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Hipaa Privacy Practices Notice

Carole Orem, BS, MBA, PhD

Licensed Psychologist

 

Please take a moment to reflect on these values. I invite you to adopt them for the course of your work with me.  

  • Life Purpose.  We have the right to our best and highest self, to live with purpose, and to make a contribution in life.

  • Crisis is OK.  Crisis is not just pain and suffering; it can be a powerful force to wake us up and lead us to seek help that brings real healing. 

  • Presence.  Everybody has their own wisdom and own inner connection to the divine.  My job is to allow space for you to access that for yourself, where your trauma can get digested allowing better access to your higher self.

  • Participation.  Healing requires participation, doing our work, taking responsibility, and eventually choosing a different way of being because that is what I want. 

  • Power.  I have the power to create a fulfilling life.  When we truly do our inner work, it reflects in our outer lives and we experience deeper happiness and satisfaction.

 

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.

                                                               

Each time you visit me, I keep a record of your care and treatment.  I take the protection of your personal information seriously.  I am required to provide you with this Notice of Privacy Practices to tell you about my legal duties and ways I may use and share your information, and to inform you about your rights regarding your health information.  I give a small number of examples to describe what the categories mean, but not every use or disclosure can be listed on this Notice.

 

You have a right to a paper copy of this Notice of Privacy Practices.

 

This Notice is effective as of January 1, 2021. I will ask you to sign a written acknowledgment of receipt of our Notice.  I reserve the right to change the terms of this Notice and post the current Notice in our office. You may obtain an updated Notice from my practice at any time. 

 

If you have any questions about this Notice of Privacy Practices, please contact Carole Orem at (207) 318-5886.

 

How I May Use and Disclose Protected Health Information:

 

For Treatment: I will use and disclose your protected health information to provide, coordinate, or manage your healthcare and related services in our office or with a third party. For example, I may share your protected health information with a specialist to whom I refer you. I may share information with persons involved in your care, such as family members.

 

For Payment: I will use your protected health information to get paid for your healthcare services.  For example, I may share information with your insurance company to obtain payment for services or to seek pre-approval for treatment.

 

For Our Healthcare or Business Operations: I may disclose your protected health information to support the business activities of this office, such as reviewing our care and our employees, for education and training, to support our electronic health record system, or for legal or accounting matters. I may contact you to remind you of your appointment. If I involve third parties, such as billing services, in our business activities, I will have them sign a "business associate agreement” obligating them to safeguard your protected health information according to the same legal standards I follow.

 

When Allowed by Law: The law allows or requires me to use or disclose your protected health information in certain situations, including:

  • When required by state or federal law, or court order;

  • To report abuse or neglect;

  • To persons authorized by law to act on your behalf, such as a guardian, health care power of attorney or surrogate;

  • For public health activities such as reporting on or preventing certain diseases;

  • To comply with Food and Drug Administration requirements;

  • For health oversight purposes such as reporting to Medicare, Medicaid or licensing audits, investigations or inspections;

  • Where required by the U.S. Department of Health and Human Services to determine our compliance;

 

With your Authorization: Other uses and disclosures will be made only with your written authorization. For example, I will ask for your written permission before promoting a product or service to you for which I will be paid by a company, and generally before sharing your health information in a way that is considered a sale under the law.  If you sign an authorization, you may revoke it at any time, except where I have already shared your information based upon your permission.

 

Your Rights: The following is a statement of your rights with respect to your protected health information.

 

You have the right to access, inspect, and copy your protected health information. 

  • This usually includes medical and/or billing records.  You must submit a written request to us, and you agree to pay the reasonable costs associated with complying with your request before I provide you with your record

  • You may ask me to provide your electronic record in electronic format. If I am unable to provide your record in the format you request, I will provide the record in a form that works for you and our office. You may ask me to transmit your record to a specific person or entity by making a written, signed request. You may request the information be sent via our email system if you sign a statement that you understand that email comes with inherent risks for which my office is not responsible.

  • Under certain circumstances, your provider may not allow you to see or access certain parts of your record.  You may ask that this decision be reviewed by another licensed professional. 

 

You have the right to request to receive confidential communications and request contact from me by alternative means or at an alternative location.

 

You have the right to request a restriction of your protected health information. 

  • This means you may ask me not to use or disclose all or part of your protected health information for certain purposes. I will consider your request carefully and may honor reasonable requests where possible. The law does not require me to agree to every request. 

  • However, if you wish to restrict certain sensitive or other health information from your insurer after you or your personal representative have paid out of pocket in full for your services, please discuss this request with us. I will honor your request where I am not required by law to make the disclosure. If your insurance plan “bundles” your services together so that I cannot withhold only one item or service from your claim, I will discuss your options with you.

  • You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

 

You have the right to receive an accounting of certain disclosures I have made of your protected health information. Please speak with me if you have this request.

 

You may have the right to request amendment of your protected health information.  While I cannot erase your record, I may add your written statement to your protected health information to correct or clarify the record where your provider approves.  If the provider disapproves, you may submit a statement of disagreement and I may submit a rebuttal, which will remain with your record.

 

Breach notification. I am required to have safeguards in place that protect your health information. In the event that there is a breach of those protections, I will notify you, the U.S. Department of Health and Human Services, and others, as the law requires.

 

You may file a complaint with me by notifying our Privacy Officer with your written complaint.  I will not retaliate against you for filing a complaint with me or the Office of Civil Rights.

 

You may complain to the Office of Civil Rights at the Department of Health and Human Services (OCR) if you believe your privacy rights have been violated by us.  You should contact the OCR in writing at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

Transform trauma and thrive

Carole Orem, PhD

Online based in South Portland, Maine

corem@caroleorem.com

207-318-5886

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