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HIPAA Notice of Privacy Practices
Nancy Wesson, Ph.D.
Licensed Psychologist: PSY9621
Professional background & approach to counseling
of Nancy Wesson, Ph.D.
I. 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.
II. IT IS MY LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH
By law I am required to insure that your PHI is kept private.
The PHI constitutes information created or noted by me that can
be used to identify you. It contains data about your past, present,
or future health or condition, the provision of health care services
to you, or the payment for such health care. I am required to
provide you with this Notice about my privacy procedures. This
Notice must explain when, why, and how I would use and/or disclose
your PHI. Use of PHI means when I share, apply, utilize, examine,
or analyze information within my practice; PHI is disclosed when
I release, transfer, give, or otherwise reveal it to a third
party outside my practice. With some exceptions, I may not use
or disclose more of your PHI than is necessary to accomplish
the purpose for which the use or disclosure is made; however,
I am always legally required to follow the privacy practices
described in this Notice.
Please note that I reserve the right to change the terms of this
Notice and my privacy policies at any time as permitted by law.
Any changes will apply to PHI already on file with me. Before
I make any important changes to my policies, I will immediately
change this Notice and post a new copy of it in my office and
on my website.You may also request a copy of this Notice from
me, or you can view a copy of it in my office or on my website,
which is located at www.wespsych.com.
III. HOW I WILL USE AND DISCLOSE YOUR PHI.
I will use and disclose your PHI for many different reasons.
Some of the uses or disclosures will require your prior written
authorization; others, however, will not. Below you will find
the different categories of my uses and disclosures, with some
A. Uses and Disclosures Related to Treatment, Payment, or Health Care Operations
Do Not Require Your Prior Written Consent. I may use and disclose your PHI
without your consent for the following reasons:
1. For treatment. I can use your PHI within my practice to provide
you with mental health treatment, including discussing or sharing
your PHI with my trainees and interns. I may disclose your PHI
to physicians, psychiatrists, psychologists, and other licensed
health care providers who provide you with health care services
or are otherwise involved in your care. Example: If a psychiatrist
is treating you, I may disclose your PHI to her/him in order
to coordinate your care.
2. For health care operations. I may disclose your PHI to facilitate
the efficient and correct operation of my practice. Examples:
Quality control - I might use your PHI in the evaluation of the
quality of health care services that you have received or to
evaluate the performance of the health care professionals who
provided you with these services. I may also provide your PHI
to my attorneys, accountants, consultants, and others to make
sure that I am in compliance with applicable laws.
3. To obtain payment for treatment. I may use and disclose your
PHI to bill and collect payment for the treatment and services
I provided you. Example: I might send your PHI to your insurance
company or health plan in order to get payment for the health
care services that I have provided to you. I could also provide
your PHI to business associates, such as billing companies, claims
processing companies, and others that process health care claims
for my office.
4. Other disclosures. Examples: Your consent isn't required if
you need emergency treatment provided that I attempt to get your
consent after treatment is rendered. In the event that I try
to get your consent but you are unable to communicate with me
(for example, if you are unconscious or in severe pain) but I
think that you would consent to such treatment if you could,
I may disclose your PHI.
B. Certain Other Uses and Disclosures Do Not Require Your Consent. I may
use and/or disclose your PHI without your consent or authorization for the
1. When disclosure is required by federal, state, or local law;
judicial, board, or administrative proceedings; or, law enforcement.
Example: I may make a disclosure to the appropriate officials
when a law requires me to report information to government agencies,
law enforcement personnel and/or in an administrative proceeding.
2. If disclosure is compelled by a party to a proceeding before
a court of an administrative agency pursuant to its lawful authority.
3. If disclosure is required by a search warrant lawfully issued
to a governmental law enforcement agency.
4. If disclosure is compelled by the patient or the patient's
representative pursuant to California Health and Safety Codes
or to corresponding federal statutes of regulations, such as
the Privacy Rule that requires this Notice.
5. To avoid harm. I may provide PHI to law enforcement personnel
or persons able to prevent or mitigate a serious threat to the
health or safety of a person or the public (i.e., adverse reaction
6. If disclosure is compelled or permitted by the fact that you
are in such mental or emotional condition as to be dangerous
to yourself or the person or property of others, and if I determine
that disclosure is necessary to prevent the threatened danger.
7. If disclosure is mandated by the California Child Abuse and
Neglect Reporting law. For example, if I have a reasonable suspicion
of child abuse or neglect.
8. If disclosure is mandated by the California Elder/Dependent
Adult Abuse Reporting law. For example, if I have a reasonable
suspicion of elder abuse or dependent adult abuse.
9. If disclosure is compelled or permitted by the fact that you
tell me of a serious/imminent threat of physical violence by
you against a reasonably identifiable victim or victims.
10. For public health activities. Example: In the event of your
death, if a disclosure is permitted or compelled, I may need
to give the county coroner information about you.
11. For health oversight activities. Example: I may be required
to provide information to assist the government in the course
of an investigation or inspection of a health care organization
12. For specific government functions. Examples: I may disclose
PHI of military personnel and veterans under certain circumstances.
Also, I may disclose PHI in the interests of national security,
such as protecting the President of the United States or assisting
with intelligence operations.
13. For research purposes. In certain circumstances, I may provide
PHI in order to conduct medical research.
14. For Workers' Compensation purposes. I may provide PHI in
order to comply with Workers' Compensation laws.
15. Appointment reminders and health related benefits or services.
Examples: I may use PHI to provide appointment reminders. I may
use PHI to give you information about alternative treatment options,
or other health care services or benefits I offer.
16. If an arbitrator or arbitration panel compels disclosure,
when arbitration is lawfully requested by either party, pursuant
to subpoena duces tectum (e.g., a subpoena for mental health
records) or any other provision authorizing disclosure in a proceeding
before an arbitrator or arbitration panel.
17. If disclosure is required or permitted to a health oversight
agency for oversight activities authorized by law. Example: When
compelled by U.S. Secretary of Health and Human Services to investigate
or assess my compliance with HIPAA regulations.
18. If disclosure is otherwise specifically required by law.
C. Certain Uses and Disclosures Require You to Have the Opportunity to Object.
1. Disclosures to family, friends, or others. I may provide your
PHI to a family member, friend, or other individual who you indicate
is involved in your care or responsible for the payment for your
health care, unless you object in whole or in part. Retroactive
consent may be obtained in emergency situations.
D. Other Uses and Disclosures Require Your Prior Written Authorization. In
any other situation not described in Sections IIIA, IIIB, and IIIC above, I
will request your written authorization before using or disclosing any of your
PHI. Even if you have signed an authorization to disclose your PHI, you may
later revoke that authorization, in writing, to stop any future uses and disclosures
(assuming that I haven't taken any action subsequent to the original authorization)
of your PHI by me.
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI.
These are your rights with respect to your PHI:
A. The Right to See and Get Copies of Your PHI. In general, you have
the right to see your PHI that is in my possession, or to get copies of it;
however, you must request it in writing. If I do not have your PHI, but I know
who does, I will advise you how you can get it. You will receive a response
from me within 30 days of my receiving your written request. Under certain
circumstances, I may feel I must deny your request, but if I do, I will give
you, in writing, the reasons for the denial. I will also explain your right
to have my denial reviewed.
If you ask for copies of your PHI, I will charge you not more
than $.25 per page. I may see fit to provide you with a summary
or explanation of the PHI, but only if you agree to it, as well
as to the cost, in advance.
B. 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. While I
will consider your request, I am not legally bound to agree. If I do agree
to your request, I will put those limits in writing and abide by them except
in emergency situations. You do not have the right to limit the uses and disclosures
that I am legally required or permitted to make.
C. The Right to Choose How I Send Your PHI to You. It is your right
to ask that your PHI be sent to you at an alternate address (for example, sending
information to your work address rather than your home address) or by an alternate
method (for example, via email instead of by regular mail). I am obliged to
agree to your request providing that I can give you the PHI, in the format
you requested, without undue inconvenience. I may not require an explanation
from you as to the basis of your request as a condition of providing communications
on a confidential basis.
D. The Right to Get a List of the Disclosures I Have Made. You are entitled
to a list of disclosures of your PHI that I have made. The list will not include
uses or disclosures to which you have already consented, i.e., those for treatment,
payment, or health care operations, sent directly to you, or to your family;
neither will the list include disclosures made for national security purposes,
to corrections or law enforcement personnel, or disclosures made before April
15, 2003. After April 15, 2003, disclosure records will be held for six years.
I will respond to your request for an accounting of disclosures
within 60 days of receiving your request. The list I give you
will include disclosures made in the previous six years (the
first six year period being 2003-2009) unless you indicate a
shorter period. The list will include the date of the disclosure,
to whom PHI was disclosed (including their address, if known),
a description of the information disclosed, and the reason for
the disclosure. I will provide the list to you at no cost, unless
you make more than one request in the same year, in which case
I will charge you a reasonable sum based on a set fee for each
E. The Right to Amend Your PHI. If you believe that there is some error
in your PHI or that important information has been omitted, it is your right
to request that I correct the existing information or add the missing information.
Your request and the reason for the request must be made in writing. You will
receive a response within 60 days of my receipt of your request. I may deny
your request, in writing, if I find that: the PHI is (a) correct and complete,
(b) forbidden to be disclosed, (c) not part of my records, or (d) written by
someone other than me. My denial must be in writing and must state the reasons
for the denial. It must also explain your right to file a written statement
objecting to the denial. If you do not file a written objection, you still
have the right to ask that your request and my denial be attached to any future
disclosures of your PHI. If I approve your request, I will make the change(s)
to your PHI. Additionally, I will tell you that the changes have been made,
and I will advise all others who need to know about the change(s) to your PHI.
F. The Right to Get This Notice by Email. You have the right to get
this notice by email. You have the right to request a paper copy of it, as
V. HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES.
If, in your opinion, I may have violated your privacy rights,
or if you object to a decision I made about access to your PHI,
you are entitled to file a complaint with the person listed in
Section VI below. You may also send a written complaint to the
Secretary of the Department of Health and Human Services at 200
Independence Avenue S.W. Washington, D.C. 20201. If you file
a complaint about my privacy practices, I will take no retaliatory
action against you.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT
MY PRIVACY PRACTICES.
If you have any questions about this notice or any complaints
about my privacy practices, or would like to know how to file
a complaint with the Secretary of the Department of Health and
Human Services, please contact me at: Nancy Wesson, Ph.D. 2672
Bayshore Parkway Suite 915, Mountain View, CA. 94043 (650) 965-7332.
VII. EFFECTIVE DATE OF THIS NOTICE.
This notice went into effect on April 14, 2003.
For an appointment for counseling for relationship issues, shyness,
self-esteem issues, codependency, or other psychological concerns call text:
Dr. Nancy Wesson at (650) 965-7332 • E-mail Dr.
Professional background & approach to counseling
of Nancy Wesson, Ph.D.