Notice of Privacy Practices
PLEASE REVIEW THIS NOTICE CAREFULLY.  IT TELLS YOU HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU AND HOW YOU CAN ACCESS THIS INFORMATION.

Parts of your health record that identify you and relate to your past, present or future physical or mental health or condition and related health care services are known as Protected Health Information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law and the NASW Code of Ethics.  It also describes your rights and tells you how to gain access to and control your PHI. 

We are required by law to maintain the privacy of PHI and to inform you regarding our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the terms of our Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request, or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment
Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment, and related services, including placing you in a mental health facility.  We may disclose PHI to any other consultant only with your authorization.

For Payment
We may use and disclose PHI so that we can receive payment for the treatment services provided to you.  This will be done only with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.  If it becomes necessary to use collection processes because we have not been paid for services rendered, we will disclose only the minimum amount of PHI necessary for purposes of collection. 

For Health Care Operations
We may use or disclose, as needed, your PHI in order to support our business activities For example, we may share your PHI with third parties who perform various business activities (e.g., billing or typing services), provided we have a written contract with each such business that requires it to safeguard the privacy of your PHI. We will not disclose PHI for training or teaching purposes unless we have your authorization.

Required by Law
Under the law, we must make disclosures of your PHI to you upon your request.  In addition, we must make disclosures to the secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

Without Authorization
Applicable law and ethical standards permit us to disclose information about you without your authorization in only a limited number of other situations.  Disclosures that may be made without your authorization include those that are:

• Required by Law, such as the mandatory reporting of actual or suspected child abuse or neglect (Connecticut General Statutes §§ 17a-101, 46b-120) or mandatory government agency audits or investigations (including those undertaken by the social work licensing board or the health department) 

• Required for compliance with civil legal proceedings and court-ordered evaluations

• Necessary to prevent or reduce a serious and imminent threat to the health or safety of a person or the public.  Such information will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat (Connecticut General Statute § 52-146f).

Verbal Permission
With your permission, we may use or disclose your information to family members who are directly involved in your treatment.

With Authorization
Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may at any time be revoked in writing addressed to Marcia E. Brubeck.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding your PHI in our records.  To exercise any of these rights, please email your request to Marcia E. Brubeck, or call (860) 586-8530.

Right of Access to Inspect and Copy
You have the right to inspect and copy PHI that may be used to make decisions about your care.  Your right to inspect and copy PHI may be restricted only in exceptional circumstances, namely those situations where there is compelling evidence that access would cause you serious harm. We may charge you the reasonable cost of making copies. 

Right to Amend
If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information.  We are not required to agree to the amendment. 

Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures that we make of your PHI.  We may charge you a reasonable fee if you request more than one accounting in any twelve-month period.

Right to Request Restrictions
You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations.  We are not required to agree to your request. 

Right to Request Confidential Communication
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.

Right to a Copy of this Notice
You have the right to a copy of this notice.

COMPLAINTS

If you believe we have violated your privacy rights, you have the right to complain in writing by emailing Marcia E. Brubeck; you may also call (860) 586-8530, or to the secretary of Health and Human Services at 200 Independence Avenue, S.W., Washington, D.C. 20201 (you may also call [202] 619-0257).  We will not retaliate against you for filing a complaint.  For a form that you can use to file a complaint, go to Health Privacy Project Web site.

The effective date of this Notice is April 14, 2003.