Notice of Privacy Practices

This Notice contains important information regarding the (i) use and disclosure of your Protected Health Information (“PHI”) and how you can get access to your PHI, (ii) Health Insurance Portability and Accountability Act (“HIPAA”), and (iii) your rights with respect to your PHI. Please review this Notice carefully.

HIPAA requires that Megan Barone, PsyD LLC d/b/a Virginia Therapy & Wellness (“Company”) maintain the privacy of your PHI, provide you with this Notice of Privacy Practices (this “Notice”) and obtain your signature hereto acknowledging that this Notice has been provided to you.

You acknowledge that Company may change the terms of this Notice at any time, and such changes may apply to your personal information, PHI, and the records we maintain related to your care. Any changes to this Notice will be available upon request, posted in our offices, and published on our website.

Use and Disclosure of Your Health Information

The following categories describe different ways that Company uses and discloses health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the below categories.

1. For Treatment, Healthcare Operations or Payment. Federal privacy rules and regulations allow health care providers who have a direct treatment relationship with a patient to use or disclose the patient’s personal health information, including, but not limited to, PHI, without the client’s written authorization, to carry out the health care provider’s own treatment or health care operations (e.g., for a quality assurance review of Company’s records). Disclosures for treatment purposes are not limited to the minimum necessary standard because clinicians and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and patient referrals from one health care provider to another. Additionally, Company may use and/or disclose your health information in connection with obtaining payment for services provided to you.
2. Certain Uses and Disclosures Requiring Your Authorization.
   1. Psychotherapy Notes. Our clinicians keep “psychotherapy notes” as that term is defined under 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization, unless the use or disclosure is (i) related to your treatment; (ii) related to training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy; (iii) in connection with the clinician’s or Company’s defense of legal claims brought by you; (iv) for use by the Secretary of Health and Human Services to investigate Company’s compliance with HIPAA and other federal and state confidentiality laws; (v) required by law and the use or disclosure is limited to the requirements of such law; (vi) required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes; (vii) required by a coroner who is performing duties authorized by law; and/or (viii) required to help avert a serious threat to the health and safety of others.
   2. Marketing Purposes; Sale of PHI. Neither Company nor its clinicians will sell your PHI in the regular course of business nor use or disclose your PHI for marketing purposes.
3. Certain Uses and Disclosures Not Requiring Your Authorization. Applicable law protects the privacy of most communication between a patient and a therapist. In most situations, Company’s clinicians can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. However, subject to certain limitations under applicable law, Company and its clinicians can use and/or disclose your PHI, without your authorization, for any of the following reasons:
   1. Legal Obligation to Act. (i) Your clinician knows, or has reason to suspect, that a child under 18 has been abused, abandoned, or neglected by a parent, legal custodian, caregiver, or any other person responsible for the child’s welfare, the law requires that I file a report with the Virginia Abuse Hotline. (ii) Your clinician knows, or has reasonable cause to suspect, that an elderly person has been abused, neglected, or exploited. (iii) Your clinician believes there is a clear and immediate probability of physical harm to you, another individual, or to the public at-large.
   2. Required by Law. When disclosure is required by applicable state or federal law and such disclosure complies with and is limited to the relevant requirements of such law.
   3. Public Health Activities. Including, but not limited to, reporting suspected child, elder, or dependent adult abuse, preventing or reducing a serious threat to anyone’s health or safety, or health oversight audits/investigations.
   4. Legal Proceedings. Pursuant to a legitimate subpoena or other order issued by a court of law.
   5. Worker’s Compensation. If treatment is related to a worker's compensation claim, information related to the treatment must be submitted to interested parties upon appropriate request.
   6. Law Enforcement. For purposes of (i) reporting crimes occurring on Company premises or (ii) identifying or locating a suspect, fugitive, material witness, or missing person.
   7. Research. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
   8. Specialized Government Functions. Including, but not limited to, ensuring the proper execution of military missions; protecting the President of the United States; a health oversight agency conducting oversight audits; conducting intelligence or counter-intelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
   9. Appointment Reminders. We may use and disclose your PHI to contact you to remind you that you have an appointment with one of our clinicians. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.
4. Uses and Disclosures To Which You Have the Right to Object. We may provide your PHI to an approved family member, friend, or other person that you indicate is involved either in your health care or in the payment for your health care, unless you object in whole or in part. Any objection to such disclosure must be provided to Company in writing. The opportunity to consent may be obtained retroactively in emergency situations.

Patient Rights

You have the following rights with respect to your PHI:

1. Request Limits on Uses and Disclosures of Your PHI. You have the right to ask Company not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Company is not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. 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 the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. Choose How I Send PHI to You. You have the right to ask Company to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests made in writing.
4. 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 records and other information that Company has about you and inspect the same. Company will provide you with a copy of your records, or a summary of such records (if you agree to receive a summary), within two (2) weeks of receiving your written request. You acknowledge that Company may charge a reasonable fee for copying and transmitting such records.
5. Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which Company has disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided Company with an authorization. Company will respond to your request for an accounting of disclosures within 60 days of receiving your written request. The list we provide will include disclosures made in the last six (6) years unless you request a shorter time. This list will be provided to you at no charge, but if you make more than one (1) request in the same year, Company reserves the right to charge you a reasonable, cost-based fee for each additional request after the first (1st) request made in a calendar year.
6. 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 Company correct the existing information or add the missing information. Company may say “no” to your request, but we will provide our basis for denying your request in writing within 60 days of receiving your written request.
7. Get a Paper or Electronic Copy of this Notice. You have the right to receive this Notice in paper copy and by e-mail. Additionally, even if you agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it without charge.
8. Receive Notice In the Event of a Breach. In the event of breach of your PHI, Company will provide you notification of such a breach as required by law.

Complaints

If you are concerned that any clinician at Company has violated your privacy rights, or you disagree with a decision that has been made about access to your records, you may contact:

Megan Barone, PsyD LLC d/b/a Virginia Therapy & Wellness
3923 Blenheim Blvd, Suite 62-C
Fairfax, VA 22030

You may also send a written complaint to the State of Virginia Department of Health or the Secretary of the U.S. Department of Health and Human Services. A representative of Company can provide you with the appropriate address upon request.

Acknowledgement of Receipt of Privacy Notice

You have certain rights under HIPAA regarding the use and disclosure of your PHI. By clicking on the checkbox at the end of this Notice and clicking “Submit,” you acknowledge that you have received a copy of this Notice and that you have read and understand the terms set forth in this Notice.