Notice of Privacy Practices (HIPAA) for Tara Yamauchi-Lum LLC
This notice will go over your information, your rights, and my responsibilities. This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please read this notice carefully.
Definition of Terms
Before diving in, here are the definitions of the common terms surrounding this notice:
Uses and Disclosures Requiring Authorization
By law and my profession, I am required to maintain the privacy of your PHI.
Authorization usually is obtained if there are reasons for me to disclose your information other than treatment, insurance payment, and healthcare operations. The authorization(s) can be revoked at any time, as long as it is provided in writing. You may not revoke authorization if the disclosure of information has already happened.
Uses and Disclosures with Neither Consent nor Authorization
There may be instances when your PHI can be disclosed without your consent or authorization:
Your Rights as a Client
You have the right to:
Marriage and Family Therapist’s Responsibilities
My responsibilities to you:
This Notice of Privacy Practices went into effect on January 1, 2019.
Definition of Terms
Before diving in, here are the definitions of the common terms surrounding this notice:
- Authorization - written permission that allows me to share your information. Usually, I will provide the form and you will be able to select what information is to be shared.
- Disclosure - activities that take place outside my private practice. This may include releasing, transferring, or providing access to information about you to other parties.
- Health Care Operations - activities that relate to the performance and operations of my practice. Examples include quality assessment and improvement activities, business related matters such as audits and administrative services, and case management and care coordination.
- HIPAA - stands for the "Health Insurance Portability and Accountability Act." This is a federal law that protects your health information.
- Treatment - services provided, case management, or coordination of services related to your time with me in therapy.
- Payment - the reimbursement I receive for the therapeutic services I provide to you.
- PHI - stands for “Protected Health Information.” This is any information in your medical record that could identify you. This includes progress notes and psychotherapy notes.
- Use - activities that take place within my practice. This may include sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
Uses and Disclosures Requiring Authorization
By law and my profession, I am required to maintain the privacy of your PHI.
Authorization usually is obtained if there are reasons for me to disclose your information other than treatment, insurance payment, and healthcare operations. The authorization(s) can be revoked at any time, as long as it is provided in writing. You may not revoke authorization if the disclosure of information has already happened.
Uses and Disclosures with Neither Consent nor Authorization
There may be instances when your PHI can be disclosed without your consent or authorization:
- Adult and Domestic Abuse - if I am aware of, informed, or believe a vulnerable adult (disabled or elderly) has been or is being abused, neglected, or exploited, the law requires me to report my knowledge or suspicion to Hawaii Adult Protective Services.
- Child Abuse - if I am aware of, informed, or believe a child or children are being abused, neglected, abandoned by a parent, legal guardian, caregiver, or other person responsible for the child’s welfare, the law requires me to report my knowledge or suspicion to the Hawaii Department of Child Welfare Services.
- Complaints and Lawsuits - if you file a complaint or lawsuit against me, I may use relevant client information to defend myself.
- Health Oversight - if there is a complaint filed against me, or I am being investigated regarding my license and practice as a marriage and family therapist, I may be required to release your PHI relevant to the complaint and/or investigation.
- Judicial or Administrative Proceedings - if you are in a court proceeding and a request is made for information about your therapeutic services and the records thereof, such information is privileged under Hawaii law. Information will only be released if you or your legal representative do so in writing, or if I am subpoenaed/court ordered.
- Threat to Health and Safety - if you present with clear and immediate signs and/or probability of harming yourself, other individuals, or society, I may share information to the potential victim(s), appropriate family member(s), law enforcement, or other appropriate authorities.
- Worker’s Compensation and Personal Injury Claims - if you file any of these claims, I may have to disclose information about the services you are receiving from me that is relevant to the claim.
- Peer Consultation - I may seek peer consultation regarding your case. If I do so, I make every effort to protect your identity. These professionals are also legally bound to keep the information I share confidential.
Your Rights as a Client
You have the right to:
- Obtain a copy of your medical record. This can be done for you electronically or through paper format. Applicable fees apply for preparing your record.
- Correct your medical record. If you feel your record is incorrect or incomplete, please discuss this with me. I may deny your request.
- Request confidential communication by alternative means and locations. You may request for me to contact you in a specific way (e.g., through cell phone or to send mail to a different address). All reasonable requests will be accepted.
- Ask me to limit the information I share. You can ask me not to use or share certain health information for treatment, payment, or my operations. However, I am not required to agree to your request, and I can decline your request if it affects 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 my operations with your health insurer. I will agree unless the law requires me to share that information.
- Obtain a list of those with whom I’ve shared your information. You can ask for a list (accounting) the times I’ve shared your health information for 6 years prior to the date you request, who I shared it with, and why. I’ll provide one accounting a year for free, but will charge a reasonable fee if you ask for another one within 12 months.
- File a complaint if you believe I have violated your privacy rights. You can contact me directly using the information on this notice or on my website. You may also contact 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. You can also call them at 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints/. I will not retaliate against you for filing a complaint.
Marriage and Family Therapist’s Responsibilities
My responsibilities to you:
- I am required to maintain the privacy and security of your PHI.
- I will inform you promptly if a breach occurs that may have compromised the privacy or security of your information.
- I must follow the duties and privacy practices described in this notice and offer you a copy of it (paper or electronically). The notice will also be posted on my website.
- I will not use or share your information other than as described here unless you tell me I can in writing. You may change your mind at any time, though I need to be informed in writing.
- I can change the terms of this notice at any time. The changes will apply to all the information I have about you. The new notice will be available upon request through paper or electronic format, as well as posted on my website.
This Notice of Privacy Practices went into effect on January 1, 2019.