Matthew Gerst, Ph.D.
Licensed Clinical Psychologist
 


Matthew Gerst, Ph.D.

Licensed Clinical Psychologist

CA License PSY13460

17705 Hale Avenue, Suite F-4

Morgan Hill, CA 95037

(408) 776-1990



NOTICE OF PRIVACY PRACTICES


The Federal Government now requires that patients receive this Notice pursuant to HIPAA Regulations

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

II.I HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).

I am legally required to protect the privacy of your PHI, which includes information that can be used to identify you that I have created or received about your past, present or future health or condition, the provision of health care to you, or the payment of this health care. I must provide you with this Notice about my privacy practices, and such Notice must explain how, when, and why I will “use” and “disclose” your PHI. A “use” of PHI occurs when I share, examine, utilize, apply, or analyze such information within my practice; PHI is “disclosed” when it is released, transferred, has been given to, or is otherwise divulged to a third party outside of my practice. With some exceptions, I may not use or disclose any more of your PHI than necessary to accomplish the purpose for which the use or disclosure is made. I am legally required to follow the privacy practices described in this Notice.

However, I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI on file with me already. Before I make any important changes to my policies, I will promptly change this Notice and post a new copy of it in my office.

III.HOW I MAY USE AND DISCLOSE YOUR PHI

I will use your PHI for many different reasons. For some of these uses or disclosures, I will need your prior authorization; for others, however, I do not. Listed below are the different categories of my uses and disclosures along with some examples of each category.

A.Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent. I can use and disclose your PHI without your consent for the following reasons:

1.For treatment. I will use and disclose your PHI to physicians, psychiatrists, psychologists and other licensed health care providers who provide you health care services or are involved in your care. For example, if a psychiatrist is treating you, I can disclose your PHI to your psychiatrist in order to coordinate your care.

2.To obtain payment for treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company or health plan to get paid for the health care services that I have provided to you. I may also provide your PHI to my business associates, such as billing companies, claims processing companies, and others that process my health care claims.

3.For health care operations. I can disclose your PHI to operate my practice. For example, I might use your PHI to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided such services to you. I may also provide your PHI to my accountants, attorneys, consultants, and others to make sure I am complying with applicable laws.

4.Other disclosures. I may also disclose your PHI to others without your consent in certain situations. For example, your consent is not required if you need emergency treatment, as long as I try to get your consent after the treatment is rendered, or if I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so.

B.Certain Uses and Disclosures Do Not Require Your Consent. I can use and disclose your PHI without your consent or authorization for the following reasons:

1.When federal, state, or local lay; judicial or administrative proceedings; or, law enforcement requires disclosure. For example, I may make a disclosure to applicable officials when a law required me to report information to government agencies and law enforcement about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding.

2.For public health activities. For example, I may have to report information about you to the county coroner.

3.For health oversight activities. For example, I may have to provide information to assist the government when it conducts an investigation or inspection of a healthcare provider or organization.

4.For research purposes. In certain circumstances, I may provide PHI in order to conduct medical research.

5.To avoid harm. In order to avoid a serious threat to my health or safety of a person or the public, I may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

6.For specific government functions. I may disclose PHI of military personnel and veterans in certain situations. I may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.

7.For workers’ compensation purposes. I may provide PHI in order to comply witgh workers’ compensation laws.

8.Appointment reminders and health related benefits or services. I may use PHI to provide appointment reminders or give information about treatment alternatives, or other healthcare services or benefits I offer.

C.Certain Uses and Disclosures Require You Have The Opportunity to Object.

1.Disclosures to families, friends or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care of the payment of your healthcare, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

D.Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections III, A, B ad C above, I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent that I have not taken any action in reliance on such authorization) of your PHI by me.

IV.What Rights You Have Regarding Your PHI.  You have the following rights with respect to your own PHI:

A.The Right to Request Limits On Uses and Disclosures of your PHI. You have the right to ask that I limit how I use and disclose your PHI. I will consider your request, but I am not legally required to accept it. If I accept your request, I will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that I am legally required to make.

B.The Right To Choose How I Send PHI To You. You have the right to ask that I send information to you at an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, e-mail instead of regular mail). I must agree to your request so long as I can easily provide your PHI to you in the format requested.

C.The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that I have, but you must make the request in writing. If I do not have your PHI but I know who does, I will tell you how to get it. I will respond to you within 30 days of receiving your written request. In certain situation, I may deny your request. If I do, I will tell you, in writing, my reasons for the denial and explain your right to have my denial reviewed. If you request copies of your PHI, I will not charge you more than twenty-five cents ($.25) for each page. Instead of providing the PHI requested, I may provide you with a summary or explanation of the PHI as long as you agree to that and the cost in advance.

D.The Right to Get a List of the Disclosures I Have Made. You have the right to get a list instances in which I have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or healthcare operations, directly to you, or to your family. The list will also not include uses and disclosures made for national security purposes, to correction or law enforcement personnel, or disclosures made before April 15, 2003.

1.I will respond to your request for an accounting of disclosures within sixty (60) days of receiving your request. The list I will give you will include disclosures made in the last six (6) years, unless you request a shorter time. The list will include the date of the disclosure, to whom your PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.

E.The Right to Get This Notice By E-mail. You have the right to get a copy of this Notice by e-mail. Even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy.

V.HOW TO COMPLAIN ABOUT MY PRIVACY PRCTICES. If you think that I may have violated your privacy rights, or you disagree with a decision I made about your access to your PHI, you may file a complaint with the person listed in section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Washington D.C. 20201. I will take no retaliatory action against you if you file a complaint about my privacy practices.

VI.PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES. If you have any questions about this Notice or any complaints about my privacy practices, or would like to know how to file a complaint with the Secretary of the Department of health and Human Services, please contact:

Name:Matthew Gerst, Ph.D.

Address: 17705 Hale Avenue, Suite F-4, Morgan Hill, CA 95037

Telephone:408-776-1990 ext. 4

VII.EFFECTIVE DATE OF THIS NOTICE.

This notice went into effect on September 1, 2006.

This notice was last reviewed on September 1, 2013



I ACKNOWLEDGE RECEIPT OF THIS NOTICE



NAME:


SIGNATURE:


DATE:






Matthew Gerst, Ph.D.

Licensed Clinical Psychologist PSY13460

17705 Hale Avenue, Suite F-4

Morgan Hill, CA 95037


408.776.1990 ext 4

408.776.1901 fax


matthew@drgerst.com


 

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