Privacy Policies and HIPAA

Our practice requires a written release of information to be documented in the client's file with a clear expiration date before we will share information. All releases automatically expire one year after the date executed if an earlier date is not specified. If there is any question when the clinician reviews the written release about whether or not specific content should be disclosed, we will err on the side of caution and our client's privacy, and we will not release information until (or if) we are able to clarify with the client.

Professional Records and HIPAA

We are required by law and by professional standards to maintain clinical records. Certain information must be documented in records, such as a description of symptoms and presenting problems and how they are impacting your life; diagnosis; health status and medical history; relevant family, social, educational, vocational, and treatment history; treatment goals; treatment plans; a record of treatment visits; progress and prognosis; any past treatment records that we receive from other providers; letters and reports; reports of any professional consultations; substantive electronic-mail and other communication; billing records; a discharge/termination summary; and any reports that have been sent to anyone, including reports to your insurance carrier (which some may request before processing claims for out of network benefits).

Pursuant to HIPAA, we may keep Protected Health Information (PHI) about you in two sets of professional records. One set constitutes your clinical record, as described above, and the second in a set of psychotherapy notes.

Except in unusual circumstances that disclosure is reasonably likely to endanger the life or physical safety of you or another person, HIPAA provides you with several rights with respect to your clinical records and disclosures of PHI. You may examine and/or receive a copy of your clinical record, if you request it in writing. To help safeguard your privacy, we only include the information necessary in your clinical record to be compliant with laws and meet the ethical standards of our profession. You have the right to request to see your record, to amend your record, to restrict what information in your record is disclosed to others, and to receive an accounting of most disclosures of Protected Health Information (PHI) that you have neither consented to nor authorized (e.g., these are usually from your insurance company). If you make any complaints about our policies and procedures, this information is also recorded in your records. Seven years from the end of treatment (or the length of time required by the standards of our profession or applicable law), it is our practice’s policy to destroy records. In some cases, your records may be maintained for longer, though this is not guaranteed. You have a right to a paper copy of this agreement, the attached notice form, and our privacy policies and procedures.

Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. For this reason, should you ever wish to review your records, we recommend that you initially review them in our presence or that you have them forwarded to another mental health professional so you can discuss the contents. In most circumstances, we are permitted to charge a copying fee (and certain other expenses). Any exceptions to this policy are contained in the HIPAA Notice Form provided with the consent forms upon intake. If we refuse your request for access to your clinical records, you have a “right of review,” which we are happy to discuss with you upon request.

Your clinician may also choose to keep a set of psychotherapy notes, which is the other set of professional records. These notes are for our use and are designed to assist us in providing you with the best treatment. While the contents of psychotherapy notes vary by clinician (in those cases where the clinician chooses to keep separate notes), they may include sensitive information that is not required to be included in your clinical record, such as the contents of therapy conversations, the analysis of those conversations, and how they impact your therapy. These psychotherapy notes are kept in a separate, secure location from your clinical record.

While insurance companies can request and receive a copy of your clinical record, they cannot receive a copy of your psychotherapy notes without your signed, written authorization. Insurance companies cannot require your authorization as a condition of coverage nor penalize you in any way for your refusal. In those cases where we are out-of-network with your insurance company, should you choose to submit receipts for services to request out-of-network reimbursement, please be aware that your insurance company may contact us to request a copy of your clinical record.

HIPAA NOTICE OF PRIVACY POLICIES

This notice describes how medical information about you may be used and disclosed and how you can access this information. 

Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, and the APA Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices.

We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you via a notification via your client portal account, sending a copy in the mail upon request, or providing one to you at your next appointment.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

1. Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization.

2. Payment: We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.

3. Health Care Operations: We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract (Business Associate Agreement) with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes, PHI will be disclosed only with your authorization.

4. Required by Law: Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.

5. Without Authorization: Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of situations.

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*Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2:

If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a).

Disclosure of these records requires your explicit written consent, except in limited circumstances such as:

(a) Medical Emergencies: to the extent necessary to treat you,

(b) Reporting Crimes on Program Premises,

(c) Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and

(d) Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications.

You may revoke this consent at any time.

*Prohibitions on Use and Disclosure of Part 2 Records:
SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI.

*This section updated 2/16/2025.

As licensed in the state of Virginia and as a member of the American Psychological Association (APA), it is our practice to adhere to more stringent privacy requirements for disclosures without an authorization. The effective date of this notice is January 1, 2022.

The following language addresses these categories to the extent consistent with the APA Code of Ethics and HIPAA:

1. Child Abuse or Neglect: We may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect.

2. Judicial and Administrative Proceedings: We may disclose your PHI pursuant to a subpoena (with your written consent), court order, administrative order or similar process.

3. Deceased Patients: We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.

4. Medical Emergencies: We may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.

5. Family Involvement in Care: We may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.

6. Health Oversight: If required, we may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors based on your prior consent) and peer review organizations performing utilization and quality control.

7. Law Enforcement: We may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.

8. Specialized Government Functions: We may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.

9. Public Health: If required, we may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.

10. Public Safety: We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

11. Research: PHI may only be disclosed after a special approval process or with your authorization.

12. Verbal Permission: We may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

13. With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that we have already made a use or disclosure based upon your authorization. The following uses and disclosures will be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and disclosures not described in this Notice of Privacy Practices.

YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing/email to David Nickelson, PsyD, JD, Clarity Psychological Services, drdwn@claritypsychological.com.

1. Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set.” A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychotherapy notes. We may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.

2. Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information, although we are not required to agree to the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy. Please contact the Privacy Officer if you have any questions.

3. Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

4. Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. We are not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, we are required to honor your request for a restriction.

5. Right to Request Confidential Communication. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. We will accommodate reasonable requests. We may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. We will not ask you for an explanation of why you are making the request.

6. Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

7. Right to a Copy of this Notice. You have the right to a copy of this notice.

PSYCHOLOGIST’S DUTIES

We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, we are required to abide by the terms currently in effect. If we revise our policies and procedures, we will provide you with a revised notice of privacy policies and procedures in person or by mail.

COMPLAINTS

If you believe we have violated your privacy rights, you have the right to file a complaint in writing to David Nickelson, PsyD, JD, by writing/email: drdwn@claritypsychological.com or by calling (703) 261-4346 or with the Secretary of Health and Human Services. We can provide you with the address upon request. We will not retaliate against you for filing a complaint.