HIPAA Notice of Privacy Practices

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.

Who this notice applies to

This notice applies to Good Psychotherapy Services and Amanda Good, LCSW (“we,” “us,” or “the Practice”). We are required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this notice, and to follow the terms currently in effect.

How we may use and disclose your health information

Treatment

We may use your PHI to provide, coordinate, or manage your health care and related services — for example, sharing information with another provider involved in your care if you give us permission.

Payment

We may use or disclose your PHI to obtain payment for services rendered. Because Good Psychotherapy Services is a cash-pay, out-of-network practice, this primarily means providing a superbill for you to submit to your insurance company.

Health care operations

We may use or disclose your PHI for our internal business operations, including quality assessment, compliance, and professional development (such as EMDR consultation services, in which PHI is de-identified to the extent possible).

Other uses and disclosures we may make without your authorization

As a licensed clinical social worker, we are required by law to disclose PHI in the following circumstances:

• Imminent danger: If you express serious and imminent intent to harm yourself or another identifiable person, we may take steps to protect you or others, which may include disclosing PHI to appropriate parties or authorities.
• Abuse or neglect: We are mandated reporters. We are required to report suspected abuse or neglect of children, elderly persons, or dependent adults to the appropriate authorities.
• Court order: We may disclose your PHI if ordered by a court of law.
• Public health: Certain disclosures may be required by public health laws (e.g., reporting communicable diseases).

Your rights regarding your health information

Right to access

You have the right to inspect and receive a copy of your PHI held in your designated record set, with limited exceptions.

Right to request amendment

If you believe your PHI is inaccurate or incomplete, you may request an amendment. We may deny the request under certain circumstances but will explain why in writing.

Right to an accounting of disclosures

You have the right to request a list of disclosures of your PHI made by us, other than those made for treatment, payment, or operations.

Right to request restrictions

You may request restrictions on our use or disclosure of your PHI. We are not required to agree to all restrictions, but will do so when reasonable.

Right to confidential communications

You may request that we communicate with you about health matters in a specific way or at a specific location (for example, by email only).

Right to a paper copy of this notice

You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.

Changes to this notice

We reserve the right to change this notice and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post the current notice on our website and provide a copy upon request.

Complaints

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

Amanda Good, LCSW
amanda@goodpsychotherapyservices.com

You will not be penalized for filing a complaint. To file a complaint with HHS, visit hhs.gov/ocr/privacy/hipaa/complaints.