Ardern Psychology

Individual, couples and family therapy in the Golden, CO area

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Privacy Policy

ARDERN PSYCHOLOGY, LLC

Privacy Official:  Heidi Ardern, Ph.D.

2801 Youngfield Street, Suite 300, Golden, CO  80401

(303) 205-8482

heidi@ardernpsychology.com     www.ardernpsychology.com

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR PLEDGE REGARDING HEALTH INFORMATION


We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

  • Make sure that protected health information (“PHI”) that identifies you is kept private.
  • Give you this notice of my legal duties and privacy practices with respect to health information.
  • Notify you if you are affected by a breach of unsecured PHI.
  • Follow the terms of the notice that is currently in effect.
  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU


The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

  1. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION

a.   Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:

  • When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
  • For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
  • For health oversight activities, including audits and investigations.
  • For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
  • For law enforcement purposes, including reporting crimes occurring on my premises or in emergencies, reporting a death, or responding to a law enforcement official’s request for information about an individual who is or is suspected to be a victim of a crime.
  • To coroners or medical examiners, when such individuals are performing duties authorized by law.
  • For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
  • Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
  • For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
  • Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with our office. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

b.   Additional Disclosures:

  • For Treatment Payment, or Health Care Operations.  Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, or if a clinician were to perform services while under another clinician’s supervision, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care.  Consequently, disclosures for treatment purposes are not limited to the minimum necessary standard.  The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

You can tell us your choices about what we share for purposes of treatment, payment, and health care operations. If you have a clear preference for how we share your information in the situations described above, please let us know. 

–     Disaster Relief.  You have both the right and the choice to tell us to share information in a disaster relief situation.  If you have a clear preference for how we use your information in those situations, tell us.   If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest.   We may also share your information when needed to lessen a serious and imminent threat to health or safety. 

  • Lawsuits and Disputes. If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
  • Fundraising.  We may contact you for fundraising efforts, but you can tell us not to contact you again.  If you have a clear preference for whether we contact you for fundraising efforts, tell us and we will honor it.
  • CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others. We 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 to a use or disclosure may be obtained retroactively in emergency situations.  You always have the right to request restrictions on uses and disclosure of your PHI to a family member, friend, or other person involved in your care. 

  • CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION

Psychotherapy Notes. Your therapist keeps “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

  • For use in treating you.
  • For use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
  • For use in defense of your therapist in legal proceedings instituted by you.
  • For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.
  • Required by law and the use or disclosure is limited to the requirements of such law.
  • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
  • Required by a coroner who is performing duties authorized by law.
  • Required to help avert a serious threat to the health and safety of others.
  • NONDISCLOSURE AND LIMITATIONS
  • Marketing Purposes. As psychotherapists, we will not use or disclose your PHI for marketing purposes.
  • Sale of PHI. As psychotherapists, we will not sell your PHI in the regular course of our business.

You may:

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. In the event of your death, whomever is designated as the executor of your estate will have the ability to access your mental health records upon request.

Request confidential communications.  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share.  If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time and let us know in writing.

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

  • The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
  • The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
  • The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.
  • The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
  • The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
  • The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

You may also file a complaint if you feel your rights are violated:

–     You can complain if you feel we have violated your rights by contacting us using the information on page 1.

–     You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

–     We will not retaliate against you for filing a complaint.

For further information related to our privacy practices or this Notice, please contact us using the information on page 1.

Effective date: July 14, 2021

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