Another Patient Privacy Protection Advisory

PRIVACY NOTICE FOR OUR PATIENTS

Psychiatric information about you is very private. In fact, we consider it too private to
transmit it electronically. As such, our practice is not covered by the Health Insurance Portability
and Accountability Act (HIPAA). HIPAA is a set of federal regulations that apply to providers
who do transmit medical information electronically. Although we are not covered by the HIPAA
regulations, we want you to be informed of our privacy practices.

You can be confident that information about you, or even the fact that you are our patient,
will generally not leave this office without your authorization. There are some rare exceptions.
For example we may need to give medical information to a referring physician, a pharmacist, a
nurse, or your primary care physician; or we may discuss treatment with a caretaker or family
member who has been involved in your care from the beginning. Even in the above circumstances
we will usually seek your authorization first. We may be obligated to break confidentiality if you
pose a physical threat to yourself or others, or if the health of a minor is significantly endangered.
Otherwise, any information we disclose would only be by your request or authorization.

We will normally have you sign an authorization form for this. If practical constraints do not
allow you to sign the form, we will obtain and document your verbal authorization. Whether your
authorization is written or verbal, you may revoke an authorization at any time.

On our “patient information form” there is a space for you to sign which allows us to
disclose your information to process an insurance claim. If you are not using insurance you do
not need to sign that space.

If you would like copies of laboratory results we will provide them to you. Other parts of
the psychiatric record contain sensitive information that may be misunderstood outside of the
clinical setting. Therefore, we do not ordinarily release these records directly to patients. If you
want to see your records you may make an appointment for that purpose. One of our clinicians
will go through it with you page by page. You may suggest amendments or insert your own.
If you have any questions about privacy or confidentiality, please ask any one of us. We
are a practice and we all are mindful of the importance of privacy and confidentiality. If the
person you ask does not have your answer, they will find someone who does.