Notice of Privacy Practices
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.
Kobe International Counseling PLLC ("the practice," "we," or "Dr. Xander") is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
For treatment
We use your health information to provide and coordinate your psychotherapy care, for example, to plan your sessions or, with your permission, to consult or coordinate with other providers involved in your care.
For payment
We may use and disclose your information to obtain payment for services, for example, to bill your insurance company or to provide documentation a plan requires to authorize or reimburse care.
For health care operations
We may use your information for the operation of the practice, such as quality review, supervision and training, and administrative functions.
Uses and disclosures that require your written authorization
Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and any sale of your information require your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization, which you may revoke in writing at any time.
Uses and disclosures permitted or required without your authorization
We may use or disclose your information without your authorization in limited circumstances, including: when required by law; for public health activities; to report suspected abuse, neglect, or domestic violence; for health oversight activities; for judicial and administrative proceedings; for certain law-enforcement purposes; to avert a serious and imminent threat to health or safety; for specialized government functions; and for workers’ compensation as authorized by law.
Your rights regarding your health information
- Access. You may inspect and obtain a copy of your health information, with limited exceptions.
- Amendment. You may request that we correct information you believe is inaccurate or incomplete.
- Accounting of disclosures. You may request a list of certain disclosures we have made of your information.
- Restrictions. You may request restrictions on certain uses and disclosures. We are not required to agree, except that we will honor a request to restrict disclosure to a health plan for services you paid for in full out of pocket.
- Confidential communications. You may request that we communicate with you in a particular way or at a particular location.
- Paper copy. You may request a paper copy of this notice at any time.
Our duties
We are required to maintain the privacy of your health information, to notify you in the event of a breach of unsecured PHI, and to abide by the terms of the notice currently in effect. We reserve the right to change this notice and to make the revised notice effective for information we already have as well as information we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the practice using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
Contact
To exercise any of your rights, or for questions about this notice, contact Dr. Xander at xander@kobeinternationalcounseling.com.