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.
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:
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.
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
If you believe that your privacy rights have been violated and wish to file a complaint, send your written complaint to:Secretary of the Department of Health and Human Services
You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint.
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.