Health Insurance Portability and Accountability Act (HIPAA)

This is a federal law that provides privacy protections and client rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of Protected Health Information (PHI) for treatment, payment, and health care operations. The law requires that I obtain your signature acknowledging that I have provided you these disclosures at the end of this session. A description of the circumstances in which I may disclose information is provided for you. Please review it carefully so you understand fully what confidentiality does and does not mean in the therapeutic relationship. I am happy to discuss any of these rights with you.

Notice of Privacy Practices

I may disclose information in the following situations:

• Consultation with other health and mental health professionals.
• The individuals providing billing services for Singh Psychology, PLLC that are under obligation to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law.
• Disclosures required by health insurers.
• Disclosures required in collecting overdue fees. If your account has not been paid for more than 30 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This requires me to disclose otherwise confidential information. If legal action is necessary, costs are included in claim.
• Court Proceedings.
• Government Agency requests for information in health oversight activities.
• Client-initiated complaint or lawsuit against me. I may have to disclose relevant information regarding the client in order to defend myself.
• Client-initiated worker’s compensation claim and the services I am providing are relevant to the injury for which the claim was made. I must, upon appropriate request, provide a copy of the client’s record to the client’s employer and the Department of Labor and Industries.
• If I have reasonable cause to believe a child has suffered abuse or neglect.
• If I have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect of an elder or vulnerable adult has occurred, the law requires that I file a report with the appropriate government agency, usually the Department of Social and Health Services. Once such a report is filed, I may be required to provide additional information.
• If I reasonably believe there is an imminent danger to the health or safety of the client or any other individual.

Expanded Clinical Records Rights

HIPAA provides you with several new or expanded rights with regard to your Clinical Records and disclosures of protected health information. These rights include:

• Requesting that I amend your record.
• Requesting restrictions on what information from your Clinical Record is disclosed to others.
• Requesting an accounting of most disclosures of protected health information that you have neither consented to nor authorized.
• Determining the location to which protected information disclosures are sent.
• Having any complaints you make about my policies and procedures recorded in your records.
• The right to a paper copy of your signed Agreement, the attached Notice form, and my privacy policies and procedures.
• If any unauthorized breach of Client information is discovered, you will be notified immediately.
• Filing a complaint, either directly with me or you may file a complaint in writing to the Washington Department of Health or to the US Secretary of Health and Human Services. I will not retaliate against you in any way for filing a complaint.

Communication

Based on the new HIPAA Guidelines I am including the following information about the use of cell phones and emails for communication. Please know that I take every precaution to be careful with my cell phone and computer. However, it is important that you know the potential risks involved with confidentiality when using these devices.

Mobile Phone Communication. Please note that if we communicate via my mobile phone by voice or text, your phone number will be stored in the phone’s memory for a period of time and therefore if my mobile phone is lost or stolen, it is theoretically possible that your contact information might be accessed. Note that my mobile phone and laptop are password protected, and kept either with me or locked away, providing two lines of defense against such a breach.

Email Communication. If you elect to communicate with me by email, please be aware that email is not completely confidential. All emails are retained in the logs of your and/or my internet service provider. While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. Any email I receive from you, and any responses that I send to you, will be considered part of your treatment record.

Voicemail and Telephone Communication. Please be aware that I regularly access email communications via my password-protected mobile phone and laptop. It is theoretically possible that if my mobile phone or laptop is lost or stolen and the password is somehow circumvented our email communications could be accessed.