Privacy Practice

LEE FOX MARLEY, LCSW
15303 TEXAS STREET
AUSTIN, TEXAS  78734

NOTICE OF PRIVACY PRACTICES FOR LEE FOX MARLEY, LCSW

Download Receipt and Acknowledgement Of Notice Form (doc) (txt) (pdf)

Effective Date is April 14, 2003

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 THIS NOTICE CAREFULLY:

  • Your health record contains personal information about you and your health.  This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (PHI).  This notice of Privacy Practices describes how I may use and disclose your PHI in accordance with applicable law and the Code of Ethics of the National Association of Social Workers.  It also describes your rights regarding how you may gain access to and control your PHI.
  • I am required by law to maintain the privacy of your PHI and to provide you with notice of my legal duties and privacy practices with respect to PHI.  I am required to abide by the terms of this Notice of Privacy Practices at any time.  Any new Notice of Privacy Practices will be effective for all PHI I maintain at that time and I will have a copy of the revised Notice in my office.

HOW I MAY USE AND DISCLOSE MENTAL HEALTH INFORMATION ABOUT YOU

  • For Treatment:  According to law, your PHI may be used and disclosed by those who provide, coordinate or manage your mental health care treatment and related services.  Since I am a solo practitioner, this applies to me.  Sometimes I seek supervision or consultation to provide the best care for you;  in that case I will have your specific authorization and will keep your identity confidential.
  • For Payment:   I may use and disclose PHI so that I can receive payment for the treatment services provided to you.  This will only be done 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 with managed care to determine if more services are needed, or doing required utilization review.
  • For Health Care Organizations:   I may use or disclose, as needed, your PHI in order to support my business activities including, but not limited to, quality assessment activities, licensing, conducting or arranging for customary business activities, and making or rescheduling appointments.  For example, I may share your PHI with third parties that perform various business activities (e.g. billing or typing services) provided we have a written contract with the business associate that requires it to safeguard the privacy of your PHI.  If I am involved in providing teaching or training, only with your authorization, would I disclose any of your PHI.
  • Under the law, I must make disclosures of appropriate PHI to you upon your request.  I must also make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of the Privacy  Rule. I will make every effort to keep your PHI private, but here are some instances when the laws require me to use or disclose it.
  • The following is a list of categories of uses and disclosures permitted without your authorization by HIPPA (Health Insurance Portability and Accountability Act):  Abuse and Neglect, National Security, Law Enforcement, Court Order, Disability Program Requirements, Emergencies, Judicial and Administrative Proceedings, Workman’s Compensation Requirements, Family Involvement in your Care (with your verbal permission)
  • Besides the treatment, payment, and health care operations noted above, any uses or disclosures not permitted by applicable law will be made only with your written authorization, which you may revoke at any time, if you wish.

YOUR RIGHTS REGARDING YOUR PHI

  • You have the following rights regarding PHI i maintain about you.  To exercise any of these rights please submit your request in writing to me at my office.
  • Right of Access to Inspect and Copy.  You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your care.  One exception to this is my psychotherapy session notes;  these notes are confidential and for my personal use only.  Your right to inspect and copy accessible PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you.  I may charge a reasonable fee for copies.
  • Right to Amend.  If you feel the PHI i have about you is incorrect or incomplete, you may ask me to amend the information, although I am not required to agree to the amendment.
  • Right to an Accounting of Disclosures.  You have the right to request an accounting of certain of the disclosures that I make of your PHI.  I may charge you a reasonable fee if you request more than one accounting in any 12 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.  I am not required to agree to your request, however.
  • Right to Request Confidential Communication.  You have the right to request that I communicate with you about treatment matters in a certain way or at a certain location.
  • Right to a Copy of this Notice.  You have a right to a copy of this notice.

COMPLAINTS

  • If you believe I have violated your privacy rights, you have the right to file a complaint in writing with me at my office or with the Secretary of Health and Human Services at 2300 Independence Avenue, S.W., Washington, DC or by calling (202) 619-0257.  I will not retaliate against you for filing a complaint.