointment. We may use or share your information to do research to improve treatments and to inform others of the effectiveness of our treatments. In all cases, your name, address, and other personal information will be removed.

Your Authorization. In addition to using your protected health information for treatment, payment, or healthcare operations, you may give us written authorization to use your protected health information or to disclose it to anyone for any other purposes, e.g. to consult with your son or daughter’s school at your request. If you give us your authorization, you may revoke it at any time in writing. Your revocation will not affect or undo any use or disclosure permitted by your authorization wile it was in effect.

Required by Law. Some federal and state laws require us to disclose protected health information. This includes situations in which we reasonably suspect that you are a possible victim of child, dependent adult, or elder abuse or neglect. We may disclose your protected health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

INDIVIDUAL RIGHTS

Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your protected health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement.

Alternative Communication. You have the right to request and receive confidential communications about your protected health information by alternative means and at alternative locations. For example, you may not want a family member to know that your are receiving our services and may request that we send your statement to another address. All such requests must be in writing.

Access. You have the right to inspect or get a copy of your protected health information as long as that protected health information is maintained in your record, with some exceptions. Any request must be received in writing and you may obtain a form to request such access by contacting our Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request. We do require a fee to be paid for the copying of records in the amount of $25.00. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format.

Amendment. You have the right to request that we amend your protected health information as long as that protected health information is maintained in your record. Your request must be in writing and explain why the information should be amended. In certain circumstances your request may be denied. On your request, we will discuss with you're the details of the amendment process.

Accounting of Disclosures. You generally have the right to receive an accounting of disclosures of your protected health information for purposes other than treatment, payment, healthcare operations, and certain other activities for the past 6 years, but not before April 14, 2003.

QUESTIONS AND COMPLAINTS

If you would like to submit a comment, question, or complaint about our privacy practices, or if you disagree with a decision we have made about access to your records, you may contact our Privacy Officer, Dr. Lisa Bolden at Emmada Psychology Center, 595 E. Colorado Blvd. Suite 635
Pasadena, CA 91101 (866) 863-4645. You may also submit a written comment to the Secretary of the U.S. Department of Health and Human Services. We will provide you with the Secretary’s address upon request. You will not be penalized for filing a complaint.