If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself.Ĥ. If a government agency is requesting the information for health oversight activities, within its appropriate legal authority, I may be required to provide it for them.ģ. If you are involved in or contemplating litigation, you should consult with an attorney to determine whether a court would be likely to order me to disclose information.Ģ. I cannot provide any information without your (or your legal representative's) written authorization, or a court order, or if I receive a subpoena of which you have been properly notified and you have failed to inform me that you oppose the subpoena. If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law. Reasons I may have to release your information without authorization:ġ. If such a situation arises, I will limit my disclosure to what is necessary. There are some situations where I am permitted or required to disclose information without either your consent or authorization. In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. The law protects the privacy of all communication between a patient and a therapist. That revocation will be binding unless I have taken action in reliance on it. You may revoke this Agreement in writing at any time. When you sign this document, it will also represent an agreement between us. If you have any questions, it is your right and obligation to ask so I can have a further discussion prior to signing this document. The law requires that I obtain your signature acknowledging that I have provided you with this. The Notice, explains HIPAA and its application to your PHI in greater detail. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. Health Insurance Portability Accountability Act (HIPAA)
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