Notice of Privacy Practices for Clients of Darrin Scott, LMFT
THIS NOTICE DESCRIBES HOW YOUR MENTAL AND MEDICAL HEALTH INFORMATION MAY BE USED AND DISCLOSED TO YOU AND OTHERS. PLEASE REVIEW IT CAREFULLY.
I HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH lNFORMATION (PHI):

I am legally required to protect the privacy of your PHI, which includes information that can be used to identify you that I've created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care.With some exceptions, I may not use or disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made. And, I am legally required to follow the privacy practices described in this Notice.
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A. Uses and Disclosures Relating to Treatment, Payment, Physical Safety or Health Care Operations Do Not Require Your Prior Written Consent, Though I Will Seek It. The law allows me to disclose your PHI without your consent:
1.) For Treatment. I can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are involved in your care. Though I will endeavor to get your written authorization in advance, I can exchange your PHI with such providers to coordinate your care. I also consult periodically re: some of cases with my one-three interns and other colleagues for advice; I avoid sharing your name or obvious identifying information, though in our fairly small town, it is conceivable that someone night recognize my description of your situation. Yet this is quite rare.
2.) To obtain payment for treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company or health plan to get paid for the health care services that I have provided to you. I may also provide your PHI to my business associates, such as billing companies and claims processing companies (e.g. Beacon, Anthem Blue Cross) that process my health care claims. I may also provide your PHI to our accountants, attorneys, consultants, et al.to make sure I’m complying with applicable laws.
3.) Risk to Physical Safety + Child or Elder Abuse or Neglect: My professional ethics require me to provide aid if you are at real and imminent risk of suicide or at risk of causing bodily harm to another person. I am not required to seek your consent, yet I will try to do so. So I will help you arrange voluntary admission to the TeleCare emergency psychiatric health facility at 2250 Soquel Ave in Santa Cruz. I prefer to have me or someone else drive you there, since if I call the cops, which is my other alternative, they will handcuff you, and I find that degrading and unnecessary. I must also alert the intended victim if I believe you are going to harm someone else. Lastly, my ethics require me to make a report to Child Protective Services(CPS) or Adult Protective Services (APS) without your permission if you share and/or I suspect neglect or abuse of a child (under 18) or an elder (over 65).
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4.) Other Personal or Public Health Situations: I may have to disclose your PHI to others without your consent in certain situations. For example, your consent isn't required if you need emergency treatment, as long as I try to get your consent after treatment is rendered, or if I try to get your consent but you are unable to communicate with me (for example, if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so. a) For health oversight activities:For example, I may have to provide information to assist the government when it conducts an inspection of a health care provider or organization, or to give notice of health treatment options. b) For research purposes: I might in the future provide PHI (without your name) in order to conduct medical research. c) To avoid harm: In order to avoid a serious threat, I may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm. d) For specific government functions: The current Patriot Act-type anti-terrorism laws require that if an FBI, CIA or other officer asks questions of me during an investigation, I must answer truthfully and must also not disclose the conversation to you. This applies to situations involving national security and/or intelligence operations. e) For workers' compensation purposes: With your permission, I provide PHI to comply with workers' compensation laws. f) For employment disability: Again, with my client's permission, I provide PHI to support the worker off work due to disability.
B. Certain Uses and Disclosures Require You to Have the Opportunity to Object. With your approval (oral or in writing), I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
C. Other Uses and Disclosures Require Your Prior Written Authorization. In any situation not described in Section A above - and even in the Section A(3) situations if I can ethically do so - I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent that I haven't taken any action in reliance on such authorization) of your PHI by me.
D. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1.) The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that I limit how I use and disclose your PHI. I am not legally required to accept it, but if I do, I will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that I am legally required or allowed to make. 2.) The Right to Choose How I Send PHI to You. You have the right to ask that I send information to you to at an alternate address (eg your work address v your home address) or by alternate means (for example, e-mail instead of regular mail). 3.) The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that I have, but you must make the request in writing. I will respond to you within 30 days of your written request. Instead of providing the extensive PHI you requested, I may provide you with a summary of the PHI as long as you agree to that and to the cost in advance. You may choose how I send PHI to you, ie to an alternative address or by e-mail instead of regular 'snail' mail. 4.) The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request (in writing) that I correct the existing information or add the missing information. I may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by me, (iii) not allowed to be disclosed, or (iv) not part of my records. .
E. AUTHORITY TO CONTACT RE: THIS NOTICE OR TO COMPLAIN ABOUT MY PRIVACY PRACTICES: If you have any If you have any questions about this notice or any complaints about my privacy practices, or would like to file a complaint with the Secretary of the Department of Health and Human Services, 200 Independence Ave, S.W. Washington, D.C. 20201. I will not take any retaliatory action against you if you do so. Any questions or concerns? Do be encouraged to contact me Darrin Scott, LMFT, 831-337-8015, 555 Soquel Avenue, Suite 190 Santa Cruz, CA, 95062, dgscotttherapy@gmail.com