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Jacqueline Bock, PhD
Neuropsychologist ~ Licensed Clinical Psychologist
Northern Psychology Resources ~ P.O. Box 1487 ~ Kenai, Alaska ~ 99611~
Phone: (907) 335-4466
*This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully. *
Notice of Policies and Practices to Protect the Privacy of Your Health Information
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted by Congress to help protect health information for workers and their families. It has also addressed electronic transaction standards and the need to ensure security and privacy of health information. Northern Psychology Resources, LLC is required by law to maintain the privacy of protected health information, and must inform you of our legal responsibility. The security and privacy of your protected health information is subject to this policy.
Use and Disclosure of Protected Health Information for Treatment, Payment, and Continuing Care
This office may use or disclose your protected health information for the purposes of treatment, payment, and continuing/coordinated care with other service providers. This notice applies to and will be followed by all employees and personnel of this office. Except where such use is otherwise prohibited by state or federal law, we are permitted or required to use or disclose your medical information without your authorization in the following circumstances:
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 Treatment~Providing information to others who are involved in your care
 Payment~To collect payment from you, an insurance company, or a third party for treatment and services you receive
Appointment Reminders~To provide you with appointment reminders, or to offer you an alternative appointment time or date
Referral Services~Providing information to other service providers with the intent of continuing or initiating services with them
*Please be advised that this is not an all inclusive list, and some situations will require special handling.*
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Uses and Disclosures Requiring Authorization
Northern Psychology Resources, LLC may use your protected health information for purposes outside of treatment, payment, or continuing/coordinated care only with your specific written authorization. No information will be released without a written authorization, except in cases as listed below.
You have the right to revoke any written authorization at any time. You may not, however, revoke an authorization that has already been executed. (ie: if your record has already been released based on a correctly obtained authorization and a copy has left our office.)
Uses and Disclosures with Neither Consent nor Authorization
Northern Psychology Resources, LLC may use or disclose your protected health information without your consent or authorization in the following situations:
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Child Abuse: If, through the course of services at Northern Psychology Resources, LLC, it is reasonably suspected that a child has suffered from child abuse or neglect it must be reported to the appropriate agencies immediately.
Domestic Violence and Adult Abuse: If, through the course of services at Northern Psychology Resources, LLC, it is reasonably suspected that a vulnerable adult suffers from abuse, neglect, abandonment, exploitation or self-harm, it must be reported to the appropriate agencies on that individual’s behalf.
By Contract: In many instances, clients of Northern Psychology Resources, LLC are here at the request of a third party, such as Disability Determination, Division of Vocational Rehabilitation, or the State of Alaska Court system. These parties have exclusive rights to the information held within a client’s notes or evaluation and will be the only entities to receive a copy of any results or notes from this office. If there should be anyone who has a legitimate request for records in such cases, the request will need to go to the appropriate entity.
Serious Threat: If the client communicates or discloses a threat of serious physical harm to the client or identified others it may become necessary to disclose that information to the appropriate agency to protect the client.
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Patient’s Rights and Responsibilities
It is the right of the patient to:
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Request restrictions for the use and disclosure of protected health information. However, Northern Psychology Resources, LLC is not required to agree to those restrictions.
Receive confidential communications by alternate means or location (ie: leaving messages on an alternate number that only you have access to, or mailing information to a different address than that listed on your registration).
Inspect and copy your records in the possession of Northern Psychology Resources, LLC with limited exceptions. These exceptions will be explained to you based on the services provided in this office.
Amend your records. You have the right to request an amendment to your record. This request will only be honored if it is pertaining to factual information (such as family history or personal demographic information). No record will be altered to obscure or omit past or present events or change the Doctor’s findings, observations, or diagnosis.
Obtain a copy of this policy at any time
It is the responsibility of the practitioner to:
Maintain the privacy of all protected health information and provide the client with a notice of the responsibility of Northern Psychology Resources, LLC in such regard
Notify the client of any changes in the privacy policy and provide a new copy of the revised policy.
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Questions and Complaints
If you have questions about this notice or disagree with a decision made regarding your protected health information you have the right to discuss them with your practitioner. If you are unhappy with the outcome, or your complaint cannot be resolved within the office, you may send a written complaint to the Secretary of the U.S. Department of Health and Human Services
Effective Date
This notice is effective in the office of Northern Psychology Resources, LLC beginning July 1, 2009.
Jacqueline Bock, PhD
Neuropsychologist ~ Licensed Clinical Psychologist
Northern Psychology Resources ~ P.O. Box 1487 ~ Kenai, Alaska ~ 99611~
Phone: (907) 335-4466
*This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully. *
Notice of Policies and Practices to Protect the Privacy of Your Health Information
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted by Congress to help protect health information for workers and their families. It has also addressed electronic transaction standards and the need to ensure security and privacy of health information. Northern Psychology Resources, LLC is required by law to maintain the privacy of protected health information, and must inform you of our legal responsibility. The security and privacy of your protected health information is subject to this policy.
Use and Disclosure of Protected Health Information for Treatment, Payment, and Continuing Care
This office may use or disclose your protected health information for the purposes of treatment, payment, and continuing/coordinated care with other service providers. This notice applies to and will be followed by all employees and personnel of this office. Except where such use is otherwise prohibited by state or federal law, we are permitted or required to use or disclose your medical information without your authorization in the following circumstances:
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Treatment~Providing information to others who are involved in your care
Payment~To collect payment from you, an insurance company, or a third party for treatment and services you receive
Appointment Reminders~To provide you with appointment reminders, or to offer you an alternative appointment time or date
Referral Services~Providing information to other service providers with the intent of continuing or initiating services with them
*Please be advised that this is not an all inclusive list, and some situations will require special handling.*
|
Uses and Disclosures Requiring Authorization
Northern Psychology Resources, LLC may use your protected health information for purposes outside of treatment, payment, or continuing/coordinated care only with your specific written authorization. No information will be released without a written authorization, except in cases as listed below.
You have the right to revoke any written authorization at any time. You may not, however, revoke an authorization that has already been executed. (ie: if your record has already been released based on a correctly obtained authorization and a copy has left our office.)
Uses and Disclosures with Neither Consent nor Authorization
Northern Psychology Resources, LLC may use or disclose your protected health information without your consent or authorization in the following situations:
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Child Abuse: If, through the course of services at Northern Psychology Resources, LLC, it is reasonably suspected that a child has suffered from child abuse or neglect it must be reported to the appropriate agencies immediately.
Domestic Violence and Adult Abuse: If, through the course of services at Northern Psychology Resources, LLC, it is reasonably suspected that a vulnerable adult suffers from abuse, neglect, abandonment, exploitation or self-harm, it must be reported to the appropriate agencies on that individual’s behalf.
By Contract: In many instances, clients of Northern Psychology Resources, LLC are here at the request of a third party, such as Disability Determination, Division of Vocational Rehabilitation, or the State of Alaska Court system. These parties have exclusive rights to the information held within a client’s notes or evaluation and will be the only entities to receive a copy of any results or notes from this office. If there should be anyone who has a legitimate request for records in such cases, the request will need to go to the appropriate entity.
Serious Threat: If the client communicates or discloses a threat of serious physical harm to the client or identified others it may become necessary to disclose that information to the appropriate agency to protect the client.
|
Patient’s Rights and Responsibilities
It is the right of the patient to:
|
Request restrictions for the use and disclosure of protected health information. However, Northern Psychology Resources, LLC is not required to agree to those restrictions.
Receive confidential communications by alternate means or location (ie: leaving messages on an alternate number that only you have access to, or mailing information to a different address than that listed on your registration).
Inspect and copy your records in the possession of Northern Psychology Resources, LLC with limited exceptions. These exceptions will be explained to you based on the services provided in this office.
Amend your records. You have the right to request an amendment to your record. This request will only be honored if it is pertaining to factual information (such as family history or personal demographic information). No record will be altered to obscure or omit past or present events or change the Doctor’s findings, observations, or diagnosis.
Obtain a copy of this policy at any time
It is the responsibility of the practitioner to:
Maintain the privacy of all protected health information and provide the client with a notice of the responsibility of Northern Psychology Resources, LLC in such regard
Notify the client of any changes in the privacy policy and provide a new copy of the revised policy.
|
Questions and Complaints
If you have questions about this notice or disagree with a decision made regarding your protected health information you have the right to discuss them with your practitioner. If you are unhappy with the outcome, or your complaint cannot be resolved within the office, you may send a written complaint to the Secretary of the U.S. Department of Health and Human Services
Effective Date
This notice is effective in the office of Northern Psychology Resources, LLC beginning July 1, 2009.
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