Kim Torrence, LCSW-C, RYT-200, 10750 Columbia Pike #401, Silver Spring, MD 20901,
(240)780-2430 kim@kimtorrence.com www.kimtorrence.com
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRBIES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
COMMITMENT TO PRIVACY
Kim Torrence, LCSW-C is committed to maintaining the privacy of your personal health information as part of providing professional care. She is also required by law to keep your information private. If you have any questions about specific privacy concerns, please notify Kim Torrence, LCSW-C, the designated Privacy Officer using the contact information listed at the top of this page.
1.1 How Kim Torrence, LCSW-C will use your Protected Health Information (PHI):
Kim Torrence, LCSW-C will use the information about your health that she gathers from you, or from others who you consent to speak with her, in order to provide you with treatment, to arrange payment from your insurance for my services, and for some other business activities which are called, in the law, health care operations. After you have read this Notice of Privacy Practices, and if you are in agreement with this policy, Kim Torrence, LCSW-C will ask you to sign an acknowledgment of having received this Notice, as well as a consent form that allows her to use and share your information in the manner stated in the paragraph above. If you do not consent and do not sign the consent form, then Kim Torrence, LCSW-C cannot treat you.
1.2 Limits of Confidentiality:
Your written and signed authorization is required before information concerning your care can be disclosed to individuals per your therapist. However, below are some of the cases in which the law dictates that your signed authorization may not be required in order for your therapist to release information:
- If your therapist believes that you are likely to harm yourself and or another person, he or she may take action necessary to protect you or others by contacting law enforcement officers, a physician, or other persons and organizations that can help to prevent or reduce the threat of danger.
- If your therapist has cause to believe that a child has been or may be abused or neglected, the clinician is required to make a report to the appropriate state agency.
- If your therapist has cause to believe that an elderly or disabled person has been or maybe abused, neglected, or subject to financial exploitation, the clinician is required to make a report to the appropriate state agency.
- If your therapist has cause to believe that Prenatal Exposure to Controlled Substances has occurred.
- If the therapist receives a subpoena, discovery request, or other lawful process related to a lawsuit or legal proceeding involving the client.
- To government agencies checking to ensure your therapist is in compliance with HIPPA.
- We may disclose PHI regarding deceased patients as mandated by state law. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate.
1.3 Your Rights Regarding Your Health Information:
- You can ask Kim Torrence, LCSW-C, to communicate with you about your health and related issues in a particular way or at a certain place which is more private for you. For example, you may request to receive phone calls at home or another preferred number, and not at work, to schedule or cancel an appointment.
- You have the right to ask Kim Torrence, LCSW-C to limit the disclosure of information to people involved in your care or the payment for your care, such as family members and friends. This request will be upheld except in cases described in the above section involving danger to self or others.
- You have the right to look at your health information that Kim Torrence, LCSW-C has gathered from you, such as medical and billing records. You may have a copy of these records, though there may be a charge to cover the cost of copying your records. You may discuss with the Privacy Officer, Kim Torrence, LCSW-C, at any time to arrange to see your records.
- If you believe the information in your records is incorrect or missing important information, you can ask Kim Torrence, LCSW-C to make changes to your health information through a process called amending. You must make this request in writing and send to Kim Torrence, LCSW-C at 10750 Columbia Pike #401, Silver Spring, MD 20901.
- Should you have any complaints, they can be directed to the Privacy Officer, Kim Torrence, LCSW-C.
2. The following uses and disclosures will be made only with your written authorization:
- Sharing of personal health information for the purpose of coordinating treatment with other providers.
- Uses and disclosures of psychotherapy notes that are not for permitted treatment, payment or health care operations;
- Uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; and
- Disclosures that constitute a sale of PHI.
3. Kim Torrence, LCSW-C is required by law to notify you of any breach of your unsecured PHI.
4. If Kim Torrence, LCSW-C intends to send fundraising communications to you, she must inform you of the same. You are thus informed that you have a right to opt out of such fundraising communications with each solicitation.
5. If you, the client, have paid for services out-of-pocket, Kim Torrence, LCSW-C must accommodate you should you request that she not disclose PHI related solely to those services paid for out-of-pocket if the disclosure is to be made to a health plan for payment or health care operations.
6. The Notice of Privacy Practices is approved by the Privacy Officer, Kim Torrence, LCSW-C. Kim Torrence, LCSW-C is responsible for revising the Notice of Privacy Practices to reflect any changes in practices regarding PHI. The Notice shall be written in plain language.
7. The Notice of Privacy Practices, or a summary of the same, shall be posted in a prominent location accessible to patients/clients. The complete Notice of Privacy Practices must be made readily available upon request to existing patients. The Notice is also available electronically through Kim Torrence LCSW-C’s website.
8. A copy of the Notice of Privacy Practices must be offered to the client/patient at the time of the first service delivery. EXCEPTION: If treatment is first rendered in an emergency, the Notice is given as soon as reasonably practicable after resolution of the emergency.
9. The staff member giving the Notice shall ask the client/patient to sign a written acknowledgement of receipt. If the patient/client refuses or is unable to sign, the circumstances will be documented on the acknowledgement form. The acknowledgement form will be retained in the patient’s/client’s record for six (6) years.
10. The Notice will be promptly revised whenever there is a material change to uses or disclosures of information, the individual’s rights, Kim Torrence LCSW-C’S legal duties or other privacy practices stated in the Notice. The revised Notice will be made available at each service delivery site for continuing patients to take with them upon request and will be posted on the organization’s website, if applicable.