Find Peace of Mind

Scott Tomey LLC
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Patient Rights

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Patient Choices

• You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide mental health care

Provider may use and share your information to:

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we will tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we have shared information

• You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices

We will never share your information unless you give us written permission unless otherwise authorized by law.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways:

Treat you

We can use your health information and share it with other professionals who are treating you.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part
2:
If applicable, your substance use disorder (“SUD”) records are protected
by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra
confidentiality protections and requires a separate patient consent for the use
and disclosure of SUD counseling notes. Each disclosure made with patient
consent must include a copy of the consent or a clear explanation of the scope of
the consent. It must also be accompanied by a written notice containing the
language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit
written consent, except in limited circumstances such as: (a) Medical
Emergencies: to the extent necessary to treat you, (b) Reporting Crimes on
Program Premises, (c) Child Abuse Reporting: In connection with incidents of
suspected child abuse or neglect to appropriate state or local authorities, and
(d) Fundraising: We will provide you with an opportunity to decline to receive
any fundraising communications prior to making such communications.
You may revoke this consent at any time.

Prohibitions on Use and Disclosure of Part 2 Records:
SUD records received from programs subject to Part 2, or testimony relaying the
content of such records, shall not be used or disclosed in civil, criminal,
administrative, or legislative proceedings against you unless based
on your written consent, or a court order after notice and an opportunity to be
heard is provided to you or the holder of the record, as provided in Part 2. A court
order authorizing use or disclosure must be accompanied by a subpoena or other
legal requirement compelling disclosure before the requested SUD record is used
or disclosed.
If SUD records are disclosed to us or our business associates pursuant to your
written consent for treatment, payment, and healthcare operations, we or our
business associates may further use and disclose such health information without
your written consent to the extent that the HIPAA regulations permit such uses
and disclosures, consistent with the other provisions in this Notice regarding
PHI.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. Some example situations are below.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Mandatory Reporting

My professional license makes me a mandatory reporter for purposes of the Social Welfare Act, Child Protection Law, and Mental Health Code. If my legal obligation to disclose information I learned during our session is triggered, the law requires me to disclose certain information to discharge that duty. In that situation, I will disclose your health information to a state or local agency that is authorized by law to receive the reports. Examples of when my mandatory reporter obligation may be triggered include reports of abuse or neglect, threats of physical harm to yourself or others, and exploitation of vulnerable adults.

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
• Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.