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Updated Notice of Privacy Practices & Medical Disclaimer

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PART 1: NOTICE OF PRIVACY PRACTICES (Updated)
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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. PLEDGE REGARDING HEALTH INFORMATION

Your provider understands that health information about you and your health care is personal, and is committed to protecting health information about you. A record of the care and services provided is created to ensure quality care and compliance with legal requirements. This notice applies to all records generated by this practice. This document also describes your rights to the health information, and describes certain obligations regarding the use and disclosure of your health information. The provider is required by law to:

  • Make sure that protected health information ("PHI") that identifies you is kept private.

  • Give you this notice of legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

The provider can change the terms of this Notice, and such changes will apply to all information the provider has about you. The new Notice will be available upon request, in the office, and on the website.

II. HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED

The following categories describe different ways health information may be used and disclosed. Not every use or disclosure in a category will be listed. However, all of the ways the provider is permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without the patient's written authorization, to carry out the health care provider's own treatment, payment, or health care operations. The provider may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, the provider would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard, because health care providers need access to the full record and/or complete information in order to provide quality care. The word "treatment" includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, the provider may disclose health information in response to a court or administrative order. The provider may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes. "Psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless: a. Used by the provider for treatment. b. Used for training or supervising mental health practitioners to help them improve their professional skills. c. Used for legal defense. d. Required by law or for certain health oversight activities. e. Required by a coroner or to avert serious threats to safety. f. For use by the Secretary of Health and Human Services to investigate compliance with HIPAA. g. Required by law, and the use or disclosure is limited to the requirements of such law. h. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes or Sale of PHI: Your provider will not use or sell your PHI for marketing purposes without your authorization.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

Subject to certain limitations in the law, the provider may use and disclose PHI without your authorization for the following reasons, among others:

  • When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

  • For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.

  • For health oversight activities, including audits and investigations.

  • For judicial and administrative proceedings, including responding to a court or administrative order.

  • For law enforcement purposes, including reporting crimes occurring on the practice's premises.

  • To coroners or medical examiners, when such individuals are performing duties authorized by law.

  • For research purposes, including studying and comparing the mental health of patients who received one form of treatment versus another.

  • Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.

  • For workers' compensation purposes. The provider may disclose your PHI in order to comply with workers' compensation laws.

  • Appointment reminders and health-related benefits or services. The provider may use and disclose your PHI to contact you to remind you of an appointment. The provider may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that the practice offers.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT

You may object to the disclosure of your PHI to family members, friends, or others involved in your care. The opportunity to consent may be retroactively obtained in emergencies.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI

  • The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask the provider not to use or disclose certain PHI for treatment, payment, or health care operations purposes. The provider is not required to agree if it affects care, and may say "no" if it is deemed it could affect your health care.

  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or service that you have paid for out-of-pocket in full.

  • The Right to Choose How PHI Is Sent to You. You have the right to ask to be contacted in a specific way (for example, home or office phone) or to send mail to a different address, and the provider will agree to all reasonable requests.

  • The Right to See and Get Copies of Your PHI. Other than "psychotherapy notes," you have the right to get an electronic or paper copy of your medical record and other information. The practice will provide you with a copy of your record, or a summary of it if you agree to receive a summary, within 30 days of receiving your written request, and you may be charged a reasonable, cost-based fee.

  • The Right to Get a List of the Disclosures. You may request a list of disclosures made without your authorization, except those for treatment, payment, or health care operations. The provider will respond within 60 days. The first list in a 12-month period is provided at no charge; you may be charged a reasonable fee for each additional request within that period.

  • The Right to Correct or Update Your PHI. If there is a mistake or missing information in your PHI, you may request an amendment. The provider may deny the request but will provide a written explanation within 60 days.

  • The Right to Get a Paper or Electronic Copy of this Notice. You have the right to request a copy of this notice at any time, even if you have agreed to receive it electronically.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the practice directly, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at:

Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building Washington, DC 20201 Customer Response Center: (800) 368-1019 Online: ocrportal.hhs.gov

You will not be penalized or retaliated against for filing a complaint.

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PART 2: MEDICAL DISCLAIMER (No Doctor-Patient Relationship)
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Medical Disclaimer

The content on this website — including text, blog posts, and any resources provided by Brain X Dynamics — is intended for general educational and informational purposes only. It is not intended to be, and should not be taken as, medical or psychiatric advice, diagnosis, or treatment.

Reading this website, submitting a contact form, or otherwise interacting with this site does not create a doctor-patient relationship between you and Dr. Clara Alvarez Villalba, MD, FAPA, or Brain X Dynamics. A doctor-patient relationship is only established once you have scheduled and completed an intake appointment and formally become a patient of the practice.

Information on this site should never replace the individualized advice of your own physician or other qualified health care provider. Always seek the guidance of a qualified mental health or medical professional with any questions you may have regarding a medical or psychiatric condition. Never disregard professional medical advice or delay seeking it because of something you read on this website.

If you are experiencing a medical or psychiatric emergency, do not use this website to seek help. Call 911, go to your nearest emergency room, or contact the 988 Suicide & Crisis Lifeline (call or text 988) immediately.

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