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Camellia ENT - HIPAA Security

Notice of Privacy Practices


I am required by the Health Insurance Portability & Accountability Act of 1996 (HIPAA) to provide confidentiality for all medical/mental health records and other individually identifiable health information in my possession. This Notice is to inform you of the uses and disclosures of confidential information that may be made by Camellia ENT, and of your individual rights and Camellia ENT’s legal duties with respect to confidential information.

Ways in which I may use and disclose your protected health information:

I may use and disclose at my discretion your medical records for each of the following purposes only: treatment, payment and health care operations.

  • Treatment means providing, coordinating or managing mental health care and related services.
  • Payment means activities such as obtaining payment for the mental health care services I provide for you from your insurance or another third party payer.
  • Health care operations include the business aspects of running a practice.

I may contact you to provide appointment reminders or other services that may be of interest to you. I will disclose your protected health information to any person you identify that is involved in payment for your care.

I will use and disclose your protected health information when required by federal, state or local law. There are certain situations in which as a therapist I am required by ethical standards to reveal information obtained during therapy to persons or agencies  even if you do not give permission. These situations are as follows: (a) If you threaten grave bodily harm or death to yourself or another person, I am required by ethical standards to inform the intended victim and/or appropriate law enforcement agencies; (b) if you report to me your knowledge of physical or sexual abuse of a minor child or of an elder (over 65) or any sexual conduct/contact with a minor, I am required by law to inform the appropriate child welfare or social agency which may then investigate the matter; (c) if I am required by a court of law (court order) to turn over records to the court or if I am ordered to testify regarding those records.

Any other uses and disclosures will be made only with your written authorization. You will be provided with an authorization form upon request. A separate form will be needed for each request for release of information. The authorization for release of records is valid until it expires or is revoked. You may revoke authorization in writing as I am required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

Understanding Your Health Record / Information

Each time you visit a healthcare facility, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • A basis for planning your care of treatment
  • A means of communication among the health professionals who contribute to your care
  • A legal document describing the care you received
  • A means by which you or a third-party payer can verify that services billed were actually provided
  • A tool in educating health professionals
  • A source of data for medical research
  • A source of information for public health officials who oversee the delivery of health care in the United States
  • A source of data for facility planning and marketing
  • A tool with which we can assess and continuously work to improve the care we render and the outcomes we achieve

By understanding what your medical record contains and how your health information is used, you can:

  • Ensure the accuracy of its contents
  • Better understand who, what, when, where, and why others may access your health information
  • Make more informed decisions when authorizing disclosure of your record to others
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