Privacy Notice

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Notice of Jeff Miller, PhD. Policies and Practices
to Protect the Privacy of You Health Information

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

Jeff Miller, PhD. may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:

  • “PHI” refers to information in your health record that could identify you.
  • “Treatment, Payment, and Health Care Operations”
    • Treatment is when we provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your family physician or another psychologist.
    • Payment is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
    • Health Care Operations are activities that relate to the performance and operation of Jeff Miller, PhD.. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
  • “Use” applies only to activities within Jeff Miller, PhD., such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
  • “Disclosure” applies to activities outside of Jeff Miller, PhD., such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

Jeff Miller, PhD. may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when we are asked for information for purposes outside of treatment, payment or health care operations, Jeff Miller, PhD. will obtain an authorization from you before releasing this information. If your psychologist keeps “psychotherapy notes,” we will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes about your conversation during a private, group, or joint counseling session, which are kept separate from the rest of your Jeff Miller, PhD. file. These notes are given a greater degree of protection than PHI. The psychologist you work with may or may not keep separate “psychotherapy notes” as defined here. Your psychologist will discuss this with you.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) Jeff Miller, PhD. has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent nor Authorization

Jeff Miller, PhD. may use or disclose PHI without your consent or authorization in the following circumstances:

  • Child Abuse – If we have reasonable cause to suspect that a child has been or may be subjected to abuse or neglect, or if we observe a child being subjected to conditions which would reasonably result in abuse or neglect, Jeff Miller, PhD. must immediately report such information to the Missouri Division of Family Services. Jeff Miller, PhD. must also report sexual abuse or molestation of a child under 18 years of age to Family Services. Jeff Miller, PhD. may also report child abuse or neglect to a law enforcement agency or juvenile office.
  • Adult and Domestic Abuse – If we have reasonable cause to suspect that an eligible adult (defined below) presents a likelihood of suffering physical harm or is in need of protective services, Jeff Miller, PhD. must report such information to the Missouri Department of Social Services.

“Eligible adult” means any person 60 years of age or older, or an adult with a handicap (substantially limiting mental or physical impairment) between the ages of 18 and 59 who is unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs.

  • Health Oversight Activities – The Missouri Attorney General’s Office may subpoena records from Jeff Miller, PhD. relevant to disciplinary proceedings and investigations conducted by the Missouri State Committee of Psychologists.
  • Judicial and Administrative Proceedings – If you are involved in a court proceeding and a request is made for information about your diagnosis or treatment and the records thereof, such information is privileged under state law, and Jeff Miller, PhD. will not release information without written authorization from you or your personal or legally-appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. We will inform you in advance if this is the case.
  • Serious Threat to Health or Safety – When we judge that disclosure is necessary to protect against a clear and substantial risk of imminent serious harm being inflicted by you on yourself or another person, Jeff Miller, PhD. must disclose your relevant confidential information to the appropriate professional workers, public authorities, the potential victim, his or her family, or your family.
  • Workers' Compensation – If you file a worker’s compensation claim, Jeff Miller, PhD. must permit your record to be copied by the Missouri Labor and Industrial Commission or the Division of Worker’s Compensation of the Missouri Department of Labor and Industrial Relations, your employer, you and any other party to the proceedings.

IV. Your Rights and Psychologist's Duties

Your Rights:

  • Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information. However, Jeff Miller, PhD. is not required to agree to a restriction you request.
  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are being seen at Jeff Miller, PhD.. On your request, we will send your bills to another address).
  • Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in Jeff Miller, PhD. mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Jeff Miller, PhD. may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, a psychologist will discuss with you the details of the request and denial process.
  • Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Jeff Miller, PhD. may deny your request. On your request, a psychologist will discuss with you the details of the amendment process.
  • Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI. On your request, a psychologist will discuss with you the details of the accounting process.
  • Right to a Paper Copy – You have the right to obtain a paper copy of the Privacy Notice from Jeff Miller, PhD. upon request.

Psychologist’s Duties:

  • Jeff Miller, PhD. is 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.
  • Jeff Miller, PhD. reserves the right to change the privacy policies and practices described in this notice. Unless Jeff Miller, PhD. notifies you of such changes, however, Jeff Miller, PhD. is required to abide by the terms currently in effect.
  • If Jeff Miller, PhD. revises our policies and procedures, we will provide you with a revised notice at your next appointment or send it to you by mail.

V. Complaints

If you are concerned that Jeff Miller, PhD. has violated your privacy rights, or you disagree with a decision Jeff Miller, PhD. made about access to your records, you may contact Jeff Miller, PhD.at (816) 224-6500.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.

VI. Effective Date, Restrictions and Changes to Privacy Policy

This notice will go into effect on April 14th, 2003.

Jeff Miller, PhD. reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. If Jeff Miller, PhD. revises this notice, we will provide you with a revised notice at your next appointment or send it to you by mail.


Jeff Miller, Ph.D.
Licensed Psychologist
jeff@jeffmiller.org

1924 Copper Oaks Circle
Blue Springs, MO 64015

Phone:+1 816 224 6500
FAX:+1 816 224 2777

2017 Jeff Miller
All Rights Reserved