Notice of Privacy Practices
SUMMARY OF NOTICE: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AS WELL AS HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Federal law, commonly called HIPAA, requires that we describe for you our medical privacy practices and your rights as a patient under this law.
If you have any concerns about your medical privacy, please call our office at: 786-356-9342 - Effective April 14, 2003
Your right to access and control your PHI
You have the following rights regarding your protected health information (PHI), provided that you make a written request:
The right to request restriction - You may request limitations on your mental health information which could be disclosed in the future. However, we are not required to agree to your request.
The right to confidential communications - You may request that communications be made in a certain way or at a certain location.
The right to inspect and copy - You have the right to inspect and copy your mental health information regarding decisions about your care; however, psychotherapy notes may not be inspected and copied, although we may provide a Summary Report of these notes. We may charge you a fee for related copying, mailing and supplies.
The right to request clarification of the record - If you believe that the PHI we have about you is inaccurate, you may ask to add clarifying information. We are not required to accept the information that you propose.
The right to accounting of disclosures - You may request a list of the disclosures of your mental health information that have been made to entities other than for routine treatment, payment or health care operations.
The right to a copy of this notice - You may request a paper copy of the full notice at any time.
Complaints
If you believe your privacy rights have been violated, you can file a complaint with us or the U.S. Dept. of Health and Human Services at 1-877-696-6775.
You will not be penalized or retaliated against in any way for making a complaint. Please speak with the Privacy Officer, Joann Gruber, ARNP- BC, as she will attempt to resolve any concerns amicably
We are required to provide you with this Notice that governs our privacy practices. We will provide any forms necessary to enforce your rights
Florida Statutes: Florida statutorily grants patients the right of access to medical records maintained by health care practitioners. The disclosure of patient information by providers is generally prohibited without the patient's consent, subject to specified exceptions. Florida also has numerous laws protecting the confidentiality of health information held by a variety of entities and government agencies.
How we may use your personal medical information:
Lisa Sharf, M.S.N., A.R.N.P., P.A. creates and receives medical information about you as a part of your care. This information is called protected health information or PHI. It is personal and private. We may use this information in many ways. We release only the information necessary to accomplish our tasks.
First, we use the information when we treat or refer you for treatment. We may communicate with other professionals and referral agencies.
Second, we may use the information to submit bills for your medical care to insurers, Medicare, Medicaid or third party payers.
Finally, we may use this information for our health care operations, meaning the work we must do to provide quality services to you and all of our patients.
We will seek your authorization when state or federal law requires it.
We may use PHI without your permission for the following reasons:
As required by state or federal law.
For public health purposes, such as reporting child or elder abuse, or if you are a danger to yourself or to others.
To treat you in an emergency.
To inform you of alternative treatments.
When ordered by a regulatory agency, such as Health and Human Services.
For law enforcement purposes or in response to a court order.
For agencies involved in a disaster situation.
For lawsuits and disputes.
To communicate with coroners, medical examiners, and funeral homes when necessary.
To communicate with federal officials involved in security activities authorized by law.
To carry out treatment and billing operations through a billing or transcription service.
Your authorization is required for other disclosures.
The following PHI receives special protections under federal and/or state law.
Psychotherapy Notes are kept separate from the medical record and receive special protection.
Psychotherapy Notes exclude: medication prescription and monitoring, counseling session start and stop times, modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date.
Alcohol and drug abuse information has special privacy protections.
Lisa Sharf, M.S.N., A.R.N.P., P.A., will not disclose any information identifying an individual as being a patient or provide any mental health or medical information relating to a patient’s substance abuse treatment unless: (1) the patient consents in writing, (2) a court order requires disclosure of the information, (3) medical personnel need the information for a medical emergency, or (4) it is necessary to report a crime or a threat to commit a crime or to report abuse or neglect as required by law.
Telemental Health Informed Consent
I, hereby consent to participate in telemental health with, Lisa Sharf, ARNP , as part of my psychotherapy. I understand that telemental health is the practice of delivering clinical health care services via technology assisted media or other electronic means between a practitioner and a client who are located in two different locations.
I understand the following with respect to telemental health:
I understand that I have the right to withdraw consent at any time without affecting my right to future care, services, or program benefits to which I would otherwise be entitled.
I understand that there are risks, benefits, and consequences associated with telemental health, including but not limited to, disruption of transmission by technology failures, interruption and/or breaches of confidentiality by unauthorized persons, and/or limited ability to respond to emergencies.
I understand that there will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.
I understand that the privacy laws that protect the confidentiality of my protected health information (PHI) also apply to telemental health unless an exception to confidentiality applies (i.e. mandatory reporting of child, elder, or vulnerable adult abuse; danger to self or others; I raise mental/emotional health as an issue in a legal proceeding).
I understand that if I am having suicidal or homicidal thoughts, actively experiencing psychotic symptoms or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telemental health services are not appropriate and a higher level of care is required.
Understand that during a telemental health session, we could encounter technical difficulties resulting in service interruptions. If this occurs, end and restart the session. If we are unable to reconnect within ten minutes, please call me at 786-356-9342 to discuss since we may have to re-schedule.
I understand that my therapist may need to contact my emergency contact and/or appropriate authorities in case of an emergency.
Emergency Protocols
I need to know your location in case of an emergency. You agree to inform me if you are attending your telemedicine appointment from somewhere other than the address you used when you registered and agreed to our terms and conditions upon intake. I also need a contact person who I may contact on your behalf in a life- threatening emergency only. This person will only be contacted to go to your location or take you to the hospital in the event of an emergency.