Dr. Jeffrey Bryer  

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Notice of My Policies and Practices to Protect the Privacy of Your 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

II.   Uses and Disclosures Requiring Authorizations

III.  Uses and Disclosures with Neither Consent nor Authorization

IV. Patients' Rights and Psychologists' Duties

V.  Complaints

VI.  Effective Date

 

 

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

 

II.  Uses and Disclosures Requiring Authorization

 

I  may use or disclose PHI for purposes outside of treatment, payment, and 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 I am asked for information for purposes outside of treatment, payment and health care operations, he will obtain an authorization from you before releasing this information

 

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

 

 

III.  Uses and Disclosures with Neither Consent nor Authorization

 

I may use or disclose PHI without your consent or authorization in the following circumstances:

 

IV.  Patient's Rights and Psychologist's Duties

 

Patients' Rights:

 

Psychologists' Duties:

 

V.  Complaints

If you are concerned that I  have violated your privacy rights, or you disagree with a decision I  made about access to your records, you may contact me directly at WCPA.

 

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

  

 

VI. Effective Date

 

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

 

 


Copyright© 2003-2010   Dr. Jeffrey Bryer