Shoreline Therapy & Consulting, LLC
Notice of Privacy Practices
As a Licensed Clinical Social Worker, I am committed to protecting my clients’ medical information. No information is released without your knowledge and written consent except for those rare instance where therapists are required by law or by court to reveal particular information. In an emergency situation where clients demonstrate a high probability of harming themselves or others, I may be required to release information to ensure safety. I am also a mandated reporter of suspected abuse or neglect of minors, disabled, and elderly individuals, as described further below. This notice describes how medical information about you or your child may be used and disclosed and how you can get access to this information.
Understanding Your Protected Health Information (PHI)
When you visit me, a record is made of you/your child’s issues, assessment, recommendations, treatment plan, and other mental health or medical information. Being aware of what is in your record will help you to make more informed decisions when authorizing disclosure to others. In using and disclosing your protected health information (PHI), it is my objective to follow the Privacy Standards of the Federal Health Insurance Portability and Accountability Act (HIPAA) and requirements of Florida law.
Your mental health and/or medical records serve as:
A basis for planning your counseling
A legal document describing the counseling care you receive
A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Right and Responsibilities of the Therapist
I am required to maintain the privacy of your protected health information (PHI) as required by law and provide you with notice of our legal duties and privacy practices with respect to the protected health information that I collect and maintain about you. This also applies to you and any other member of your family that participates in the counseling process aimed to help you/your child.
I have the right to change the notice of privacy practices and to make the new provisions effective for all protected health information that we maintain, including that obtained prior to the change. Should my information practices change, I will provide you with a copy.
I will accommodate reasonable requests to communicate with you about protected health information by alternative means. For example, you may not want a family member to know that you are participating in counseling. Upon your request, I will communicate with you, if needed, at a different time or via other means of communication.
I will use or disclose your health information only with your authorization, except as described in this notice.
Your Protected Health Information (PHI) Rights
You have the right to:
Review and obtain a paper copy of the notice of privacy practices upon request.
Request and provide written authorization and permission to release information for purposes of outside treatment and health care operations. This authorization excludes psychotherapy notes and any audio/video tapes that may have been made with your permission.
Revoke your authorization in writing at any time to use, disclose, or restrict health information except to the extent that action has already been taken.
Request confidential communications of your health information by alternative means, such as only at home or only by mail.
Request disclosure of your health information to yourself. In certain situations, when disclosure of your information could be harmful for you or another person, I may limit the information available to you, or use an alternative means of meeting your request.
Special Conditions
I will use your PHI, without your consent or authorization, in the following circumstances:
Emergency Situations: If you are unable to consent to the disclosure of your or your child’s health information, such as in a medical emergency, I may disclose your or your child’s personal information to a family member or friend to the extent necessary to help with your or your child’s health care. I will only do so if the disclosure is in you/your child’s best interest.
Child Abuse or Neglect: If I have reasonable cause to suspect that a child seen in the course of professional duties has been abused or neglected, or have reason to believe that a child seen in the course of professional duties has been threatened with abuse or neglect, and that abuse or neglect of the child will occur, I must report this to the relevant child protective services agency, police, and/or sheriff’s department.
Adult and Domestic Abuse: If I believe that an elder or disabled person may be the victim of abuse, neglect, or domestic violence or the possible victim of other crimes, I may report such information to the relevant protective services department and/or state official.
Serious Threat to Health or Safety: If I have reason to believe, exercising best judgment, professional care and skill, that you may cause harm to yourself or another person, I may take steps, without your consent to notify the relevant police or sheriff’s department to ensure safety.
Judicial or administrative proceedings: If you are involved in a court proceeding and a request is made for information about your counseling treatment and the records thereof, such information is privileged under state law and I will not release the information without written authorization from you, and a subpoena/court order. Under circumstances where the child’s best interest is in question regarding the release of records, records for minors will only be released, if deemed necessary by an attorney ad litem, appointed on behalf of the child.
As required by law for national security and law enforcement: I may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. I may disclose health information required for lawful intelligence, counterintelligence, and other national security activities to authorized federal officials. I may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or crime investigation.
Law/Health Oversight: As required by law, I may disclose your health information to governmental and/or licensing agencies. For example, if the Florida Department of Regulation and Licensing requests that we release records to them in order for the Examining Board to investigate a complaint against a provider, I must comply with such a request.
Worker’s Compensation: I may disclose health information to the extent authorized by you and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law; I may be required to testify.
As required by law for purposes of public health: I may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, as required by law.
For more information or to report a problem
If you would like to make a request to amend or restrict the use or disclosure of your health information, or if you have questions or would like additional information, please let me know. If you are concerned that your privacy rights have been violated or if you disagree with a decision that I have made about access to your health information, please discuss the matter with me. If you have continued concerns or the matter is unresolved, you may file a complaint with the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling, through the Department of Health.