HIPAA Notice of Privacy Statement

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW CAREFULLY:

We are 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 Telepsychology Associates, P.A., and of your individual rights and Telepsychology Associates, P.A.'s legal duties with respect to confidential information.

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

We may use and disclose at our 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.

We may contact you to provide appointment reminders or other services that may be of interest to you. We 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 we are 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, we are 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, we are required by law to inform the appropriate child welfare or social agency which may then investigate the matter; (c) if we are required by a court of law (court order) to turn over records to the court or if we are 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, we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

Due to the personal and sensitive nature of assessment, counseling, and testing, questions regarding confidentiality are completely understandable.

All therapeutic services at ESAD are strictly confidential. This means that nothing you share with us is revealed to anyone without your permission. We are not allowed to even disclose your name or identifying information to anyone including your family, other physicians, or places of business. Our psychological services are bound by the legal requirements of the National Privacy Principles from the Privacy Amendment (Private Sector) Act 2000.

In order to provide you with the highest quality of care, we may consult with various clinicians in our therapeutic group. Other than these internal assessments, it is completely your decision whether to tell anyone that you are using our services.

We are unable to guarantee a confidential phone line, since wireless technology may be used in this process.

Review of your Protected Health Information

You affirmatively consent to the fact that ESAD’s personnel will, as needed, review your particular "Session Transcripts" or "Rooms" in a HIPAA/HITECH approved form, generally but not limited to the following purposes:

  • ‍During your on-boarding and during the Provider matching process to ascertain you are able to successfully engage with the Provider. This access may be accomplished using an ESAD on-boarding specialist and not a Provider;
  • To review your complaint about a particular issue/instance that your report about your Provider or about a particular language intention with your Provider;
  • For your safety concerns or complaints of unethical Provider practices;
  • To transition you to a new Provider or if your account is non responsive or inactive for an extended period of time; or
  • To address raised quality assurance concern(s) that may apply to an individual Provider, a state-wide compliance issue or a national network issue.

You consent to ESAD using "Meta Data" and other search terms to scan only HIPAA ‘Safe Harbor” transcripts to search for trends and patterns that may affect the quality of services provided to you or the practices of the Providers. If your particular complaint requires a review of Session Transcripts in the original form, you consent to ESAD personnel accessing your account only to respond to your particular complaint or raised issue.

You consent to ESAD recording your calls to Customer Service to assist with quality assurance.

You affirmatively grant ESAD permission to have your Provider periodically provide non-content based clinical assessments of your progress to ESAD. You understand that ESAD may provide the Providers with clinical assessment tools that serve to provide information on your mental health and well-being and that results can be seen by your Provider to discuss with you.

All de-data, meta-data and research data collected by ESAD through your use of the Services remains the sole property of ESAD. You shall not request that ESAD remove or delete any of such data and agree that you waive any right, now or in the future to do so.

You agree that the email username you provide can be used by ESAD to send you marketing offers from ESAD Providers and ESAD partners.

You acknowledge and understand that ESAD may store all personal data as required by law, typically for no less than seven (7) years, and further, may be prohibited from deletion of such medical records data, even upon your direct request.

You acknowledge and understand that ESAD reserves the right, and in some states may be obligated should it become  aware of same, to forward any and all transcripts or other information provided, to applicable law enforcement agencies should you disclose the intent to commit any crime or divulge certain prior criminal acts.

Are there limits to confidentiality?

Yes. There are situations in which we are required by law and/or professional ethics to release information.

These include:

  • Our assessment that you may be a danger to yourself or others.
  • Our assessment that a child or elder is being abused, neglected, or exploited.
  • If we are required to present records or information as a part of a legal proceeding and are subpoenaed by the court.

Although these are very rare occurrences, should any of these situations arise, our staff will make every effort to discuss with you what steps will be taken.

What about airline inquiries?

Some airlines do, in fact, check to make sure that the mental health professional who signs your treatment recommendation letter for an emotional support animal is a licensed clinician, although they typically do this via online verification by a state board of certification website (there’s one for each state).

By federal law, a mental health professional or related agency is unable to release any information about a client without his or her express written permission. Airlines and other businesses may call or email us (our contact info and office telephone number is listed on the “contact us” page of this website) to verify licensure information, but it is unlawful for us to confirm even the name of a client.