Notice of Privacy Practices – The Psychiatry Practice of Anne S. Clark, MD

Notice of Privacy Practices Anne S. Clark, MD

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. If you have questions about this policy or our practices, you may ask to speak to our Privacy Officer. Our Privacy Officer is: Perry Clark. Phone: 913-738-9235; email: pclark@anneclarkmd.com

Your Rights

When it comes to your health information, you have certain rights. Those rights include, but are not limited to, the following:

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. If you so desire, simply ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.

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 cooperate with all reasonable requests regarding your desired means of communication.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would adversely affect your care.
If you pay for a service or health care item out-of-pocket and 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.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, whom we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
We’ll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You may ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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.

File a complaint if you feel your rights are violated

You may complain if you feel we have violated your rights, by contacting our Privacy Officer using the information at the top of this document.
You may also 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 in any form.

Your Choices

For certain health information, you can tell us your choices about what and how we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions to the extent allowed by law.

In these cases, you have choices about how we share information:

Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may share information about you if we believe it is in your best interest. We may also share your information when necessary to lessen a serious, imminent threat to health or safety.

In the following cases we never share your information unless you give us written permission:

Marketing purposes or sale of your information (We are required to note this, though we never market or sell patient/client information.)
Sharing of psychotherapy notes (Dr. Clark does not do psychotherapy, and so this is largely irrelevant for our clientele.)

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again. At this time we foresee no circumstances in which we might contact you for fundraising purposes.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways. In all cases, we share only the information necessary in the circumstances. Examples include:

To treat you or help others provide treatment to you. We can use your health information and share it with other health care professionals who are treating you. Example: A doctor treating you asks another doctor about your previous care.

Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use your personal information to coordinate our services to you.

Bill for services. We use and share your personal information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan administrators so the insurer can pay for services as appropriate.

How else can we use or share your health information? We are allowed, or sometimes required, to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. (See list below.) We must meet many legal conditions before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues
- We can share health information about you for certain situations such as:
  - Preventing disease
  - Helping with product recalls
  - Reporting adverse reactions to medications
  - Reporting suspected abuse, neglect, or domestic violence
  - Preventing or reducing a serious threat to anyone’s health or safety
Do research
- We may share your information for purposes of medical research. In such cases, the information shared is “de-identified”, by which we mean that all personal identifying information is removed.
Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
- We can share pertinent health information about you with organ procurement organizations should they request information in order to comply with your organ/tissue donation wishes.
Work with a medical examiner or funeral director
- We can share relevant health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, and other government requests
- We can use or share health information about you:
  - For workers’ compensation claims
  - For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
- We can (and in most cases must) share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will never share any substance abuse treatment records without your written permission, unless you are incapacitated and the provision of appropriate care to you demands it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Effective date of this notice: June 6, 2024.