The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.

Exceptions include:

Suspected child abuse or dependant adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.

HIPPA Privacy Practice Notice

This Notice describes how information about you, as my client, may be used and disclosed and how you can get access to this information. Please review it carefully.

As a client, you are entitled to receive notice about my privacy practices and how I may use and disclose your personal health information in different circumstances. This Notice explains how I may use and disclose your personal health information, the choices and rights you have about how your personal health information may be used and disclosed, and my obligation to protect the privacy of your personal health information.

As a therapist in a private, outpatient practice, the mental healthcare services I provide are individual and group psychotherapy to adolescents and adults. I have a doctoral degree in social work and am a licensed clinical social worker. I am also qualified at a higher level of competency as a member of the Academy of Certified Social Workers and have had extensive clinical post doctoral training.

Introduction. When you become a client, you provide information about your health. Each time you visit, another record of your visit and what was done is made. Your health record is the information that I use to plan your care, provide treatment and receive payment for services. It is important for you to understand that your health record contains personal health information that is protected by federal and state laws.

Responsibilities

I am required to maintain the privacy of your personal health information and to provide you with a notice about my legal duties and privacy practices with respect to your personal health information. I am also required to accommodate reasonable requests that you make to communicate personal health information by alternative means or at alternative locations. Any time I use or disclose your personal health information, I must follow the terms of this Notice.

How I Use And Disclose Your Protected Health Information

Uses and Disclosures for Treatment, Payment and Health Care Operations. After making a good faith effort to provide you with this Notice, I may use your personal health information to provide your treatment, to obtain payment for your treatment and for my internal health care operations. I may use and disclose your personal health information for such purposes in the following ways:

(1) For Treatment. I may use and disclose your personal health information to plan, provide and coordinate your health care services. For example, I may, with your authorization, coordinate your care with your physician.

(2) For Payment. I may use and disclose your personal health information to obtain payment for health care services I have provided to you. For example, your insurance company may require your diagnosis, treatment codes and dates of service. MORRIS BILLING SERVICE is my billing service and they will submit this information to your insurance company. You can contact them at: (801) 565-1112. As a contracted business associate, they have a written services agreement that requires that they adhere to the Standards for Privacy of Individually Identifiable Health Information.

(3) For Health Care Operations. I may use or disclose your protected health information for health care operations. For example, I may use or disclose your personal health information to perform risk assessments and other administrative tasks to monitor the quality of care that I provide.

Uses and Disclosures With Authorization

For uses and disclosures of your personal health information not involving treatment, payment or health care operations, we will receive your written authorization prior to using or disclosing any personal health information (unless I am required or permitted by law to use or disclose your information as set forth below). You have the right to revoke any authorization previously granted. If you have any questions about written authorizations, please contact me at (801) 583-1740, and I will provide you with the information you need to revoke your authorization.

Uses and Disclosures Without Authorization

I may use and disclose your personal health information without obtaining your consent or authorization, in the following situations:

(1) Business Associates. There are some services that I provide through contracts with business associates such as Scharp Management Systems. In such situations, I may disclose your personal health information to my business associates so they can perform the job I contract with them to do. I require all business associates to appropriately safeguard your information, in accordance with applicable law.

(2) Notification of Family or Close Friends. I may use or disclose your personal health information to notify a family member, personal representative or another person responsible for your care, provided you have the opportunity to agree or object to the disclosure. If you are unable to agree or object, I may disclose this information as necessary if I determine that it is in your best interest based upon my professional judgment. In all cases, I will only disclose the health information that is directly relevant to that person’s involvement with your health care.

(3) Required by Law. I may use or disclose your personal health information to the extent that I am required by law to do so. The use or disclosure will be made is full compliance with the applicable law governing the disclosure.

(4) Public Health Activities. I may disclose your personal health information for public health activities to a public health authority authorized by law to collect or receive information for the purpose of controlling disease, injury or disability. I may also disclose your health information to a public authority authorized to receive reports of child abuse or neglect or to report information about products or services under the jurisdiction of the United States Food and Drug Administration. Additionally, I may disclose your health information to a person who may have been exposed to a communicable disease or otherwise be at risk of contacting or spreading a disease and to your employer for certain work-related illness or injuries.

(5) Health Oversight Activities. I may make disclosures of your personal health information to a health oversight agency charged with overseeing the health care industry. Disclosures will be made only for activities authorized by law.

(6) Judicial and Administrative Proceedings. I may disclose your personal health information in the course of any judicial or administrative hearing in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request or other lawful process where I receive satisfactory assurance that appropriate precautions have been taken. In all cases, I will take reasonable steps to protect the confidentiality of your health information.

(7) Law Enforcement. I may disclose your personal health information for a law enforcement purpose to law enforcement officials in compliance with and as limited by applicable law.

(8) Research and Clinical Case Example. I may use or disclose your personal health information without authorization when such research or clinical case example ensures the privacy of your personal health information.

(9) Victims of Abuse, Neglect or Domestic Violence. I may disclose personal health information about an individual whom I reasonably believe to be a victim of abuse, neglect or domestic violence to a government authority, including a social service or protective service agency authorized by law to receive reports of child abuse, neglect or domestic violence. Any such disclosures will be made in accordance with and limited to the requirements of the law.

(10) Limited Government Functions. I may disclose your personal health information to certain government agencies charged with special government functions, as limited by applicable law. For example, we may disclose your health information to authorized federal officials for the conduct of national security activities, as required by law.

(11) Organ Procurement. As allowed by law, I may disclose personal health information to organ procurement organizations for organ, eye or tissue donation purposes.

(12) Coroners, Medical Examiners and Funeral Directors. I may disclose personal health information to a coroner or medical examiner to identify a deceased person, determine a cause of death or for other duties as authorized by law. I may also disclose personal health information to funeral directors in accordance with applicable laws.

(13) Health and Safety. I may disclose your personal health information to prevent or lessen a serious threat to a person or the public’s health and safety. In all cases, disclosures will only be made in accordance with applicable law and standards of ethical conduct.

(14) Workers Compensation. I may disclose your personal health information in accordance with workers compensation laws.

Your Rights.

You have the right to do the following:

Right to Receive a Copy of this Notice. You have the right to a personal copy of this Notice and should receive it on your initial visit. A copy is also available for your review in the office waiting room.

Right to Receive Further Information. You have the right to ask that I provide additional information about my privacy practices and your privacy rights. If you disagree with a decision I have made about your personal health information or if you believe that I have violated your privacy rights, please notify me immediately.

Right to Inspect and Copy Your Health Information. Upon written request, you have the right to access and obtain a copy of the health information that I maintain. Please contact me directly to access and receive a copy of your protected health information.

Right to Amend Your Health Information. You have the right to request in writing that I amend health information maintained in your health record. I will comply with your request in the event that I determine the information that should be amended is false, inaccurate or misleading. Please contact me directly to request an amendment of your personal health information.

Right to Request Additional Restrictions on Uses and Disclosures of Your Health Information. You have the right to request in writing that I place additional restrictions on how I use or disclosure your personal health information. While I will consider any request for additional restrictions, I am not required to agree to your request. Please contact me directly to request additional restrictions on how I may use and disclose your personal health information.

Right to Request an Accounting of Disclosures. You have a right to request in writing an accounting of certain disclosures made of your personal health information. For each disclosure, the accounting will include the date the information was disclosed, to whom, the address of the person or entity that received the disclosure (if known), and a brief statement of the reason for the disclosure. Please contact me directlyfor information you need to request an accounting of disclosures.

Right to Request Confidentiality in Certain Communications. You have the right to request to receive your health information by alternative means of communication or at alternative locations. I will accommodate any such reasonable written request. Please contact me directly to request confidentiality in certain communications.

Right to File a Complaint. If you believe your privacy rights have been violated, in addition to notifying me with your complaint, you have the right to file a written complaint with the Office of Civil Rights of the United States Department of Health and Human Services. Upon request, I will provide you with the information needed to file your complaint. Under no circumstances will I retaliate against you for making a complaint to me or for filing a complaint with the Office of Civil Rights.

Changes to Notice. I reserve the right to change my privacy practices and to alter this notice according to those changes. In the event that my Notice changes, I will mail you a copy of my revised notice to the address you have supplied.

Privacy Officer. As an individual private practitioner, I serve as my own Privacy Officer and personally respond to all contacts. Please address all requests to:

Barbara W. Snow DSW/LCSW

Mental Health Management, Inc.

PO Box 712260

Salt Lake City, Utah 84108

801-230-3377

bsnowtherapy@icloud.com

Effective Date of this Notice . This Notice is effective as of April l4, 2003.

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