This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and express any questions or concerns that you may have.

Privacy is a very important concern for all those who come to this office. It is also complicated, because of the many federal and state laws and our professional ethics. If you have any questions, the privacy officer (Dr. Dillmann is the privacy officer, contact info is: 760-743-7789; info@drdillmann.com) will be happy to help you understand these policies and your rights.

Contents of this notice

            A. Introduction: To my clients

            B. What I mean by your medical information

            C. Privacy and the laws about privacy

            D. How your protected health information can be used    and shared

                        1. Uses and disclosures with your consent

                                    a. The basic uses and disclosures: For treatment, payment,   and health care operations

                                    b. Other uses and disclosures in health care

                        2. Uses and disclosures that require your authorization

                        3. Uses and disclosures that do not require your consent or authorization

                                    a. When required by law

                                    b. For law enforcement purposes

                                    c. For public health activities

                                    d. Relating to decedents

                                    e. For specific government functions

                                    f. To prevent a serious threat to health or safety

                        4. Uses and disclosures where you have an opportunity to object

                        5. An accounting of disclosures I have made

            E. Your rights concerning your health information

            F. If you have questions or problems

Introduction

This notice will tell you how Dr. Dillmann handles your medical information, how Dr. Dillmann uses this information in this office, how it is shared with other professionals/organizations, and how you can see it. Dr. Dillmann wants you to know all of this so that you can make the best decisions for yourself. If you have any questions or want to know more about anything in this notice, please ask Dr. Dillmann, the privacy officer, for more explanations/ details.

What is meant by your medical information

Each time you visit Dr. Dillmann or any doctor’s office, hospital, clinic, or other health care provider, information is collected about you and your physical and mental health. It may be information about your past, present, or future health or conditions, or the tests and treatment you got from me or from others, or about payment for health care. The information Dr. Dillmann collects from you is called “PHI,” which stands for “protected health information.” This information goes into your medical or health care record.

In this office, your PHI is likely to include these kinds of information:

- Your history: Things that have happened to you; your life experiences; relationships & personal data.

- Reasons you came for treatment: Your problems, complaints, symptoms, or needs.

- Diagnoses: These are the medical terms for your problems or symptoms.

- A treatment plan: This is a list of the treatments that Dr. Dillmann thinks will best help you.

- Progress notes: Each time you come in, Dr. Dillmann writes a note that summarizes how you are doing, what Dr. Dillmann notices about you, and what you tell her.

- Records Dr. Dillmann gets from others who have treated you or evaluated you.

- Psychological test scores, school records, and other reports.

- Information about medications you took or are taking.

- Legal matters.

- Billing and insurance information

- There may also be other kinds of information that go into your health care records here.

Dr. Dillmann uses PHI for many purposes. For example:

- To plan your care and treatment.

- To decide how well treatments is working for you.

- When to talk with other health care professionals, with your consent, who are also treating you.

- To show that you actually received services, which Dr. Dillmann billed for.

- For teaching and training other health care professionals.

- For medical or psychological research.

- For public health officials trying to improve health care in this area of the country.

- To improve the way Dr. Dillmann does this job by measuring the results of therapy.

When you understand what is in your record and what it is used for, you can make better decisions about who, when, and why others should have this information. Although your health care records are Dr. Dillmann’s physical property, the information within them belongs to you. You can read your records, and if you want a copy Dr. Dillmann can make one for you (there may be a charge for the costs of copying and mailing, if you want it mailed to you). In some very rare situations, you cannot see all of what is in your records. If you find anything in your records that you think is incorrect or believe that something important is missing, you can ask Dr. Dillmann to amend (add information to) your records, although in some rare situations Dr. Dillmann doesn’t have to agree to do that. If you want, the privacy officer, Dr. Dillmann, can explain more about this.

Privacy and the laws about privacy

Dr. Dillmann is required to tell you about privacy because of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires Dr. Dillmann to keep your PHI private and to give you this notice about Dr. Dillmann’s legal duties and privacy practices. Dr. Dillmann will obey the rules described in this notice. If Dr. Dillmann changes the privacy practices, they will apply to all the PHI. Dr. Dillmann will also post the new notice of privacy practices in the office where everyone can see. You or anyone else can also get a copy from the privacy officer at any time. It is also posted on Dr. Dillmann’s website at www.drdillmann.com .

How your protected health information can be used and shared

Except in some special circumstances, when Dr. Dillmann uses your PHI in this office or discloses it to others, Dr. Dillmann will share only the minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know about your PHI, to know how it is used, and to have a say in how it is shared. Dr. Dillmann primarily uses and discloses your PHI for routine purposes to provide for your care. For other uses, Dr. Dillmann must tell you about them and ask you to sign a written authorization form. However, the law also says that there are some uses and disclosures that don’t need your consent or authorization.

1. Uses and disclosures with your consent

After you have read this notice, you will be asked to sign a separate consent form to allow me to use and share your PHI. In almost all cases Dr. Dillmann intends to use your PHI here or share it with other people or organizations to provide treatment to you, arrange for payment for services, or some other business functions called “health care operations.” In other words, Dr. Dillmann needs information about you and your condition to provide care to you. You have to agree to let me collect the information, use it, and share it to care for you properly. Therefore, you must sign the consent form before Dr. Dillmann begins to treat you. If you do not agree and consent Dr. Dillmann cannot treat you.

a. The basic uses and disclosure: For treatment, payment, and health care operations

For treatment. Dr. Dillmann uses your medical information to provide you with psychological treatments or services. These might include individual, family, or group therapy; psychological, educational, or vocational testing; treatment planning; or measuring the benefits of our services.

Dr. Dillmann may share your PHI with others who provide or who will provide treatment to you only with your consent.

For payment. Dr. Dillmann may use your information to bill you, your insurance or a third party. Dr. Dillmann may contact your insurance company to find out exactly what your insurance covers. Dr. Dillmann may have to tell them about your diagnoses, what treatments you have received, & expected changes in your conditions. Dr. Dillmann will need to tell them about when sessions occurred, your progress, & similar information.

For health care operations. Using or disclosing your PHI for health care operations goes beyond Dr. Dillmann’s care and your payment. For example, Dr. Dillmann may use your PHI to see where Dr. Dillmann can make improvements in the care and services provided. Dr. Dillmann may be required to supply some information to some government health agencies, so they can study disorders and treatment and make plans for services that are needed. If such information is shared, your name and personal information will be removed from what Dr. Dillmann sends.

b. Other uses and disclosures in health care

Appointment reminders. Dr. Dillmann may use and disclose your PHI to reschedule or remind you of appointments for treatment or other care. If you want Dr. Dillmann to call or write to you only at your home or your work, or you prefer an alternate means for contact, Dr. Dillmann can usually arrange that.

Treatment alternatives. Dr. Dillmann may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of help to you.

Other benefits and services. Dr. Dillmann may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.

Research. Dr. Dillmann may use or share your PHI to do research to improve treatments—for example, comparing two treatments for the same disorder, to see which works better or faster or costs less. In all cases, your name, address, and other personal information will be removed from the information given to researchers. If they need to know who you are, Dr. Dillmann will discuss the research project with you, and Dr. Dillmann will not send any information unless you sign a special authorization form.

2. Uses and disclosures that require your authorization

If Dr. Dillmann wants to use your information for any purpose besides those described above, Dr. Dillmann needs your permission on an authorization form. Dr. Dillmann doesn’t expect to need this very often. If you do allow Dr. Dillmann to use or disclose your PHI, you can cancel that permission in writing at any time. Dr. Dillmann would then stop using or disclosing your information for that purpose. Of course, Dr. Dillmann cannot take back any information already disclosed or used with your permission.

3. Uses and disclosures that don’t require your consent or authorization

The law lets us use and disclose some of your PHI without your consent or authorization in some cases. Here are some examples of when Dr. Dillmann might do this.

a. When required by law

There are some federal, state, or local laws that require us to disclose PHI:

- Dr. Dillmann has to report suspected child abuse. If you are involved in a lawsuit or legal proceeding, and Dr. Dillmann receives a subpoena, discovery request, or other lawful process, Dr. Dillmann may have to release some of your PHI. Dr. Dillmann will only do so after trying to tell you about the request, consulting your lawyer, or trying to get a court order to protect the information they requested.

- Dr. Dillmann has to disclose some information to the government agencies that check to see that Dr. Dillmann is obeying the privacy laws.

b. For law enforcement purposes

Dr. Dillmann may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.

c. For public health activities

Dr. Dillmann may disclose some of your PHI to agencies that investigate diseases or injuries.

d. Relating to decedents

Dr. Dillmann may disclose PHI to coroners, medical examiners, or funeral directors, and to organizations relating to organ, eye, or tissue donations or transplants.

e. For specific government functions

Dr. Dillmann may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment. Dr. Dillmann may disclose your PHI to workers’ compensation and disability programs, to correctional facilities if you are an inmate, or to other government agencies for national security reasons.

f. To prevent a serious threat to health or safety

If Dr. Dillmann comes to believe that there is a serious threat to your health or safety, or that of another person or the public, Dr. Dillmann can disclose some of your PHI. Dr. Dillmann will only do this to persons who can prevent the danger.

4. Uses and disclosures where you have an opportunity to object

Dr. Dillmann will only share information about you with your family or close others if you complete an authorization to release information. Dr. Dillmann will ask you what information you to have shared. You can tell Dr. Dillmann what you want, and Dr. Dillmann will honor your wishes as long as it is not against the law.

If it is an emergency, and Dr. Dillmann cannot ask if you disagree, Dr. Dillmann can share information if Dr. Dillmann believes that it is what you would have wanted and if Dr. Dillmann believes it will help you. If Dr. Dillmann does share information, in an emergency, Dr. Dillmann will tell you as soon as possible. If you do not approve Dr. Dillmann will stop, as long as it is not against the law.

5. An accounting of disclosures Dr. Dillmann has made

When Dr. Dillmann discloses your PHI, Dr. Dillmann will keep a record of whom the information was share with, what was shared and when it was shared. You can get an accounting (a list) of these disclosures.

E. Your rights concerning your health information

1. You can ask Dr. Dillmann to communicate with you about your health and related issues in a particular way or at a certain place that is more private for you. For example, you can ask Dr. Dillmann to call you at home, and not at work, to schedule or cancel an appointment.

2. You have the right to ask Dr. Dillmann to limit what is shared with people who are involved in your care or with payment for your care, such as family members and friends. Dr. Dillmann does not have to agree to your request, but if Dr. Dillmann can agree, Dr. Dillmann will honor it except: when it is against the law, is an emergency, when the information is necessary to treat you.

3. You have the right to look at the health information Dr. Dillmann has about you, such as your medical and billing records. You can get a copy of these records, but Dr. Dillmann may charge you. Contact the privacy officer, which is Dr. Dillmann, to arrange how to see your records.

4. If you believe that the information in your records is incorrect or missing something important, you can ask Dr. Dillmann to make additions to your records to correct the situation. You have to make this request in writing and send it to the privacy officer. You must state the reasons you want to make the changes. This information would then be added to your file; however, the original information will not be deleted out of your file – rather the information you provide will amend the file.

5. You have the right to a copy of this notice. If Dr. Dillmann changes this notice, Dr. Dillmann will post the new one in the office, on the website and you can always get a copy from the privacy officer.

6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our privacy officer and with U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. All complaints must be in writing. Filing a complaint will not change the health care Dr. Dillmann provides to you. You may have other rights that are granted to you by the laws of California, and these may be the same as or different from the rights described above. Dr. Dillmann will be happy to discuss these situations with you now or as they arise.

F. If you have questions or problems

If you need more information or have questions about the privacy practices described above, please speak to the privacy officer, who is Dr. Dillmann. If you have a problem with how your PHI has been handled, or if you believe your privacy rights have been violated, contact the privacy officer. As stated above, you have the right to file a complaint. Dr. Dillmann pledges not to limit your care or take any actions against you if you complain. If you have any questions or problems about this notice or Dr. Dillmann’s health information privacy policies, please contact the privacy officer: Susanne M. Dillmann, Psy.D, contact information is: 210 S. Juniper St., Suite 213; Escondido, CA 92025; 760-743-7789; www.drdillmann.com

For more information about understanding HIPAA and these privacy matters, you can visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html and http://dhcs.ca.gov/privacyoffice