Notice of Privacy Practices 

I. 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. 

II. MICHELLE HARWELL THERAPY HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH lNFORMATION (PHI) 

Michelle Harwell Therapy is legally required to protect the privacy of your PHI, which includes information that can be used to identify you that Michelle Harwell Therapy created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. Michelle Harwell Therapy must provide you with this Notice about our privacy practices, and such Notice must explain how, when, and why they will “use” and “disclose” your PHI. A “use” of PHI occurs when Michelle Harwell Therapy shares, examines, utilizes, applies, or analyzes such information within their practice; PHI is “disclosed” when it is released, transferred, has been given to, or is otherwise divulged to a third party outside of the Michelle Harwell Therapy practice. With some exceptions, Michelle Harwell Therapy may not use or disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made. And, Michelle Harwell Therapy is legally required to follow the privacy practices described in this Notice. Michelle Harwell Therapy will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Michelle Harwell Therapy can change the terms of this notice, and the changes will apply to all information Michelle Harwell Therapy has about you. The new notice will be available upon request, in our offices, and on our website, www.michelleharwelltherapy.com.

III. HOW MICHELLE HARWELL THERAPY MAY USE AND DISCLOSE YOUR PHI. 

Michelle Harwell Therapy will use and disclose your PHI for many different reasons. For some of these uses or disclosures, Michelle Harwell Therapy will need your prior written authorization; for others, however, Michelle Harwell Therapy does not. Listed below are the different categories of uses and disclosures along with some examples of each category. 

A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Which Do Not Require Your Prior Written Consent. 

Michelle Harwell Therapy can use and disclose your PHI without your consent for the following reasons: 

1. For Treatment. Michelle Harwell Therapy can use your PHI within our practice to provide you with mental health treatment, including discussing or sharing your PHI with psychotherapists and psychiatrists who are part of Michelle Harwell Therapy. Michelle Harwell Therapy can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are involved in your care. For example, if a psychiatrist is treating you, Michelle Harwell Therapy can disclose your PHI to your psychiatrist to coordinate your care. 

2. To Obtain Payment for Treatment. Michelle Harwell Therapy can use and disclose your PHI to bill and collect payment for the treatment and services provided by Michelle Harwell Therapy to you. Michelle Harwell Therapy may provide your PHI to business associates in order to process payment. 

3. For Health Care Operations. Michelle Harwell Therapy can use and disclose your PHI to operate its practice. For example, Michelle Harwell Therapy might use your PHI to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided such services to you. Michelle Harwell Therapy may also provide your PHI to its accountant, attorney, consultants, or others to further its health care operations. 

4. Patient Incapacitation or Emergency. Michelle Harwell Therapy may also disclose your PHI to others without your consent if you are incapacitated or if an emergency exists. For example, your consent isn't required if you need emergency treatment, as long as Michelle Harwell Therapy tries to get your consent after treatment is rendered, or tries to get your consent but you are unable to communicate with Michelle Harwell Therapy or your therapist (for example, if you are unconscious or in severe pain) and Michelle Harwell Therapy or your therapist think that you would consent to such treatment if you were able to do so. 

B. Certain Other Uses and Disclosures Also Do Not Require Your Consent or Authorization. Michelle Harwell Therapy can use and disclose your PHI without your consent or authorization for the following reasons: 

1. When federal, state, or local laws require disclosure. For example, Michelle Harwell Therapy may have to make a disclosure to applicable governmental officials when a law requires it to report information to government agencies and law enforcement personnel about victims of abuse or neglect. 

2. When judicial or administrative proceedings require disclosure. For example, if you are involved in a lawsuit or a claim for workers’ compensation benefits, Michelle Harwell Therapy may have to use or disclose your PHI in response to a court or administrative order. Michelle Harwell Therapy may also have to use or disclose your PHI in response to a subpoena. 

3. When law enforcement requires disclosure. For example, Michelle Harwell Therapy may have to use or disclose your PHI in response to a search warrant. 

4. When public health activities require disclosure. For example, Michelle Harwell Therapy may have to use or disclose your PHI to report to a government official an adverse reaction that you have to a medication. 

5. When health oversight activities require disclosure. For example, Michelle Harwell Therapy may have to provide information to assist the government in conducting an investigation or inspection of a health care provider or organization. 

6. To avert a serious threat to health or safety. For example, Michelle Harwell Therapy may have to use or disclose your PHI to avert a serious threat to the health or safety of others. However, any such disclosures will only be made to someone able to prevent the threatened harm from occurring. 

7. For specialized government functions. If you are in the military, Michelle Harwell Therapy may have to use or disclose your PHI for national security purposes, including protecting the President of the United States or conducting intelligence operations. 

8. To remind you about appointments and to inform you of health-related benefits or services. For example, Michelle Harwell Therapy may have to use or disclose your PHI to remind you about your appointments, or to give you information about treatment alternatives, other health care services, or other health care benefits that Michelle Harwell Therapy offers that may be of interest to you.

C. Certain Uses and Disclosures Require You to Have the Opportunity to Object. 

1. Disclosures to Family, Friends, or Others. Michelle Harwell Therapy may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations. 

D. Other Uses and Disclosures Require Your Prior Written Authorization.

In any other situation not described in sections III A, B, and C above, Michelle Harwell Therapy will need your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent that Michelle Harwell Therapy hasn’t taken any action in reliance on such authorization) of your PHI by Michelle Harwell Therapy. 

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI 

You have the following rights with respect to your PHI: 

A. The Right to Request Restrictions on My Uses and Disclosures.

You have the right to request restrictions or limitations on Michelle Harwell Therapy’s uses or disclosures of your PHI to carry out treatment, payment, or health care operations. You also have the right to request that Michelle Harwell Therapy restrict or limit disclosures of your PHI to family members or friends or others involved in your care or who are financially responsible for your care. Please submit such requests to your therapist or psychiatrist in writing. Michelle Harwell Therapy will consider your requests, but is not legally required to accept them. If Michelle Harwell Therapy does accept your requests, Michelle Harwell Therapy will put them in writing and will abide by them, except in emergency situations. However, be advised, that you may not limit the uses and disclosures that Michelle Harwell Therapy is legally required to make. 

B. The Right to Choose How Michelle Harwell Therapy Sends PHI to You.

You have the right to request that Michelle Harwell Therapy send confidential information to you at an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, e-mail instead of regular mail). Michelle Harwell Therapy must agree to your request so long as it is reasonable and you specify how or where you wish to be contacted, and, when appropriate, you provide Michelle Harwell Therapy with information as to how payment for such alternate communications will be handled. Michelle Harwell Therapy may not require an explanation from you as to the basis of your request as a condition of providing communications on a confidential basis. 

C. The Right to Inspect and Receive a Copy of Your PHI.

In most cases, you have the right to inspect and receive a copy of the PHI that Michelle Harwell Therapy has for you, but you must make the request to inspect and receive a copy of such information in writing. If Michelle Harwell Therapy doesn’t have your PHI but knows who does, they will tell you how to get it. Michelle Harwell Therapy will respond to your request within 30 days of receiving your written request. In certain situations, Michelle Harwell Therapy may deny your request. If they do, Michelle Harwell Therapy will tell you, in writing, their reasons for the denial and explain your right to have their denial reviewed. If you request copies of your PHI, Michelle Harwell Therapy will charge you not more than $.25 for each page. Instead of providing the PHI you requested, Michelle Harwell Therapy may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance. 

D. The Right to Receive a List of the Disclosures Michelle Harwell Therapy Has Made.

You have the right to receive a list of instances, i.e., an Accounting of Disclosures, in which Michelle Harwell Therapy has disclosed your PHI. The list will not include disclosures made for my treatment, payment, or health care operations; disclosures made to you; disclosures you authorized; disclosures incident to a use or disclosure permitted or required by the federal privacy rule; disclosures made for national security or intelligence; disclosures made to correctional institutions or law enforcement personnel; or, disclosures made before January 1, 2020. Michelle Harwell Therapy will respond to your request for an Accounting of Disclosures within 60 days of receiving such request. The list Michelle Harwell Therapy will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date the disclosure was made, to whom the PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. Michelle Harwell Therapy will provide the list to you at no charge, but if you make more than one request in the same year, it may charge you a reasonable, cost-based fee for each additional request. 

E. The Right to Amend Your PHI.

If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that Michelle Harwell Therapy correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. Michelle Harwell Therapy will respond within 60 days of receiving your request to correct or update your PHI. Michelle Harwell Therapy may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by Michelle Harwell Therapy, (iii) not allowed to be disclosed, or (iv) not part of Michelle Harwell Therapy records. If your request is denied, Michelle Harwell Therapy’s written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and the Michelle Harwell Therapy denial be attached to all future disclosures of your PHI. If Michelle Harwell Therapy approves your request, they will make the change to your PHI, tell you they have done so, and tell others that need to know about the change to your PHI. 

F. The Right to Choose Someone to Act For You.

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

G. The Right to Receive a Paper Copy of this Notice.

You have the right to receive a paper copy of this notice even if you have agreed to receive it via email. 

V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES 

If you think that Michelle Harwell Therapy may have violated your privacy rights, or you disagree with a decision Michelle Harwell Therapy made about access to your PHI, you may file a complaint with the person listed in Section Vl below. You also may send a written complaint to the Privacy Officer, CA Department of Health, Services, P.O. Box 997413, MS 0010, Sacramento, California 95899-7413; (916) 445-4646 or (877) 735-2929 (TTY/TDD).  You may also contact the Secretary of the U.S. Department of Health and Human Services by writing or calling the Office for Civil Rights, U.S. Department of Health & Human Services, 90 7th Street, Suite 4-100, San Francisco, CA 94103, (415) 437-8310; (415) 437-8311 (TDD); (415) 437-8329 FAX. Michelle Harwell Therapy will take no retaliatory action against you if you file a complaint about its privacy practices. 

VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact our Security Officer at clinicalcarecoordinator.mht@gmail.com or call (626) 382-8005. Michelle Harwell Therapy, 2120 Colorado Blvd Suite 2, Los Angeles, CA 90041. 

VlI. EFFECTIVE DATE OF THIS NOTICE: January 1, 2020