Privacy and Practice Policies
Practice Policies
Welcome to my psychotherapy practice. I look forward to working together. Please read the following description of my practice policies carefully. I will happily answer any questions you have about this information (psst; feel free to text or email me if you have any questions that come up as you’re going through this). Your signature on this document is an agreement between us to work together.
Psychotherapy Practice
Seeking psychotherapy is a major decision. There is no “one-size-fits-all” for therapy as every therapist and client different. Your needs are unique, and so the solutions we come up with together will be unique to you. Our first few sessions will include an assessment of your needs. Additionally, I will ask questions to better get to know you (social history, academic and professional history, strengths, challenges, etc.). Having a broad understanding of who you are helps me better serve you.
After the initial assessments, together, we will develop a treatment plan to best address these needs. I seek feedback in therapy to ensure therapy is meeting your needs. I hope to adjust the therapy process to best meet your needs. Further I hope to address any concerns or questions you have in our sessions. If you are not satisfied with your therapy, I will assist you in finding another mental health professional.
Psychotherapy may have both risks and benefits. Discussing problems and difficulties may bring up unpleasant feelings, such as distress, sadness, anxiety, anger, guilt, and helplessness. However, actively addressing problems and difficulties may lead to improved relationships, reduction in feelings of depression and anxiety, resolution to specific problems, and better understanding of oneself. Because each client is unique, there are no guarantees of how you will experience psychotherapy.
Sessions
For individual sessions, therapy sessions are 53 minutes (I know it’s a weird time limit… it’s set by insurance companies). For simplicity, whether you are paying privately or with insurance, we will adhere to the 53 minutes for each session.
I generally see people once a week to once every two weeks. The first 1-3 sessions will involve an evaluation of what you would like to get out of therapy and whether we will be a good fit in order to work together.
Punctuality
I do my best to begin and end sessions on time. If I start your session late, I will extend your appointment to ensure you get the full 53-minute session. If you are late a few minutes to a session, the session will end at the normally scheduled time.
I will wait 20 minutes for you to join virtually or arrive in-person to your session. If you have not arrived or contacted me within that time, the appointment will be considered a “no-show,” and you will be charged the full session fee. If you are running late, please let me know by texting 801-513-1328 or emailing CL@ChristofferLoderup.com.
Payment
Whether you have a copay or pay the full session rate, I see clients on a fee-for-service basis. During our initial phone conversation or in-person session, we will discuss my rates and your insurance coverage. My current rate for therapy is $200 for the first 50-minute session, and $165 for all following 50-minute sessions. In order to keep pace with inflation, my rates will increase by 3% to 5% each year. Separate from an “inflation raise”, as my experience and training increases, I will increase my rates more akin to a “promotion”. I will give at least 30 days’ notice before making any rate increases.
During our work together, if for any reason you are unable to afford my rates, be it from rate increases, or changes to your financial situation, please discuss this with me. I have a limited number of sliding scale spots available, and if available and needed, we may be able to modify rates to better accommodate your financial situation.
Insurance
I currently work with Aetna (commercial plans), Blue Cross Blue Shield (BCBS), Regence, University of Utah Health Plans, Select Health, and HMHI-BHN insurance. At the time of our visit, you are responsible for your co-pay and I will file your insurance for the reimbursement. If you are insured with another carrier, you may contact that insurance carrier about out-of-network provider benefits. If you decide to file out-of-network benefits with your insurance carrier, I can provide you with necessary codes and documentation.
Due to the complications in working with insurance companies, if you are covered by two insurance companies, you will be responsible for the full session fee at the beginning of each session. I will provide you the necessary codes and documentation for you to submit the claims to your insurance companies and seek reimbursement yourself.
Past Due Balances
Accounts that are over 60 days past due may be turned over to a collection agency or charged interest. The accrued interest will be added to account balances. Names and necessary information will be released to collection agencies.
I agree that interest will accrue on all past due amounts at the rate of 18% per annum (1.5% per month) until paid in full. In the event any amount(s) is/are referred to a third-party debt collection agency, I agree to pay a collection fee of 33.33%, interest, court costs, and reasonable attorney’s fees.
Cancellations
If you need to cancel or reschedule an appointment, please provide 24 hours advance notice. If you cancel within a 24-hour period, you will charged the full session fee via the credit card you provide for me to keep on file. This is necessary because a time commitment is made to you and is held exclusively for you. If you are using insurance, please note insurance companies do not reimburse late-cancellation fees, and you will be responsible for the full out-of-pocket session fee. If you or a dependent family member are sick and unable to make an in-person appointment, we can move the appointment online or I will charge my full rate for a late cancellation.
Teletherapy
I offer teletherapy sessions through a HIPAA-compliant platform called Simple Practice. Should we decide to meet virtually, I will provide you with a separate electronic teletherapy consent form, and we will discuss mutual boundaries regarding privacy and location to ensure our sessions are secure and effective.
For our work to be productive, whether meeting in-person or virtually, I expect you to be fully present. For teletherapy, this includes being in a private, stationary location. For safety reasons, I will not conduct a session if you are actively driving; you must be parked for the entire duration of our appointment. Similarly, if I get the impression you are significantly distracted or engaged in other activities during a virtual session, I will address it. If you are unable to meet these expectations, it will result in the session being ended and treated as a late cancellation.
Additional Services
For clients seeking a letter for an emotional support animal, in most cases, I require that we meet weekly for six months or every other week for one year. Meeting for this duration of time allows me to better understand your individual situation and the potential role of an emotional support animal. I do not write letters for emotional support animals based on housing concerns, such as wanting a pet in a location with a no pet clause on the lease.
I pro-rate my hourly session rate ($165) for all letter writing and requested documentation (i.e. disability paperwork, ESA letters, requests of records, etc.).
Illness Concerns
If either one of us has a contagious illness, I recommend either wearing masks or moving our sessions online. I will occasionally mask if I have upcoming travel/important event. I am happy to mask during our sessions for any reason to help you feel more comfortable.
Contact information
It is best to text or email me for concerns related to scheduling. I generally check my texts, emails, and voicemail throughout the day and return communications within 24 hours. If you are experiencing a psychiatrist or medical emergency, you should call 911 or go to nearest emergency room. If I am on vacation and unavailable, I will give you the contact information of a back-up mental health professional if you are in need of more immediate assistance.
Confidentiality
State and federal laws protect your personal health information and ensure the confidentiality of your treatment. I respect your privacy and am committed to maintaining confidentiality of your treatment, our sessions, and our conversations. In order to share information with other health professionals, you will need to provide a signed “release of information.” However, there are a few exceptions to maintaining your confidentiality:
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If I believe a client is at risk of hurting him or herself, I may be obligated to seek hospitalization and/or contact family members who may help provide protection to the client.
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If I believe that a client is at risk of hurting someone else, I am required to contact authorities and/or the other person in order to provide protection.
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If I suspect that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years, I am required by law to contact the authorities to provide protection.
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If a client becomes involved in a lawsuit in which mental health is an issue, the court or lawyers may obtain information from me.
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If an account is 60 days past due, I may notify a collection agency and release a client’s name and necessary contact information.
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Clients who are under 18 years-old are considered minors in the state of Utah. I may share information related to client safety to minor client’s parents and/or legal guardians.
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In order to best meet your needs, I may seek consultation or supervision from another licensed mental health professional. If this is the case, all identifying information and your confidentiality will be protected.
Electronic Communication
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine. Telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:
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You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
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All existing confidentiality protections are equally applicable.
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Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
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Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
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There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.
Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences.
When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression.
Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.
Minors
If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.
Recording Sessions
While Utah is a one-party consent state regarding the recording of conversations, you agree as a condition of your treatment not to record any portion of your therapy sessions (audio or video) without first obtaining explicit (verbal or written) consent from me.
Termination
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for four consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
International Therapy
If needed to conduct psychotherapy, I explicitly consent to the transfer of my health data to the United States for processing.
Social Media
Social media is a great tool to help people stay connected to and informed about their communities. To be transparent with you, I have created this social media policy to help you understand how I use social media and how it could impact you and your relationship with me. If you have any questions about this policy, don’t hesitate to ask me.
The main purpose for these policies is to protect your privacy and to protect the therapeutic relationship we will develop (or have already developed). Regarding confidentiality, you get to decide what you keep confidential and what you share. I must keep my relationship with you completely confidential unless in cases where you might harm yourself or others. Consequently, if you post or comment on a professional social media page connected to me, people may infer you see a therapist here. Simply put, you get to choose what you share online. By I will never share my connection to you with others.
The following explains how I handle different social media situations:
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Confidentiality and Boundaries: While I am your therapist, I may have professional social media accounts. These professional accounts are kept separate from my personal social accounts. There is no expectation for you to follow or engage with these accounts. You are welcome to follow or like professional social media accounts, but know that I will not engage in counseling or give professional help via these pages. You can comment on these pages, but please know doing so may compromise your confidentiality and privacy if you reveal yourself as a client. I will not accept friend requests to my personal social media accounts from clients (current or past).
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Purpose of Social Media Accounts: Professional social media accounts are to share mental health articles, quotes, and blog posts. Professional counseling, therapy, or individual help will not be given through social media accounts.
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Friending: To respect your privacy and confidentiality, I do not accept friend requests on personal accounts from current or former clients on any social networking site. Further, I don’t accept friend requests to my professional pages either.
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Liking: You can choose to “like'' blogs, or Facebook or Instagram pages or posts. But please know that doing so, you are choosing to reveal that you are connected to us in some way.
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Following: I may have accounts that you can “follow”. I have no expectations that you will follow any social media accounts. You are welcome to decide for yourself if you want to follow my professional social media accounts. Please know, I will not follow you back to protect your privacy. I mainly follow other professional accounts. If there are things from your online life that you wish to share with me, please share them in your sessions where we can fully explore them together.
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Interacting and Communication: The best way to interact with me between sessions is to give me a phone call, text, or email. I ask that you do not contact me via social media messaging for private matters. I don’t monitor these as frequently, and wouldn’t want to miss your message in the case of an emergency. You can comment on public social media pages, but because I won’t disclose that you are my client, I would interact with you as if I don’t know you.
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Client Reviews and Online Presence: I do not ask for clients to review me directly. If you choose to do so, due to privacy laws, I will not be able to acknowledge any reviews publicly however you may discuss them with me in session.
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Location Based Services: If you used location-based services on your mobile phone, you may wish to be aware of the privacy issues related to using these services. I do not place my practice as a check-in location on various sites such as Foursquare, Gowalla, Loopt, etc. However, if you have GPS tracking enabled on your device, it is possible that others may surmise that you are a therapy client due to regular weekly check-ins at my office. Please be aware of this risk if you are intentionally “checking in” from my office, or if you have a passive location-based-services app enabled on your phone.
TEXTING POLICY (OPTIONAL)
In my work as a therapist, I’ve found that many clients prefer to communicate via texting or messaging apps instead of email. Due to being a healthcare provider, I cannot communicate with you via text messaging and other apps unless:
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I educate you about the risk of using texting as a messaging platform, and…
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You consent to use texting as a communication method fully accepting the risks.
Completely Optional
Please know consenting to use texting as a communication method is completely optional. If you do not want to consent to use texting or other messaging apps, you may click the “documents” section at the top of your screen to go back to the remaining documents you need to sign. By not signing this document, you understand our communication will only be over email, voicemail, and phone calls.
Risks of Using Texting to Communicate
In order to consent to use texting, I am required to explain the risks of texting your private health information. Texting is a non-HIPPA compliant method of communication. It is not always encrypted, and texts can be intercepted, stored, or read, by others. Additionally, there is a risk of someone accessing your texts by opening your phone or laptop.
How to Redact Your Consent
Please note that your consent to this non-mandatory form can be removed at any time by communicating your intent to do so in writing.
MY COMMITMENT TO BEST PRACTICES - RIGHT TO ADJUST POLICIES
To ensure my practice continues to operate effectively and ethically, these policies may be updated periodically. I am committed to transparency and will always provide you with written notice before any policy changes take effect. By signing this agreement, you consent to the current policies and agree to abide by future policies after you have been notified of them.
CONCLUSION
Thank you for taking the time to review my General and Social Media Policies. If you have questions or concerns about any of the policies, please bring them to my attention so that we can discuss them.
Privacy Policies
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. MY PLEDGE REGARDING HEALTH INFORMATION:
I understand that health information about you and your health care is personal. I am committed to protecting your health information. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
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Give you this notice of my legal duties and privacy practices with respect to health information.
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Follow the terms of the notice that is currently in effect.
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I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, and in your patient portal.
2. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
3. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
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Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For my use in treating you. b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
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Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes. Your mobile phone contact information will not be shared or sold to third parties for marketing purposes.
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Sale of PHI. As a psychotherapist, I will never sell your PHI.
4. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:
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When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
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For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
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For health oversight activities, including audits and investigations.
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For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
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For law enforcement purposes, including reporting crimes occurring on my premises.
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To coroners or medical examiners, when such individuals are performing duties authorized by law.
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Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
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For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
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Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
5. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:
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Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
6. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
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The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
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The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
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The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
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The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so.
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The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request.
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The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
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The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
CONCLUSION
Thank you for taking the time to review my Privacy Practices. If you have questions or concerns, please bring them to my attention so that we can discuss them.
