Notice of Privacy Practices...
This Notice describes how medical information about you
may be used and disclosed and how you can get access to this
information. Please review it carefully.
Protected Health Information (PHI) about you is obtained
as a record of your contacts or visits for healthcare services
with Sara L. Boswell, Ph.D. at Boswell Neuropsychology. Specifically,
PHI is information about you, including demographic information
(e.g. name, address, phone, etc) that may identify you and
relates to your past, present or future physical or mental
health condition and related health care services.
We are required to follow specific rules on maintaining
the confidentiality of your protected health information,
how our staff uses your information, and how we disclose
or share this information with other healthcare professionals
involved in your care. This notice describes your rights
to access and control your protected health information.
It also describes how we follow those rules and use and disclose
your protected health information to provide your treatment,
obtain payment for services you receive, manage our health
care operations, and for other purposes that are permitted
or required by law.
I. Your Rights under the Privacy Rule
- You have the right to receive and we are required
to provide you with a copy of this Notice of Privacy
Practices. We are required to follow the terms of this
notice. We reserve
the right to change the terms of our notice at any time.
If needed, new versions of this notice will be effective
for all protected health information that we maintain
at that time. Upon your request, we will provide you with
revised Notice of Privacy Practices if you call our office
and request that a revised copy be sent to you in the
mail or ask for one at the time of your next appointment.
- You have the right to authorize other use and disclosure.
This means you have the right to authorize or deny any other
use or disclosure of protected health information not specified
in this notice. You may revoke an authorization, any time,
in writing, except to the extent that your neuropsychologist
or our office has taken an action in reliance on the use
or disclosure indicated in the authorization.
- You have the right to designate a personal representative.
This means you may designate a person with the delegated
authority to consent and authorize the use or disclosure
of protected health information.
- You have the right to inspect and copy your protected
health information. This means you may inspect and obtain
a copy of protected health information about you that is
contained in your patient record.
- You have the right to request a restriction of your
protected health information. This means you may ask us,
in writing, not to use or disclose any part of your protected
health information for the purposes of treatment, payment
or healthcare operations. You may also request that any part
of your protected health information not be disclosed to
family members or friends who may be involved in your care.
In certain cases, we may deny your request for a restriction.
- You may have the right to have us amend your protected
health information. This means you may request an amendment
of your PHI for as long as we maintain this information.
In certain cases, we may deny your request for an amendment.
- You have the right to request disclosure accountability.
This means that you may request a listing of disclosures
we have made of your PHI to entities or persons outside of
II. Uses and Disclosures Requiring Authorization
- We may use or disclose PHI for purposes outside of treatment,
payment and healthcare operations when your authorization
is obtained. In those instances when we are asked for
information for purposes outside of treatment and payment
we will obtain an authorization from you before releasing
- You may revoke or modify all such authorization of PHI
at any time; however, the revocation or modification is
effective until we receive it.
III. Uses and Disclosures Without Consent or Authorization
We may use or disclose PHI without your consent or authorization
in the following circumstances;
Child Abuse: Whenever we, in our professional capacity,
have knowledge of or observe a child we know or reasonably
suspect, has been the victim of child abuse or neglect, we
must immediately report this to a police department or sheriff’s
department, county probation department, or county welfare
department. Also, if we have knowledge of or reasonably suspect
that mental suffering has been inflicted upon a child or
that his or her emotional well being is endangered in any
other way, we may report it to the above agencies.
Adult and Domestic Abuse: If we, in our professional capacity,
have observed or have knowledge of an incident that reasonably
appears to be physical abuse, abandonment, abduction, isolation,
financial abuse or neglect of an elder or dependent adult,
or if we are told by an elder or dependent adult that she
or he has experienced these, or if we reasonably suspect
such, we must report the known or suspected abuse immediately
to the local ombudsman or the local law enforcement agency.
We do not have to report such an incident if:
- We have been told by an elder or dependent adult that
he or she has experienced behavior constituting physical
abuse, abandonment, abduction, isolation, financial abuse
- We are not aware of any independent evidence that
corroborates the statement that the abuse has occurred.
- The elder or dependent adult has been diagnosed with
a mental illness or dementia, or is the subject of
conservatorship because of a mental illness or dementia;
- In the exercise of clinical judgment, we reasonably
believe that the abuse did not occur.
Health Oversight: If a complaint is filed against Boswell
Neuropsychology or Dr. Sara L. Boswell with the Board of
Psychology, the Board has the authority to subpoena confidential
mental health information from us relevant to the complaint.
Judicial or Administrative Proceedings: If you are involved
in a court proceeding and a request is made about the professional
services that we have provided you, we must not release your
information without (1) your written authorization or the
authorization of your attorney or personal representative;
(2) a court order; or (3) a subpoena to produce records where
the party seeking your records provides us with a showing
that you or your attorney have been served with a copy of
the subpoena, affidavit and the appropriate notice, and you
have not notified us that you are bringing a motion in the
court to quash (block) or modify the subpoena. The privilege
does not apply when you are being evaluated for a third party
or where the evaluation is court ordered. We will inform
you in advance if this is the case.
Serious Threat to Health or Safety: If you communicate to
us a serious threat of physical violence against an identifiable
victim, we must make reasonable efforts to communicate that
information to the potential victim and to the police. If
we have reasonable cause to believe that you are in such
a condition as to be dangerous to yourself or others, we
may release relevant information as necessary to prevent
the threatened danger.
Workers’ Compensation: If you file a workers’ compensation
claim, we must furnish a report to your employer, incorporating
our findings about your injury and treatment, within five
working days from the date of your initial examination, and
at subsequent intervals as may be required by the administrative
director of the Workers’ Compensation Commission in
order to determine your eligibility for workers’ compensation.
IV. Questions and Complaints
If you have questions about this notice, disagree with a
decision we make about access to your records, or have other
concerns about privacy rights, you may contact us at:
Sara L. Boswell, Ph.D. PSY 19003
8910 University Center Lane, Suite 550
San Diego, California 92122
If you believe that your privacy rights have been violated
and wish to file a complaint, send your written complaint
Secretary of the Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
You have specific rights under the Privacy Rule. We will
not retaliate against you for exercising your right to file
This notice will go into effect on April 13, 2003
We reserve the right to change the terms of this notice
and to make the new notice provisions effective for all PHI
that we maintain. If requested, we will provide you with
a revised notice.