Notice of Privacy Practices

Please review this notice carefully

This notice describes how health information may be used and disclosed and how you can get access to this information.

It applies to the records of care generated by Revibe Therapy. This notice took effect on September 20, 2013. Clients acknowledge receipt during intake. Information collected only because you browsed revibetherapy.com is described in the Privacy Policy.

Our pledge

Health information about you and your care is personal. Revibe Therapy creates a record of the care and services you receive. We need that record to provide care and to meet legal requirements.

• Protected health information that identifies you is kept private.
• We give you this notice of our legal duties and privacy practices.
• We follow the terms of the notice that is currently in effect.
• We can change this notice. A change applies to all information we have about you. The new notice will be available on request, at the office, and on this website.

How we may use and share health information

Federal privacy rules allow a provider in a direct treatment relationship to use or disclose health information, without a separate written authorization, for that provider’s own treatment, payment, or health care operations. We may also disclose protected health information for the treatment activities of another health care provider. For example, a clinician may consult another licensed provider about your condition so that the consultation can assist in diagnosis and treatment.

Disclosures for treatment are not limited to the minimum necessary standard, because providers need access to the full record in order to provide care. Treatment includes coordination of care, consultations between providers, and referrals.

If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information.

Uses that need your authorization

Revibe Therapy keeps psychotherapy notes as that term is defined in 45 CFR § 164.501. Any use or disclosure of those notes requires your authorization, except when the use or disclosure is:

• For use in treating you.
• For training or supervising mental health practitioners in group, joint, family, or individual counseling or therapy.
• For defending the practice in a legal proceeding you institute.
• For use by the Secretary of Health and Human Services to investigate HIPAA compliance.
• Required by law, and limited to what that law requires.
• Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
• Required by a coroner performing duties authorized by law.
• Required to help avert a serious threat to the health and safety of others.

We will not use or disclose your protected health information for marketing purposes. We will not sell your protected health information in the regular course of business.

Uses that do not need your authorization

Subject to the limits in the law, we can use and disclose protected health information without your authorization for the following reasons:

• When disclosure is required by state or federal law, and the use or disclosure stays within what that law requires.
• 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.
• Health oversight activities, including audits and investigations.
• Judicial and administrative proceedings, including a response to a court or administrative order. Our preference is to obtain your authorization before doing so.
• Law enforcement purposes, including reporting crimes occurring on the premises.
• Coroners or medical examiners, when they are performing duties authorized by law.
• Research, including studying and comparing the mental health of patients who received one form of therapy with those who received another form for the same condition.
• Specialized government functions allowed by law, including military missions, protection of the President, intelligence or counter-intelligence operations, and safety in correctional institutions.
• Workers’ compensation. Our preference is to obtain your authorization. We may still provide protected health information when workers’ compensation laws require it.
• Appointment reminders and health-related benefits or services, including a reminder of an appointment and information about treatment alternatives or other services we offer.

Uses you can object to

We may provide your protected health information to a family member, friend, or other person you indicate is involved in your care or the payment for your care, unless you object in whole or in part. In an emergency, the opportunity to consent may be obtained afterward.

Your rights

• You may ask us not to use or disclose certain protected health information for treatment, payment, or health care operations. We are not required to agree. We may say no if we believe it would affect your health care.
• You may request restrictions on disclosures to a health plan for payment or health care operations if the information relates only to an item or service you paid for out of pocket in full.
• You may ask us to contact you in a specific way, or to send mail to a different address. We will agree to all reasonable requests.
• Other than psychotherapy notes, you may get an electronic or paper copy of your medical record and other information we have about you. We will provide a copy, or a summary if you agree to a summary, within 30 days of your written request. We may charge a reasonable, cost-based fee.
• You may request a list of disclosures made for purposes other than treatment, payment, or health care operations, and other than disclosures you authorized. We will respond within 60 days. The list covers the last six years unless you request a shorter time. The first list in a year is free. We may charge a reasonable, cost-based fee for each additional request in the same year.
• You may ask us to correct a mistake in your protected health information or to add missing information. We may say no, and we will tell you why in writing within 60 days of your request.
• You may get a paper or email copy of this notice. Agreeing to email does not take away the right to a paper copy.