The Federal Health Insurance Portability and Accountability Act (HIPAA) requires mental health professionals to issue this official Notice of Privacy Practices. This notice describes how information about you is protected, the circumstances under which it may be used or disclosed and how you may gain access to this information. Please review it carefully.

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For psychotherapy to be beneficial, it is important that you feel free to speak about personal matters, secure in the knowledge that the information you share will remain confidential. You have the right to the confidentiality of your medical and psychological information, and this practice is required by law to maintain the privacy of that information.

 

My practice is required to abide by the terms of the Notice of Privacy Practices currently in effect, and to provide notice of its legal duties and privacy practices with respect to protected health and psychological information.

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Any health care professional authorized to enter information into your medical record and other personnel at this practice who may need access to your information must abide by this Notice. All subsidiaries, business associates (e.g., a billing service), sites and locations of this practice may share medical information with each other for treatment, payment purposes or health care operations described in this Notice. Except where treatment is involved, only the minimum necessary information needed to accomplish the task will be shared.

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I may use or disclose your Protected Health Information (PHI), for treatment, payment, and health care operations purposes. The following should help clarify these terms:

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• PHI refers to personal health information in your health record that could identify you. For example, it may include your name, contact information, the fact you are receiving treatment here, and other basic information pertaining to your treatment.

• Use applies only to activities within my office and practice, such as sharing, employing, applying, utilizing, and analyzing information that identifies you.

• Disclosure applies to activities outside of my office or practice, such as releasing, transferring, or providing access to information about you to other parties.

• Authorization is your written permission to disclose confidential health information. All authorizations to disclose must be made on a specific and required form and I will obtain a written authorization from you before releasing this information. This may at times include clinical progress notes as these are considered part of your mental health record. This authorization will remain in effect for a length of time you and I determine. You may revoke the authorization at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that 1) I have already acted upon that authorization; or 2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

• Treatment is when I provide, coordinate, or manage your mental health care and other services related to your care. I may disclose your PHI to other professionals who provide you with health care services or are otherwise involved in your care. For example, with your written authorization I may provide your information to your physician or psychiatrist to ensure they have the necessary information to diagnose, treat you, or coordinate your care.

• Payment - Your PHI may be used, as needed, in activities related to billing and obtaining payment for the treatment and services I have provided to you. For example, I might send your select PHI to your insurance company or health plan in order to get payment for the health care services that I have provided to you. I could also provide your PHI to business associates, such as billing companies, claims processing companies, and others that process health care claims for my office. I may also provide you documentation of your care so that you may obtain reimbursement from your insurer.

• Health Care Operations are activities that relate to the performance and operation of my practice. I may use or disclose, as needed, your PHI to facilitate the efficient and correct operation of this practice. For example, I might use your PHI in the evaluation of the quality of health care services that you have received or for appointment reminders and health related benefits or services. I may also provide your select PHI to my attorneys, accountants, consultants, and others to make sure that I am in compliance with applicable laws.

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Any other uses and disclosures of your PHI beyond those listed above will be made only with your authorization, unless otherwise permitted or required by law.

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CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

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There are some disclosures that do not require your Authorization. I may use or disclose PHI without your consent in the following circumstances:

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• Judicial and Administrative Proceedings, or Law Enforcement: I may make a disclosure to the appropriate officials if you are involved in a court proceeding and a request is made for information about the professional services that I have provided you and/or the records thereof, although my preference is to obtain an Authorization from you before doing so. Such information is privileged under state law, and I will not release information without: 1) written authorization from you or your legally-appointed representative; 2) a court order; or 3) compulsory process (a subpoena) or discovery request from another party to the court proceeding where that party has given you proper notice (when required), has stated valid legal grounds for obtaining PHI, and I do not have grounds for objecting under state law (or you have instructed me not to object). The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. I will inform you in advance if this is the case.

• To Avoid Harm: I may provide PHI to law enforcement personnel or persons able to prevent or mitigate a serious threat to the health or safety of a person or the public (i.e., adverse reaction to meds).

• Serious Threat to Health or Safety of Self or Others: If you communicate to me a specific threat of imminent harm against another individual or if I believe that there is clear, imminent risk of injury being inflicted against another individual, I may make disclosures that I believe are necessary to protect that individual from harm. If I believe that you present an imminent, serious risk of injury or death to yourself, I may make disclosures I consider necessary to protect you from harm.

• Child Abuse: If I have reasonable cause to believe a child may be abused or neglected, I must report I must immediately report this belief to the Montana Department of Public Health and Human Services, or the local law enforcement agency.

• Adult and Domestic Abuse: If I have reason to believe that an individual such as an elderly or disabled person protected by state law has been abused, neglected, or financially exploited, I must report this to the local ombudsman, Department of Public Health and Human Services, or the local law enforcement agency. An elderly person means a person who is at least 60 years of age and unable to provide protection for him/herself from abuse, sexual abuse, neglect or exploitation because of a mental or physical impairment, or because of frailties or dependencies brought about by advanced age.

• For Public Health Activities: I may disclose PHI in the event of your death, if a disclosure is permitted or compelled, I may need to give the county coroner information about you.

• Health Oversight Activities: I may disclose your PHI to a health oversight agency, such as The Montana Board of Behavioral Health, for oversight activities authorized by law, including licensure, investigations, or disciplinary actions. If a client files a complaint or lawsuit against me, I may disclose relevant information regarding that client in order to defend myself.

• For Essential Government Functions: I may disclose PHI if you are a member of U.S. or foreign military forces (including Veterans) and/or if required by appropriate authorities for national security.

• Worker's Compensation: I may disclose PHI regarding you as authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault. If you file a worker’s compensation claim, you will be authorizing disclosure of your records relevant to that claim to the worker’s compensation insurer.

• Law Enforcement: I may disclose PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.

• By Law: I may disclose PHI if disclosure is otherwise specifically required by law.

• Appointment Reminders and Health-Related Benefits or Services: I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.

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CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

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• Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other individual who you indicate is involved in your care or responsible for the payment for your health care, unless you object in whole or in part. Retroactive consent may be obtained in emergency situations.

• Other Uses and Disclosures Require Your Prior Written Authorization: In any other situation not described in sections above, I will request your written authorization before using or disclosing any of your PHI.  Even if you have signed an authorization to disclose your PHI, you may later revoke that authorization, in writing, to stop any future uses and disclosures (assuming that I haven’t taken any action subsequent to the original authorization) of your PHI by me.

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SPECIAL AUTHORIZATIONS

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Certain categories of information have extra protections by law, and thus require special written authorizations for disclosures.

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• Psychotherapy Notes: I will obtain a special authorization before releasing your Psychotherapy Notes. "Psychotherapy Notes" are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your record. These notes are given a greater degree of protection than PHI.

• HIV/AIDS Information: Special legal protections apply to HIV/AIDS related information. I will obtain a special written authorization from you before releasing information related to HIV/AIDS.

• Alcohol and Drug Use Information: Special legal protections apply to information related to alcohol and drug use and treatment. I will obtain a special written authorization from you before releasing information related to alcohol and/or drug use/treatment. You may revoke all such authorizations (of PHI, Psychotherapy Notes, HIV/AIDS information, and/or Alcohol and Drug Use Information) at any time, provided each revocation is in writing, signed by you, and signed by a witness. You may not revoke an authorization to the extent that: 1) I have relied on that authorization; or 2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.

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Client’s Rights:

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• Right to Inspect and Copy: In most cases, you have the right to inspect or obtain a copy your medical and billing records. In such cases I will discuss with you the process involved. If you request a copy of the information, I may charge a fee for costs of copying and mailing. I may deny your request to inspect and copy in some circumstances. I may refuse to provide you access to certain psychotherapy notes or to information compiled in reasonable anticipation of, or use in, a civil criminal, or administrative proceeding.

• Right to Request Restrictions: You have the right to request restrictions on certain uses/disclosures of PHI. However, I am not required to agree to the request. You also have the right to request a limit on the medical information I disclose about you to someone who is involved in your care or the payment for your care. If you ask me to disclose information to another party, you may request that I limit the information I disclose. However, I am not required to agree to a restriction you request. To request restrictions, you must make your request in writing, and tell me: 1) what information you want to limit; 2) whether you want to limit my use, disclosure or both; and 3) to whom you want the limits to apply. You do not have the right to limit the uses and disclosures that I am legally required or permitted to make.

• Right to Receive Confidential Communications by Alternative Means: You have the right to request and receive confidential communications by alternative means and locations. (For example, you may not want a family member to know that you are seeing me. On your request, I will send your bills to another address. You may also request that I contact you only at work, or that I do not leave voicemail messages.) To request alternative communication, you must make your request in writing, specifying how or where you wish to be contacted. I am obliged to agree to your request providing that I can give you the PHI, in the format you requested, without undue inconvenience.  I may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis.

• Right to an Accounting of Disclosures: You are entitled to a list of disclosures of your PHI that I have made. The list will not include uses or disclosures to which you have already consented, i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes or to corrections or law enforcement personnel.  Disclosure records will be held for six years. I will respond to your request for an accounting of disclosures within 60 days of receiving your request.  The list I give you will include disclosures made in the previous six years unless you indicate a shorter period. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure.

• Right to Amend: If you feel that PHI I have about you is incorrect or incomplete, it is your right to request that I correct the existing information or add the missing information for as long as it is maintained in the record. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of receipt of your request. I may deny your request, in writing, if I find that: the PHI is 1) correct and/or complete, 2) forbidden to be disclosed, 3) not part of my records, or 4) written by someone other than me. My denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and my denial be attached to any future disclosures of your PHI. If I approve your request, I will make the change(s) to your PHI. Additionally, I will tell you that the changes have been made, and I will advise all others who need to know about the change(s) to your PHI.

• Right to a Copy of this Notice: You have the right to obtain a paper copy of this Notice of Privacy Practices from me at any time upon request.

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My duties:

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• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.

• I will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.

• If I revise my policies and procedures, I will notify you at our next session, or by mail at the address you provided me.

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If you believe your privacy rights have been violated, you may file a complaint to me:

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Joanna Townsend, LCSW, LICSW, LCSW-C

Root & Rise LLC

105 W Main St Ste 2G

Bozeman, MT 59715

www.rootandrisebozeman.com

joanna@rootandrisebozeman.com

406-201-5790‬

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Or you may also send a written complaint to the Secretary of the Department of Health and Human Services at:

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200 Independence Avenue S.W. Washington, D.C. 20201.

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If you file a complaint about my privacy practices, you will not be penalized or discriminated against for filing a complaint.

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This notice went into effect on July 1, 2019 and will remain so unless new notice provisions effective for all protected health information are enacted accordingly.

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