This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Waco Psychological Associates (WPA) may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions. PHI refers to information in your health record that could identify you. Treatment is when WPA provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when WPA consults with another health care provider, such as your family physician or another psychologist. Payment is when WPA obtains reimbursement for your healthcare. Examples of payment are when WPA discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage. Health care operations are activities that are related to the performance and operation of WPA practice. Examples of health care operations are quality assessment and improvements activities, business-related matters such as audits and administrative services, and case management and care coordination. Use applies only to activities within WPA (office, clinic, practice group, etc.), such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. Disclosure applies to activities outside of WPA (office, clinic, practice group, etc.), such as releasing transferring, or providing access to information about you to other parties.
WPA may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An authorization is written permission above and beyond the general consent that permits only specific disclosures. In those instances when WPA is asked for information for purposes outside of treatment, payment, and health care operations, WPA will obtain an authorization from you before releasing this information. WPA will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes WPA have made about our conversation during a private, group, joint, or family counseling session, which WPA have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that WPA the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.
WPA may use or disclose PHI without your consent or authorization in the following circumstances:
Child Abuse: If WPA has cause to believe that a child has been, or may be, abused, neglected, or sexually abuse, WPA must make a report of such within 48 hours to the Texas Department of Protective and Regulatory Services, the Texas Youth Commission, or to any local or state law enforcement agency.
Adult and Domestic Abuse: If WPA has cause to believe that an elderly or disabled person in a state of abuse, neglect, or exploitation, WPA must immediately report such to the Department of Protective and Regulatory Services.
Health Oversight: If a complaint is filed against WPA with the Texas State Board of Examiners of Psychologist, they have the authority to subpoena confidential mental health information from me relevant to that complaint.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis, and treatment and the records thereof, such information is privileged under state law, and WPA will not release information, without written authorization from you or your personal or legally appointed representative, or a court order. You will be informed in advance if this is the case.
Serious Threat to Health or Safety: If WPA determines that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to you, WPA may disclose relevant confidential mental health information to medical or law enforcement personnel.
Right to request Restrictions: You have to the right to request restrictions on certain uses and disclosures of protected health information about you. However, WPA is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing someone at WPA, and upon request WPA will send your bills to another address)
Right to Impact and Copy: You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in WPA mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. WPA may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, WPA will discuss with you the details of the request and denial process.
Right to an Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. WPA may deny your request. On your request, WPA will discuss with you the details of the amendment process.
Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section 3 of this Notice). On your request, I will discuss with you the details of the accounting process.
Right to a Paper Copy: You have the right to obtain a paper copy of the notice from WPA upon request, even if you have agreed to receive the notice electronically.
WPA Privacy Officer is Roderick Hetzel, Ph.D.
WPA is required by law to maintain the privacy of PHI and to provide you with a notice of WPA legal duties and privacy practices with respect to PHI.
WPA reserves the right to change the privacy policies and practices described in this notice. Unless WPA notifies you of such changes, however, WPA is required to abide by the terms currently in effect. If WPA revises policies and procedures, WPA will provide you written notification by mail.
If you have questions about this notice, disagree with a decision made about access to your records, or have other concerns about your privacy rights, you may contact WPA at (254) 751-1550. If you believe that your privacy rights have been violated and wish to file a complaint with WPA, you may send your written complaint to Waco Psychological Associates, 8401 Old McGregor Rd, Waco, TX 76712. You may also file a complaint to the Texas Behavioral Health Executive Council or the U.S. Department of Health and Human Services. WPA can provide you with the appropriate address upon request. You have specific rights under the Privacy Rule. WPA will not retaliate against you for exercising your right to file a complaint.