HIPAA Notice of Privacy Practices
Last updated: December 7, 2022
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.
This notice is effective as of December 7, 2022. The purpose of this notice is to inform you of the privacy practices of Recharge Online Therapy A Marriage and Family Therapy Corporation (the Provider). The Provider is a Covered Entity as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
If you have any questions about this notice, would like a copy of this notice, need more information, or would like to request your records, please contact: info@rechargeonlinetherapy.com.
I. Our Pledge Regarding Health Information:
- Make sure that PHI that identifies you is kept private and secure.
- Let you know promptly if a breach occurs that may have compromised the privacy and security of PHI.
- Give you this notice of our legal duties and privacy practices with respect to 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 and on our website.
II. How We May Use and Disclose Health Information About You:
We will use and disclose your PHI for many different reasons. For some of these uses and disclosures, we will need you prior authorization; for others, however, we do not. Listed below are the different categories of our uses and disclosures along with some examples of each category.
1. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Consent:
a. For Treatment: We can disclose your PHI to physicians, psychiatrists, psychologists, psychotherapists, and other health care providers who provide you with health care services or are involved in your care. For example, if you are being treated by a psychiatrist, we can disclose your PHI to your psychiatrist in order to coordinate your care.
b. To Obtain Payment for Treatment: We can use and disclose your PHI to bill and collect payment for the treatment and services provided by us to you. For example, we may provide your PHI to our business associates such as billing companies, claims processing companies and others that process our health care claims.
c. For Health Care Operations: We can disclose your PHI to physicians, psychiatrists, psychologists, psychotherapists, and other health care providers who provide you with health care services or are involved in your care. For example, if you are being treated by a psychiatrist, we can disclose your PHI to your psychiatrist in order to coordinate your care.
d. Other Disclosures: We can disclose your PHI to physicians, psychiatrists, psychologists, psychotherapists, and other health care providers who provide you with health care services or are involved in your care. For example, if you are being treated by a psychiatrist, we can disclose your PHI to your psychiatrist in order to coordinate your care.
2. Certain Other Uses and Disclosures Do Not Require Your Consent:
a. When Disclosure is Required by Federal, State or Local Law; Judicial or Administrative Proceedings; or Law Enforcement: For example, we may make a disclosure to applicable officials when the law requires us to report information to government agencies and law enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding.
b. When Responding to Lawsuits, Disputes and Legal Actions: For example, if you are involved in a lawsuit, we may disclose PHI in response to a court or administrative order. We may also disclose PHI 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.
c. When Complying With Special Laws: There are special laws that protect some types of health information. We will respect these laws when they are stricter than this notice.
d. For Public Health and Safety Activities: For example, we may have to report information about you to coroners or medical examiners, when such individuals are performing duties authorized by law. Another example, we may have to disclose your information if we are reporting suspected child, elder, or dependent adult abuse. Another example, in order to avoid a serious threat to anyone’s health and safety, we may have to disclose your information to law enforcement or persons able to prevent or reduce such harm.
e. For Health Oversight Activities: For example, we may have to provide information to assist the government in audits, investigations or inspections of health care providers or organizations.
f. For Research Purposes: In certain situations, we can use or disclose your information for health research.
g. For Specific Government Functions: For example, we may disclose PHI for military, national security, intelligence operations, and presidential protective services purposes.
h. For Workers’ Compensation Purposes: We may provide PHI in order to comply with workers’ compensation laws.
i. For Appointment Reminders and Health Related Benefits or Services: We may use and disclose PHI to provide appointment reminders or give you information about treatment alternatives or options, or health care services or benefits that may be of interest to you.
j. To Business Associates: We may use and disclose PHI to our business associates who perform functions on our behalf or provide us with services, if the PHI is necessary for those functions and services.
k. To Personal Representatives: We can use and disclose PHI to your personal representative (e.g. a medical power of attorney), if you have one. Your personal representative can also exercise your rights and make choices about your health care.
3. Certain Uses and Disclosures Require You to Have the Opportunity to Object:
a. 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 health 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.
4. Other Uses and Disclosures Require Your Authorization: In any other situation not described in sections II 1, 2, and 3 above, we will ask for 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 we haven’t taken any action in reliance on such authorization) of your PHI by us.
a. If your provider keeps “psychotherapy notes,” or notes recorded in any medium documenting or analyzing the contents of conversation during a session that are separated from the rest of your medical record, any use or disclosure of such notes requires your authorization unless the use or disclosure is: (1) for treatment purposes, (2) for training or supervising purposes, (3) for use in self-defense in legal proceedings instituted by you, (4) for use by the Secretary of Health and Human Services to investigate our compliance with HIPAA, (5) required by law, (6) required to help avert serious threat to the health and safety of others.
b. Most uses and disclosures of health information for marketing purposes, and disclosures that constitute a sale of health information, require your authorization.
III. You Have the Following Rights With Respect to Your PHI:
You have the following rights with respect to your PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask that we limit how we use and disclose your PHI for treatment, payment or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care. You may not limit the uses and disclosures that we are legally required or allowed to make. To request restrictions, you must make your requests in writing to Recharge Online Therapy. Your request must state the specific restriction requested, whether you want to limit our use and/or disclosure and to whom you want the restriction to apply.
2. 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 you pay for a service or health care item out-of-pocket, in full. To request restrictions, you must make your requests in writing to Recharge Online Therapy. Your request must state the specific restriction requested, whether you want to limit our use and/or disclosure and to whom you want the restriction to apply.
2. 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 you pay for a service or health care item out-of-pocket, in full. To request restrictions, you must make your requests in writing to Recharge Online Therapy. Your request must state the specific restriction requested, whether you want to limit our use and/or disclosure and to whom you want the restriction to apply.
4. 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 we have about you. We 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 we may charge a reasonable, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made: You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, health care operations, or for which you provided us with an authorization. The list also won’t include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or disclosures made before April 15, 2003. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable, cost-based fee for each additional request. To request this list or accounting of disclosures, you must submit your request in writing to Recharge Online Therapy.
6. 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 we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request. You must provide the request and your reason for the request in writing to Recharge Online Therapy.
7. 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. Even if you have agreed to receive this notice via e-mail, you also have the right to request a paper copy of it.
IV. How to Complain About Our Privacy Practices:
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint by contacting Emily Sharaf at emilysharaf@rechargeonlinetherapy.com. You also may send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W. Washington, DC 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.