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: 509 7th St. Floor 2

Santa Rosa, CA 95401

Telephone: 707-978-2944

VII.EFFECTIVE DATE OF THIS NOTICE.

This notice went into effect on September 1, 2006.

This notice was last reviewed on September 1, 2018