At INTRA Teletherapy, we respect clients’ confidentiality and only release information about you in accordance with state and federal laws. THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice describes the policies related to the use of the records of your care at this office. We are required to give you this Notice about (1) the use and disclosure of your health information, (2) our legal responsibilities, and (3) your rights concerning your health information and to abide by the terms of this notice.

You may request a copy of this Notice at any time.
For more information about our privacy practices, or for additional information, contact me at (503) 974-8811.

SEND ALL MAIL TO THE MAILING ADDRESS:
Valerie Lamke, LMFT, 13601 W McMillan Rd Suite 102, PMB 104, Boise, ID 83713.

1. USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
We use and disclose the minimum necessary health information about you for your treatment and for payment for your services.

a. If it is necessary to provide information outside of this office for your treatment by another health care provider, we will have you sign an authorization for release of information. Furthermore, an authorization is required for most uses and disclosures of psychotherapy notes.

b. For Payment. we may use and disclose your health information to obtain payment for services provided to you. For example, we may need to give insurance companies or other agencies the minimum necessary information in order for them to pay me for the service provided to you.

2. INFORMATION DISCLOSED WITHOUT YOUR CONSENT
Under California and federal law, information about you may be disclosed without your consent in the following circumstances.

a. Emergencies. Information may be shared to address an immediate emergency you are facing.

b. Judicial and Administrative Proceedings. We may disclose your personal health information in the course of a judicial or administrative proceeding in response to a valid court order or other lawful process, including if you were to make a claim for Workers Compensation.

c. Public Health Activities. If we felt you were an immediate danger to yourself or others, we may disclose health information about you to the authorities, as well as alert any other person who may be in danger.

d. Child/Elder Abuse. We may disclose health information about you related to the suspicion of child and/or elder abuse or neglect.

e. Criminal Activity or Danger to Others. We may disclose health information if a crime is committed on our premises or against our personnel, or if we believe there is someone in immediate danger.

f. National Security, Intelligence Activities, and Protective Services to the President and Others. We may release health information about you to authorized federal officials as authorized by law in order to protect the President or other national or international figures, or in cases of national security.

g. Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These activities might include audits or inspections and are necessary for the government to monitor the health care system and assure compliance with civil rights laws. Regulatory and accrediting organizations may review your case record to ensure compliance with their requirements. The minimum necessary information will be provided in these instances.

h. Scheduling Appointments. We may use your phone number to call you and leave messages to schedule or remind you of appointments.

3. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:

a. Right to Inspect and Copy. You have the right to look at or get copies of your health information, with limited exceptions. Your request must be in writing. If you request a copy of the information, a reasonable charge may be made for the costs incurred.

b. Right to Amend. You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We have the right to deny your request under certain circumstances.

c. Right to an Accounting of Disclosures. You have the right to receive a list of instances in which we have disclosed your health information for a purpose other than treatment or payment. To request an accounting of disclosures, you must submit your request in writing to this office. Such accountings are available for disclosures beginning from the date of your first visit and remain available for seven years after the last date of service at this office.

d. Right to Notification. You have the right to or will receive notifications of any breaches of unsecured PHI.

e. Right to Request Restrictions. You have the right to restrict certain disclosures of Protected Health Information to a health plan when you pay out of pocket in full for the healthcare item or service. While you are in treatment, a written request for the restriction should be made with this therapist. To request a restriction after therapy is completed, you must make your written request to this office.

f. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at work. You must make this request in writing and it must specify the alternative means or location that you would like me to use to provide you information about your health care. We will make every attempt to accommodate reasonable requests.

g. Right to Obtain a Paper Copy of this Notice. You have the right to receive a paper copy of this notice and any amended notice upon request. Copies will be available at the office. You may also obtain a copy of this notice at our web site, www.myboisetherapist.com.

Any other uses and disclosures not set out in the information above will be made only with your written authorization. You may revoke a written authorization for release of information at any time. The revocation must be in writing and will become effective when it has been received and will only be for disclosures not already completed. All electronic submissions for billing are made using the most updated and secured encrypted software available. All clinical notes are stored on a Professional Electronic Filing Platform with Encryption approved by HIPPA. The files are archived for up to 10 years. All files will be deleted within the guidelines set by law.

This office reserves the right to change the privacy practices provided as such changes are permitted by applicable law. Before the effective date of a material change, however, we will change this Notice and make a new Notice available to you at the office and on our website.

QUESTIONS AND COMPLAINTS

If you believe your privacy rights have been violated, you may make a complaint directly to our office, or you may file a complaint with the U. S. Department of Health & Human Service OCRComplaint@hhs.gov. We will not retaliate in any way if you choose to file a complaint.