​

NOTICE OF PRIVACY PRACTICES

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

 

Krista Jorgenson LLC may use or disclose your  protected health information (PHI) for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An authorization is obtained via a written Release of Information that permits only specific disclosures at the request or consent of the client. When the therapist is asked for information for purposes outside of treatment, payment, or health care operations, the therapist will obtain an authorization from the client before releasing this information. The therapist will need to obtain an authorization before releasing any psychotherapy notes they may have taken during sessions. Psychotherapy notes are notes the therapist has made about conversations and content covered during an individual, couples, family or group psychotherapy session, which are kept separate from the rest of the client’s medical record. These notes are given a greater degree of protection than PHI.

 

The client may revoke, in writing, all such authorizations of your PHI at any time. The client may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

 

USES AND DISCLOSURES REQUIRING NEITHER YOUR CONSENT NOR YOUR AUTHORIZATION

 

In general, the law protects the privacy of communication between a client and a therapist. Krista Jorgenson LLC only can release information about the client’s treatment to others if the client signs a Release of Information form. The client can revoke, in writing, any such authorization at any time. In the following situations however, your authorization is not required for Krista Jorgenson LLC to release information:

 

• When the client provides written authorization to do so.

• Therapist’s duty to warn another in the case of potential suicide, homicide or threat of imminent, serious harm to another individual.

• Therapist’s duty to report suspicion of abuse, neglect, or exploitation of children or vulnerable adults.

• Therapist’s duty to report prenatal exposure to cocaine, heroin, phencyclidine, methamphetamine, amphetamine or their derivatives, THC, and excessive and habitual use of alcohol.

• Therapist’s duty to report the misconduct of mental health or health care professionals.

• Therapist’s duty to provide a spouse or parent of a deceased client access to their child or spouse’s records.

• Therapist’s duty to release records if subpoenaed by the courts.

• Therapist’s obligations to contracts (e.g. to employer of client, worker’s compensation).

• Therapist’s duty to provide parents of minor children access to their child’s records. Minor clients can request, in writing, that particular information be disclosed to parents. Such a request should be discussed with the therapist

• Therapist may be compelled to disclose clinical records when related to military, national security or lawful intelligence activities. 

Please discuss any questions or concerns you have about confidentiality with the therapist at any time. If a client has specific legal questions about the law regarding confidentiality, the exceptions and how it may relate to your situation, please seek formal legal advice from an attorney.

 

CLIENTS RIGHTS AND RESPONSIBILITIES 

 

The client has rights concerning their health information. This section explains the client’s rights and the responsibility to Krista Jorgenson LLC to help the client.

 

Right to inspect and copy of your mental health and billing records.

• You can request, in writing, to inspect and/or obtain a copy of the records and medical information used to make decisions about your care for as long as long as your records are maintained.

• The therapist may deny your access to records under certain circumstances, where release of records would be deemed harmful to yourself or others, and you may also have this decision further reviewed.

• The therapist will provide a copy or a summary of your therapy within a reasonable time.

Right to amend a therapy record.

• The client can request, in writing, for the therapist to correct health information that you believe is inaccurate or incomplete for as long as your record exists. 

• The therapist may deny the client’s request if the client not provide reasons to support the request. Additionally, the client’s request may be denied if the amendment is for information that is not part of the client’s record, is for information that is accurate and complete, and is not part of the information the client would be permitted to inspect or copy.

• The client may request that the therapist discuss with them the details of the amendment process.

Right to request and receive confidential communications by alternative means and alternative locations.

• The client has the right to request confidential communication by alternative means and alternative locations. For instance, the client may request to be contacted only via cell phone or mail. The therapist will make every effort to accommodate these requests.

Right to request restrictions.

• The client can request restriction on certain uses and disclosures of your protected health information. The client may pay for a service or health care item out-of-pocket in full, and the client can request the therapist not share this information for the purpose of payment with a health insurer. The therapist will agree to this request unless a law requires the therapist to share that information.

• The therapist is not required to agree to the client’s request and may deny the request if it would affect the client’s care.

Right to an accounting of disclosures.

• The client generally has the right to receive an accounting or list of those with whom the therapist has shared information without the client’s consent or authorization.

• The client may also request why the therapist shared information with them (i.e. billing, mandated reporting, etc.)

Right to request a paper copy of this notice.

• The client can request a paper copy of this privacy notice at any time, even if they have agreed to receive the notice electronically. 

Right to file a complaint.

• The client has a right to file a complaint if they believe their rights have been violated. The client may file this complaint with the therapist or with the Secretary of the Department of Health and Human Services.

Requests must be made, in writing, and must contain (1) the information you want to limit; (2) whether and how you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.

 

PSYCHOTHERAPIST RESPONSIBILITIES  

​

• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI. 

• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect. 

• If I revise my policies and procedures, I will mail the revised Notice to you, as well as making it available in my office. 

QUESTIONS AND COMPLAINTS

 If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, please express concerns to Krista Jorgenson. Krista Jorgenson LLC will not retaliate against you for exercising your right to file a complaint. 

 

EFFECTIVE DATE, RESTRICTIONS AND CHANGES TO PRIVACY POLICY

 

This notice will go into effect on April 1, 2019. Krista Jorgenson LLC reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI maintain. Clients will provided with a revised notice by either distributing it to you in the office, emailing it to you (if you have authorized email correspondence), or mailing it to your home address.