NOTICE OF POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION

This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

RCC may use or disclose your protected health information (PHI), for treatment, payment, and health care operations including purposes with your written authorization. To help clarify these terms, here are some definitions: • PHI refers to information in your health record that could identify you. • Treatment, Payment, and Health Care Operations o Treatment is when a RCC therapist provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when your therapist consults with another health care provider, such as your family physician or another mental health provider. o Payment is when RCC obtains reimbursement for your healthcare. Examples of payment are when RCC or biller discloses your PHI to your health insurer to obtain reimbursement for your health care to determine eligibility or coverage. o Health Care Operations are activities that relate to the performance and operations of RCC’s practice. Examples of health care 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 RCC’s office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. • Disclosure applies to activities outside of RCC’s office, such as releasing, transferring, or providing access to information about you to other parties. • Authorization is your written permission to disclose confidential mental health information. All authorizations to disclose must be on a specific legally required form.

II. Other Uses and Disclosures Requiring Authorization

RCC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when RCC or your therapist is asked for information for purposes outside of treatment, payment, or health care operations, your therapist or RCC will obtain an authorization from you before releasing this information. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) RCC has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures without Authorization

RCC or your therapist may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse – If your therapist has reasonable cause to believe a child known to your therapist in a professional capacity may be an abused or neglected child, your therapist must report this belief to the appropriate authorities.

Adult and Domestic Abuse – If your therapist has reason to believe that an individual (who is protected by state law) has been abused, neglected, or financially exploited, your therapist must report this belief to the appropriate authorities.

Health Oversight Activities – your therapist or RCC may disclose protected health information regarding you to a health oversight agency for oversight activities authorized by law, including licensure or disciplinary actions.

Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information by any party about your evaluation, diagnosis, and treatment and the records thereof, such information is privileged under state law, and RCC must not release such information without a court order. The privilege does not apply when you are being evaluated for a third party where the evaluation is court-ordered. You must be informed in advance if this is the case.

Serious Threat to Health or Safety – If you communicate to your therapist a specific threat of imminent harm against another individual or if your therapist believes that there is a clear, imminent risk of physical or mental injury being inflicted against another individual, your therapist may make disclosures that they believe is necessary to protect that individual from harm.

Worker’s Compensation –your therapist may disclose protected health information regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law, that provide benefits for work-related injuries or illness without regard to fault.