This HIPAA Notice of Privacy Practices describes how information about you may be used and disclosed and also describes your rights and how you can get access to this information. This is not an authorization. Please review it carefully.

High Tide Psychiatry is committed to protecting your confidentiality and it is of the upmost importance in our clinic. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI). PHI refers to any information in your medical records that could potentially identify you. It can include, but is not limited to; name, address, date of birth, contact information, mental health or medical diagnoses, treatment plans, and billing records. 

We reserve the right to change or modify the terms of this notice at any time and make the modified notice effective in the future. The changes will apply to all information we have about you. The notice will always be available upon request, in our office, and on our web site to view or download.

Patient Rights
When it comes to your health information you have certain rights. This section explains your rights and some of our responsibilities

Right to view and/or receive a copy of your records.  
• You can ask to see or obtain an electronic or paper copy of your medical record and other health information we have about you. You will need to submit a written request to the practice in order to do this.  
• We will provide a copy or a summary of your health information, usually within 30 days of your request.
• We may charge a cost-based fee, for copying, mailing, or otherwise supplying these records. If you would like an electronic copy of your records, this will be supplied if it is possible to produce the records in this way.
• Federal law prohibits inspecting or copying PHI including but not limited to; psychotherapy notes, information compiled in reasonable anticipation of legal or administrative action or proceeding, information related to medical research you have agreed to participate in, information that may result in injury or harm to yourself or others, or information assembled under a promise of confidentiality.
Right to correct or amend your records.
• You may submit a written request for us to correct health information about you that you think is incorrect or incomplete.
• We may deny your request, but we will provide you with a written notice explaining our reasoning within 60 days.
• Information regarding your requests will be included in your records.
Right to request confidential communications
• You may ask us to contact you about your healthcare in a specific way, for example, at your home instead of your office, or to send mail to a different address.
• We will not ask the reason for this request and will honor all reasonable requests.
Right to request limitations
• You can ask us to further limit or restrict the use or disclosure of certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may deny this request if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will honor this request unless a law requires us to share that information.
Right to an accounting of disclosures, a list of those with whom we’ve shared information
• You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures such as any you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• Please submit a written request if you wish to obtain an accounting of disclosures.
Right to receive a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have received the notice electronically. We will provide you with a paper copy promptly.
Right to choose someone to act on your behalf
• If you have named a personal representative who may act on your behalf or have given someone medical power of attorney, that person can exercise your rights and make choices about your health information.
• Parents or guardians generally have the ability to exercise the rights and control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.
Right to file a complaint if you feel your rights are violated
• If you feel we have violated your rights, you can file a complaint with us by contacting our office or file with the Secretary of the Department of Health and Human Services.
• We will not retaliate against you or withhold treatment for filing a complaint.

Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know within 60 business days if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described in this notice unless you authorize it in writing. You may change your authorizations at any time by notifying us in writing.

Requirement for Written Authorization
For certain health information, you can tell us your preferences about what we share, and we must obtain your written authorization before using or sharing your health information.

In the following cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.

In the following situations we will never share your information unless you give us written permission:
• Marketing purposes
• Sale of your PHI
• Most uses of psychotherapy notes; when appropriate

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

You may revoke your written authorization for the above purposes at any time, except when we have already relied upon it, by submitting a written request to our office.

Uses and Disclosures
There are some situations when we do not need your authorization before using your health information or sharing it with others.

We typically use or share your health information in the following ways.

Treatment
• We can use and share your protected health information to provide, coordinate, or manage your health care and we may share it with other professionals who are treating you.
Example: A provider treating you for a mental health disorder asks another provider about your overall health condition.
Healthcare Operations.
• We can use and share your protected health information, as needed, in order to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your Services
• We can use and share your protected health information, as needed, after we have provided treatment to bill and obtain payment from insurance companies or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
Appointment Reminders and other Health Related Services
• We can use and share your protected health information, as needed, to contact you for appointment reminders and inform you of other benefits or services that may be of interest to you. We may contact you for fundraising, but you will have the option to opt in or out of these activities.
Example: Texting or emailing you a reminder of an upcoming appointment.
Business Associates
• We can use and share your protected health information with business associates who need the information in order to help us collect payments or carry out our business operations. These business associations are required by law to abide by HIPAA regulations.
Example: Billing companies, accounting firms, or law firms that provide services or professional advice to us.
Incidental Disclosures
• Certain disclosures of your protected health information may occur during or as a direct, unavoidable result of otherwise permissible uses or disclosures. We will take reasonable steps to prevent from this occurring and to protect the privacy of your health information.
Example: During a treatment session others overhear discussion of your protected health information.

Emergencies and other Uses or Disclosures of PHI
We may use or share your protected health information if you require emergency treatment or if we are required to treat you by law.

We are also allowed or required to use or share your protected health information in other ways, usually in ways that contribute to the public good, without your authorization. These uses may include helping with public health and safety issues, preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety, doing health research, complying with the law (state or federal), responding to organ and tissue donation requests, communicating with organ procurement organizations, working with a coroner, medical examiner, or funeral director when an individual dies, addressing workers’ compensation, law enforcement, and other government requests, working with health oversight agencies, for special government functions such as military, national security, and presidential protective services, and responding to lawsuits and legal actions such as in a response to a subpoena. We have to meet many conditions in the law before we can share your information for these purposes.

Use and Disclosure where Special Protections may Apply 
Certain types of information, such as alcohol and substance abuse treatment, HIV, mental health, psychotherapy, and genetic information are considered so sensitive that state and/or federal laws provide special protections for them. Due to this, some parts of this general Notice of Privacy Practices may not apply to these types of information. If you have questions or concerns about the way these types of information may be used or shared, please speak with your provider.