Notice of Privacy Practices
Effective date: [add date]
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.
Our commitment
McMahon Mental Health is committed to protecting the privacy of your protected health information (PHI). We are required by law to maintain the privacy of your PHI, to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
- Treatment: We may use and disclose your PHI to provide, coordinate, or manage your care, including consulting with or referring you to other providers.
- Payment: We may use and disclose your PHI to bill and obtain payment for services, for example by sharing information with your health plan through our billing partner.
- Health care operations: We may use your PHI for activities necessary to run the practice, such as quality assessment and administrative functions.
- As required or permitted by law: We may disclose PHI when required by law, to public health authorities, to prevent a serious threat to health or safety, or in other circumstances the law permits.
Uses and disclosures that require your authorization
Most uses and disclosures of psychotherapy notes, uses for marketing, and any sale of PHI require your written authorization. You may revoke an authorization in writing at any time.
Your rights
- Request access to and a copy of your PHI.
- Request an amendment to your PHI.
- Request an accounting of certain disclosures.
- Request restrictions on certain uses and disclosures.
- Request confidential communications (for example, by a specific method or location).
- Receive a paper copy of this notice on request.
- Be notified in the event of a breach of your unsecured PHI.
Our duties
We are required to maintain the privacy of your PHI and to notify you following a breach of unsecured PHI. We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as any we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the practice at erin@mcmahonmentalhealth.com, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized for filing a complaint.
Contact
To exercise any of your rights or for questions about this notice, contact us at erin@mcmahonmentalhealth.com.