Privacy Policy

NOTICE OF PRIVACY PRACTICES OF SAGE PSYCHIATRY & WELLNESS 

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.

The practitioners at Sage Psychiatry & Wellness (collectively referred to as “We”, below) are required by law to maintain the privacy and security of your protected health information (PHI), which is defined as any health information that identifies you or that could be used to identify you. The law also requires that We provide you with this Notice of Privacy Practices. This notice describes the legal duties and privacy practices that We must follow regarding the use and disclosure of PHI. This notice also describes your rights related to your PHI. We are required by law to let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI. We can change the terms of this notice, and the changes will apply to all PHI We have about you. We will notify you of any changes and the new notice will be available on my website and, upon request, in my office. 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU 

We typically use or share your health information in the following ways: 

  • Treatment: We can use your PHI and share it with other professionals who are treating you. 

  • Payment: We can use and disclose your PHI to bill and collect payment from you or other appropriate entities. 

  • Healthcare Operations: We can use and disclose your PHI to run my practice, speak with your other providers, speak with your pharmacy, improve your care, leave you voicemails, email you, and contact you when necessary. These activities include, but are not limited to, calling you by first name in the waiting room when We are ready to see you and contacting you to remind you of an appointment. 

We are allowed or required to share your information without your consent or authorization in the circumstances outlined below. We have to meet many conditions in the law before We can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

  • Suspicions of Abuse, Neglect, or Imminent Harm: We will be required to use or disclose your PHI to the appropriate government agency if there is any suspicion of child or elder abuse and/or neglect, or when deemed necessary to prevent a serious threat to your health or safety, or the health and safety of others. We are required to report any threats to harm a third party to law enforcement and the subject of the threat. 

  • Legal Proceedings: We will use or disclose your PHI when required to do so by local, state, or federal law. Therefore, We may use and disclose your PHI for judicial and administrative proceedings as required by a court or administrative order, or in response to a subpoena, discovery request, or other legal processes. Your PHI may also be disclosed if required for my legal defense in the event of a lawsuit. 

  • Additional Issues of Public Health & Safety: Your PHI may be disclosed, and may be required by law to be disclosed, for public health and safety risks. This includes: to prevent or control disease; report births and deaths; report adverse reactions to medications or problems with health products; and to help with product recalls. 

  • Workers’ Compensation: If you file a workers’ compensation claim, We will be required to file periodic reports with your employer which shall include relevant information about history, diagnosis, treatment, and prognosis. HIPAA Notice of Privacy Practices Minors (Under Age 14): The PHI of clients who are under the age of 14 will be disclosed to their parents or legal guardians, unless prohibited by law. Under Pennsylvania law, clients who are 14 years of age or older control the release of their own mental health records, except as noted elsewhere in this document. 

  • Other Special Circumstances:

    • For law enforcement purposes or with a law enforcement official in limited situations, such as when information is needed to locate a suspect or stop a crime

    • For special government functions such as military, national security, and presidential protective services

    • Working with a medical examiner, coroner, or funeral director when an individual dies.

USES AND DISCLOSURES THAT MAY BE MADE EITHER WITH YOUR AGREEMENT OR OPPORTUNITY TO OBJECT 

For certain health information, you can tell me your choices about what We share. In these cases, you have both the right and choice to tell me to: 

  • Share information with a family member, close friend, or others involved in your care

  • Share information in a disaster relief situation 

  • Include your information in a hospital directory

 If you are unable to agree or object to such a disclosure, for example, if you are unconscious, We may disclose PHI as necessary if We determine that it is in your best interest based on my professional judgment. 

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION 

Any other use or disclosure of PHI, other than those listed elsewhere in this document, will only be made with your written authorization (unless otherwise permitted or required by law). Authorization may be revoked at any time, in writing, except to the extent that We have already used or disclosed PHI in reliance on that authorization. 

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

  • Right to Inspect and Copy: You can ask to receive a copy of your PHI in your clinical record. You must submit your request in writing. We will respond to all requests to inspect and copy PHI within 30 days. You are entitled to receive a copy of these records, unless We believe that seeing them would be emotionally damaging. If this is the case, We will be happy to provide a summary of your records to an appropriate mental health professional of your choice, or to prepare an appropriate summary for you instead. Because client records are professional documents, they can be misinterpreted and can be upsetting. Charges for clinical summaries do apply, and are discussed in the initial consent for treatment. 

  • Right to Request a Correction or Amendment to Your Clinical Record: You can ask me to correct or amend PHI about you that you think is incorrect or incomplete. You must submit your request in writing and must include the reason for the request and any supporting documentation. We have the right to say “no” to your request but, in this event, We will tell you why in writing within 60 days. 

  • Right to Request Confidential Communications: You can ask me to contact you in a specific way (e.g., home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests. HIPAA Notice of Privacy Practices 3. 

  • Right to Request Limits to Use or Sharing: You can ask me not to use or share certain PHI for treatment, payment, or practice operations. We are not required to agree to your request, and We may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask me not to share that information for the purpose of payment or health care operations with your health insurer. We will say “yes” unless a law requires me to share that information. 

  • Right to Obtain an Accounting of Disclosures: You can ask for a list (accounting) of the times We have shared your PHI for 6 years prior to the date you ask, who We shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked me to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 

  • Right to Obtain a Paper Copy of This Privacy Notice: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

  • Right 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 and make choices about your PHI. We will make sure the person has this authority and can act for you before We take any action. 

  • Right to File a Complaint If You Feel Your Rights are Violated: If you have questions about this notice or have other concerns about your privacy rights, you may contact us at 610-510-4881 or communicate your concerns by sending a written complaint to us at 800 Avondale Road, Unit 4p, Wallingford, PA 19086. If you believe your privacy rights have been violated, you can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/ hipaa/complaints/ 

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES: 

You hereby confirm that the Patient has been provided with a copy of the Practice’s current Notice of Privacy Practices before signing this document (the first of the 3 agreements in this group of files, which you initialed above). The Notice of Privacy Practices describes the types of uses and disclosures of the Patient’s protected health information that will occur for the Patient’s treatment, payment of my bills or in the performance of healthcare operations of the Practice and the Practice’s duties regarding the Patient’s protected health information. The Notice of Privacy Practices also describes the Patient’s rights with respect to the Patient’s protected health information and how the Patient may exercise these rights. The Practice reserves the right to change the practices described in the Notice of Privacy Practices. The Patient may obtain a revised Notice of Privacy Practices by calling Practice’s office and requesting a revised copy. By signing below, You acknowledge receipt of the Notice (on behalf of the Patient, as applicable).