Privacy Policy
Notice of Katharine Jamison, LCPC’s Policies and Practices to Protect the Privacy of Your Health Information
This notice describes how psychological and mental health, or professional information about you may be used and disclosed and how you can obtain access to this information should you need it. The document (the Agreement) contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operation. HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment, and health care operations. The Notice, which you are given with this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that we obtain your signature acknowledging that we have provided you with this information. Although these documents are long and sometimes complex, it is very important that you read them carefully before your treatment here. We can discuss any questions you have about the procedures during session. You may revoke this Agreement in writing at any time. That revocation will be binding on us unless we have taken action in reliance on it; if there are obligations imposed on us by your health insurer in order to substantiate claims made under your policy; or if you have not satisfied any financial obligations you have incurred. PLEASE REVIEW IT CAREFULLY.
USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
Katharine Jamison, LCPC may use or disclose your Protected Health Information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
“PHI” refers to information in your health record that could identify you.
“Treatment” is when Katharine Jamison, LCPC provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when Katharine Jamison, LCPC consults with another health care provider, such as your family physician, your psychiatrist, or another psychologist with whom you have been in treatment.
“Payment” is when Katharine Jamison, LCPC obtains reimbursement for your healthcare. Examples of payment are when Katharine Jamison, LCPC discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
“Healthcare Operations” are activities that relate to the performance and operation of therapy practice. Examples of healthcare operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
“Use” applies only to activities within my office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
“Disclosure” applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties.
USES AND DISCLOSURES REQUIRING AUTHORIZATION
Katharine Jamison, LCPC may use or disclose PHI for purposes outside of treatment, payment, and health care operations only when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when Katharine Jamison, LCPC is asked for information for purposes outside of treatment, payment, and health care operations, Katharine Jamison, LCPC will always obtain an authorization from you before releasing this information. Katharine Jamison, LCPC will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes Katharine Jamison, LCPC has made about our conversation during a private counseling or consulting session, which Katharine Jamison, LCPC has kept safe according to HIPAA guidelines. You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, by providing each request in writing.
Nature of Counseling Services
Counseling sessions are collaborative and aim to address personal, relational, or behavioral concerns. The success of counseling depends on my willingness to be open and engaged in the process, as well as my commitment to implementing suggested strategies between sessions.
Risks and Benefits
I understand that while counseling may improve my emotional health and interpersonal relationships, it may also bring up uncomfortable feelings or memories. However, these experiences are often part of the therapeutic process and typically lead to personal growth and resilience.
USES AND DISCLOSURES WITH NEITHER CONSENT NOR AUTHORIZATION
Katharine Jamison, LCPC may use or disclose PHI without your consent or authorization only in the following circumstances:
Child Abuse: If Katharine Jamison, LCPC has cause to believe that a child has been, or may be, abused, neglected, or sexually abused, Katharine Jamison, LCPC must make a report of such within 48 hours to the State Department of Protective and Regulatory Services, the State Youth Commission, or to any local or state law enforcement agency.
Adult and Domestic Abuse: If Katharine Jamison, LCPC has cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, Katharine Jamison, LCPC must immediately report such to the Department of Protective and Regulatory Services.
Health Oversight: If a complaint is filed against me with the State Board of Examiners of Psychologists, they have the authority to subpoena confidential mental health information from me relevant to that complaint.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records therefore, such information is privileged under state law, and Katharine Jamison, LCPC will not release information without written authorization from you or your personal or legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
Serious Threat to Health or Safety: If Katharine Jamison, LCPC determines that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to you, Katharine Jamison, LCPC may disclose relevant confidential mental health information to medical or law enforcement personnel.
PATIENT'S RIGHTS AND MY DUTIES
Client Rights under HIPAA
Access to Records: I may request a copy of my records at any time, with some exceptions.
Request for Confidential Communications: I may request alternative communication methods (e.g., phone or email).
Request for Restrictions: I may limit how my information is used or disclosed.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, Katharine Jamison, LCPC is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me. Upon your request, Katharine Jamison, LCPC will send information to another address.)
Right to Inspect and Copy: The laws and standards of my profession require that Katharine Jamison, LCPC keeps your PHI in your Clinical Record, stored according to HIPAA guidelines. Except in unusual circumstances that involve danger to yourself and/or others, you may examine and/or receive a copy of your Clinical Record if you request it in writing. If Katharine Jamison, LCPC refuses your request for access to your records, you have a right of review, which Katharine Jamison, LCPC will discuss with you upon your request.
Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Katharine Jamison, LCPC may deny your request. On your request, Katharine Jamison, LCPC will discuss with you the details of the amendment process.
Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in the previous sections). On your request, Katharine Jamison, LCPC will discuss with you the details of the accounting process.
Right to a Paper Copy: You have the right to obtain a paper copy of this notice from me upon request, even if you have agreed to receive the notice electronically.
Katharine Jamison, LCPC is 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.
Katharine Jamison, LCPC reserves the right to change the privacy policies and practices described in this notice. Unless Katharine Jamison, LCPC notifies you of such changes, however, Katharine Jamison, LCPC is required to abide by the terms currently in effect.
If Katharine Jamison, LCPC revises policies and procedures, Katharine Jamison, LCPC will provide you a revised copy at your next visit or by mail.
APPOINTMENTS
Appointments are usually scheduled on the hour and last 53 minutes (one professional hour). Counseling or Consulting is a time-sensitive activity, and your appointment is reserved specifically for you. If you must cancel an appointment or reschedule, please cancel or email 24 hours in advance of the appointment. The cancellation fee is $75.00 for missed appointments without 24 hours notice.
