Jim Moyers, MA, MFT
CA License MFC 21697
Berkeley Office & Mailing Address: 2424 Dwight Way, Suite 1, Berkeley, CA 94704
Hayward Office: 1345 B Street, Hayward, CA 94541
NOTICE OF JIM MOYERS’, MFT PRIVACY PRACTICES AS REQUIRED BY THE
I. WHAT THIS NOTICE IS
This notice explains how, when, and why I may be legally permitted to disclose to others information that clients may disclose to me in the course of psychotherapy. It is important to know that while I may be legally permitted to disclose information as described below, such disclosures to a third party would be very unusual except in instances such as insurance billing or contacting another treatment provider who is also seeing a client. In these cases I would have obtained client permission prior to disclosure. This notice also describes how clients can get access to this information. I am legally required to provide clients with this notice about the practices I follow to safeguard their' privacy. Federal and California laws require me to follow the practices described in this notice.
"Protected information" as used in this document includes any documents that can be used to identify a psychotherapy client that have been created or received about that client's past, present, or future mental health or condition, the provision of mental health care to the client, or payment for this mental health care. A "use" of such information occurs when it is shared, examined, utilized, applied, or analyzed; protected information is "disclosed" when it is released, transferred, given to, or otherwise divulged to a third party.
THE CONFIDENTIAL NATURE OF PSYCHOTHERAPY IS VERY IMPORTANT TO ME, AND I WILL DO EVERYTHING I CAN REASONABLY DO TO ENSURE THAT ANYTHING CLIENTS DISCLOSE TO ME INCLUDING THE FACT THAT THEY ARE IN PSYCHOTHERAPY WITH ME WILL NOT BE REVEALED TO ANYONE ELSE WITHOUT THEIR EXPRESS WRITTEN PERMISSION.
II. LEGAL SAFEGUARDS
I am legally required by both federal and California laws to safeguard the privacy of anything a client may disclose in the course of psychotherapy as well as the fact that the client is receiving psychotherapy.
By law I may not use or disclose any more of a client's protected information than is necessary to accomplish the purpose for which the use or disclosure is made. While I am legally permitted to disclose protected information in certain instances (see III below), I will make a reasonable effort to obtain a client's prior written consent for any such disclosure and will not disclose information about a client without the client's consent except in situations involving emergencies or instances in which reporting of certain information is legally mandated (see III.1 below).
If a client chooses to sign an authorization allowing me to disclose protected information, the client can at any later time revoke such authorization and stop any future uses and disclosures (to the extent that action taken in reliance on such authorization has not already occurred) of protected information by me. Although other health care providers are required to adhere to the same standards for confidential communication of protected information, clients should be aware that I have no control over how others may use information that has been disclosed to them.
I am required to notify clients of any breach of the security of their protected health information.
III. IN ACCORDANCE WITH PROFESSIONAL ETHICAL GUIDELINES:
I do not use any personal or protected information information about clients in marketing my services.
I do not sell client information to third parties for any purpose whatsoever, solicit client testimonials, and do not contact clients for fundraising purposes.
I keep brief psychotherapy notes about what clients discuss with me. I take care to safeguard psychotherapy notes and will not disclose their contents without prior client authorization except in instances where such disclosure is legally mandated (see section IV below). If I do have to make such a mandated report I will disclose only the minimum required information and if at all possible I will inform the affected client that I am doing so.
IV. HOW I MAY USE AND DISCLOSE CLIENTS' PROTECTED INFORMATION
While I am legally permitted to disclose protected information in the instances detailed below, I will make a reasonable attempt to secure client consent prior to any disclosure I might make.
A. There are a few legally mandated exceptions to the requirement for prior consent for disclosure of protected information:
1. An emergency situation in which the duty to ensure the safety of the client and/or others must take precedence over the obligation to safeguard privacy. This includes instances in which I perceive a serious threat of violence or suicide as well as medical emergencies.
2. I am legally required to make a report to designated authorities if I believe a child, dependent adult, or elder is being abused or neglected or is in danger of abuse or neglect. I will, however, inform the affected client of any such mandated disclosure if I can reasonably do so.
B. Ways in which I may legally use clients' protected information
1. For treatment
I may legally disclose a client's protected information to physicians, psychiatrists, psychologists, and other licensed health care providers who provide the client with health care services or are involved in the client's care. For example, if a client is being treated by a psychiatrist, information that I have about the client may be disclosed to the psychiatrist in order to coordinate care. However, except in the case of emergencies, I will secure the client's written consent before contacting another treatment provider with information about her/him.
2. To obtain payment for treatment
I may legally use and disclose protected information to bill and collect payment for the treatment and services provided by me. For example, protected information may be given to a client's insurance company or health plan to obtain payment for the services that have been provided. If an insurance company or other third party will be paying for a client's psychotherapy, I routinely obtain the client's written consent via signature at the start of treatment. Clients have the right to restrict what information will be sent to a third party payer if they have paid out-of-pocket in full for services.
3. Other disclosures
I am legally permitted to disclose protected information to others without client consent in certain situations. For example, consent is not required if a client needs emergency treatment, so long as a reasonable attempt is made to get consent after treatment is rendered, or an attempt is made to get consent but the client is unable to communicate (for example, if a client is unconscious or in severe pain) and it is reasonable to believe that the client would consent to such treatment if s/he were able to do so.
C. Certain Uses and Disclosures Do Not Legally Require Client Consent
A client's protected information may be legally disclosed without the client's consent or authorization for the reasons listed below. However, I will not do so without prior written consent except in emergency situations and instances in which disclosure without client consent is legally mandated.
1. As required by federal, state or local law; judicial or administrative proceedings; or, law enforcement. For example, disclosure may be made to applicable officials when a law requires reporting information to government agencies and law enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding. In such instances I will make a reasonable effort to inform the client of the necessity of the disclosure except in certain exceptional situations involving national security in which I can be forbidden by the investigating agency from making a disclosure to the client. If I am subpoenaed to disclose information about a client, I will make a reasonable effort to safeguard so far as I can the confidential nature of psychotherapeutic communication.
2. Disclosures to family, friends, or others
I will always seek client consent to provide information about the client to a family member, friend, or other person who the client indicates is involved in his/her care or the payment for her/his psychotherapy. An exception is in emergency situations where the opportunity to consent may legally be obtained retroactively.
3. For public health activities
For example, in the event of death, a report may have to be made to the county coroner.
4. For health oversight activities pertaining to my professional actions.
For example, information may be provided to assist a government entity in conducting an investigation or inspection of me including an investigation of my compliance with HIPPA.
5. To avoid harm.
In order to avoid a serious threat of harm to a client or others, protected information may be provided to law enforcement personnel or other persons who are in a position to prevent or lessen such harm.
6. For workers' compensation purposes
Information may be disclosed in order to comply with workers' compensation laws. I will, however, seek to secure the client's permission for any such disclosure.
7. Appointment reminders and health related benefits or services
I may provide appointment reminders (via, for example, phone messages or mail) or give a client information about treatment alternatives, or other health care services or benefits. Clients have the right to specify how I may contact them for such purposes (see section V.B below).
8. For training/supervising students, interns, or other mental health professionals
Any information so used will be disguised to conceal the identity of the client.
9. For purposes of defending myself in legal actions or proceedings brought by a client.
V. LEGAL RIGHTS REGARDING CLIENTS' PROTECTED INFORMATION
A. The Right to Request Limits on Uses and Disclosures of Information
By law clients may not limit the uses and disclosures that I am legally required or permitted to make. However clients do have the right to ask that I limit the use and disclosure of their protected information beyond the limits specified in this notice. While I am not legally required to accept it, such a request will given consideration with due regard for clinical as well legal issues. If I accept the request, I will put the requested limits in writing and abide by them except in emergency situations.
B. The Right to Choose How I Send Protected Information
Clients have the right to ask that information be sent to them at an alternate site (for example, sending information to a work address or telephone rather than home mail or an answering machine) or by alternate means (for example, e-mail instead of regular mail). I will agree to the request so long as I can readily provide the information in the format requested.
C. The Right to See and Get Copies of Protected Information
In most cases, clients have the right to look at or get copies of the information about them that I have, but the request must be made in writing. If I don't have the information but know who does, I will tell the client how to get it. I will act within 5 days of receiving a client's written request. In certain situations due to clinical considerations, I may deny the request. If I do, I will tell the client, in writing, my reasons for the denial and explain the client's right to have my denial reviewed. Instead of providing the information requested, I may provide a summary or explanation of the protected information as long as the client has agreed to that in advance.
D. The Right to Get a List of the Disclosures I Have Made
Clients have the right to get a list of instances (occurring after HIPPA went into effect 4/14/03) in which I have disclosed their protected information. The list will not include uses or disclosures that the client has already consented to, such as those made for treatment, payment, or health care operations, or those made directly to the client or the client's family. I will respond to a request for an accounting of disclosures within 60 days of receiving the request. The list I will give the client will include disclosures made in the last six years unless a shorter time period is requested. The list will include the date of the disclosure, to whom protected information was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. The list will be provided at no charge to the client, but if more than one request is made in the same year, I may charge a reasonable cost based fee for each additional request.
E. The Right to Correct or Update Protected Information
If a client believes that there is a mistake in the information I have about him/her or that important information is missing, the client has the right to request that I correct the existing information or add the missing information. The request and the reason for the request must be presented in writing. I will respond within 5 days of receiving the request to correct or update protected information. I may deny the request in writing if the protected information is (i) correct and complete, (ii) not created by me, (iii) not allowed to be disclosed, or (iv) not part of my records. My written denial will state the reasons for the denial and explain the client's right to file a written statement of disagreement with the denial. If the client chooses not to file such a statement, the client has the right to request that the original request and my denial be attached to all future disclosures of the protected information. If I approve the request for a change, I will make the change to the protected information, tell the client that I have done it, and tell inform any others that may need to know about the change.
F. The Right to Get This Notice by E-Mail
Clients have the right to get a copy of this notice by e-mail. Even if a client has agreed to receive this notice via e-mail, the client also has the right to request a paper copy of it.
VI. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES
If anyone has any questions about this notice or complaints about my privacy practices please contact me:
Jim Moyers, MFT
2424 Dwight Way, #1
Berkeley, CA, 94704
(510) 843 2424
A complaint may be sent to:
Secretary of the Department of Health and Human Services
200 Independence Avenue S.W.
Washington, D.C. 20201.
I shall take no retaliatory action against anyone who files a complaint.
VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect April 14, 2003 and was most recently updated February 18, 20015
© 2007 James Moyers