Amanda Thurman-Hatch, LMFT 102970
161 W. Hanford Armona Rd. Suite J, #191
Lemoore, CA 93245
Effective Date: 08/03/2022, Revised 01/27/2023
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Amanda Thurman-Hatch, LMFT (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice’s legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
In order to provide you with quality care and to comply with certain legal requirements, your Provider creates a record of the services you receive with the Practice.
The Practice is required by law to:
- Make sure that information that identifies you is kept private;
- Give you this notice of the Practice’s legal duties and privacy practices with respect to health information about you; and
- Follow the terms of this notice that is currently in effect.
The following categories describe different ways that the Practice uses and discloses your health information. It also contains examples to help explain the purpose of the disclosure, but not every use or disclosure within that category will be listed. However, all of the ways that the Practice uses and discloses your information will fall within one of those categories.
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted above.
To inspect and copy PHI.
- You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.
- The Practice may deny your request if it believes the disclosure will endanger your life or another person’s life. You may have a right to have this decision reviewed.
- The Practice may also deny your request if it believes the disclosure will identify another person.
To amend PHI.
- You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
- The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
- You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.
To limit what is used or shared.
- You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
- You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
To obtain a list of those with whom your PHI has been shared.
- You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
- You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To choose someone to act for you.
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
To file a complaint if you feel your rights are violated.
- You can file a complaint by contacting the Practice using the following information:
161 W HANFORD ARMONA RD. SUITE J, # 191
LEMOORE, CA 93245
You can file a complaint with the Secretary of the Department of Health and Human Services.
SECRETARY U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICE
OFFICE FOR CIVIL RIGHTS/ATTENTION: REGIONAL MANAGER
90 7TH ST. STE. 4-100
SAN FRANCISCO, CA 94103
1-800-368-1019, VOICE PHONE 1-415-437-8310, FAX 1-415-437-8329, TDD 1-415-437-8311
- The Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you.
- The Practice can use and share PHI with other professionals who are treating you. We may use information about you with treatment or services. Information about you may be shared with other providers involved in your treatment for the purpose of coordination of care with your other providers. This may include doctors, nurses, other therapists, case managers, and other clinical staff involved in your care.
- Example: Your primary care doctor asks about your mental health treatment.
To run the health care operations.
- The Practice can use and share PHI to run the business, improve your care, and contact you. This may also include disclosing information to those designated to review the Practice’s procedures and practices to ensure the Practice is in compliance with regulations and that the services the Practice provides meet acceptable standards of care.
- Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
- The Practice can use and share PHI to bill and get payment from health plans or other entities. Your Provider uses Headway and Grow Therapy for in-network insurance billing and self-pay.
- Example: The Practice gives PHI to your health insurance plan so it will pay for your services.
Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:
- The disclosure is made to a health care personnel in a medical or psychiatric emergency, including the evaluation and hospitalization if it is believed you are a danger to yourself, a danger to others, or unable to provide for your basic needs.
- The disclosure is required by the Secretary of Health and Human Services. Your Provider may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
- The disclosure is required for health oversight, for audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
- The disclosure is to report a crime committed by a client against the Provider or about any threat to commit such a crime to local authorities.
- The disclosure is to report suspected intention to physically harm another person to local authorities and the identified person targeted for harm.
- The disclosure is to report elder or dependent adult abuse or neglect to local authorities.
- The disclosure is to report child abuse or neglect to local authorities.
- The Practice may disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- The disclosure is part of a breach notification.
To comply with the law, law enforcement, or other government requests:
- Required by law: If required by federal, state, or local law.
- Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
- Law enforcement: To locate and identify you or disclose information about a victim of a crime.
- Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
- National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons, or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
- Workers’ Compensation: To comply with workers’ compensation laws or support claims.
To comply with oversight activities:
- The Practice may disclose health information about you to a health oversight agency for activities authorized by law.
- This may include audits, investigations, inspections, and licensure. These activities are necessary for Federal, State, and local government agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.
To comply with other requests:
- Coroners and Funeral Directors: To perform their legally authorized duties.
- Organ Donation: For organ donation or transplantation.
- Research: For research that has been approved by an institutional review board.
- Inmates: The Practice created or received your PHI in the course of providing care.
- Business Associates: To organizations that perform functions, activities or services on our behalf.
Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Practice may disclose PHI:
- To your family, friends, or others if PHI directly relates to that person’s involvement in your care.
- If it is in your best interest because you are unable to state your preference.
Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:
- Marketing, sale of PHI, and psychotherapy notes.
- You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in the Notice unless you give your permission in writing.
- The Practice is required by law to maintain the privacy and security of PHI.
- The Practice will retain your medical record for approximately seven years after your last clinical contact with your Provider. After that time has elapsed, the record will be destroyed or otherwise maintained in a way that protects your privacy.
- The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
- The Practice reserves the right to amend the Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website www.amandathurmanhatch.com.
- The Practice will inform you if PHI is compromised in a breach.
CHANGES TO THIS NOTICE
The Practice reserves the right to change this notice. The Practice reserves the right to make the revised or changed notice effective for the health information we already have about you, as well as any information we receive in the future. A copy of the changed notice will be posted on the Practice’s website, with the effective date at the bottom of the notice.