Privacy Notice of
Jamie M Glaser LLC
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice gives you information required by the Health Insurance Portability and Accountability Act of 1996 (HIPPA) that prescribes legal duties and privacy practices to protect the privacy of your individual identifiable health information; this is, Protected Health Information (PHI), as that term is defined in the HIPAA under Information.
THE EFFECTIVE DATE OF THIS NOTICE IS January 2013. Jamie M Glaser LLC (Glaser LLC) is required to follow the terms of this Notice until it is replaced. Glaser LLC may make changes to the terms of this Notice at any time. Upon your request, we will provide you with a copy of the current Notice. Glaser LLC reserves the right to make the changes apply to your Information maintained in files before and after the effective date of the new Notice. The following is a general description of how Federal and State law permits me to use and disclose your Information.
Purposes for which Glaser LLC May Use or Disclose Your Mental Health Information with your Consent
Glaser LLC may request your consent for the use and/or disclosure of your Information for treatment, payment or health care operations as described below:
Treatment. I will use and disclose your Information to provide, coordinate, or manage your mental health care and any related services.
Glaser LLC may disclose your Information to physicians, therapists, other mental health providers, or other health care providers who are treating you or assisting in your diagnosis, treatment, or recovery.
Payment. Your Information will be used and disclosed, as needed, to obtain
payment for your mental health care services. This may include certain activities
that your health insurance plan undertakes before it approves or pays for the
mental health care services Glaser LLC recommends for you, such as making a determination
of eligibility or coverage for insurance benefits, reviewing services provided to you
for medical necessity, and utilization review activities. If more than one, third
party payer is responsible for payment for your health care, Glaser LLC may disclose your Information to more than one health plan and those health plans may share your Information with each other. Your Information may also be used and disclosed as needed to obtain payment for mental health care services rendered to you by other providers.
Mental Health Care Operations. Glaser LLC may use or disclose, as needed, your Information in order to support delivery of mental health care services. Glaser LLC may call you by name in the waiting room area, or may use or disclose your Information, as necessary, to contact you to schedule an appointment or remind you of your appointment.
Glaser LLC may share your Information with third party Business Associates who
perform various administrative services. For example, those within Glaser LLC, or with whom Glaser LLC contracts, to perform billing services, transcription services,
record retention, or other professional consultants. Whenever an arrangement between a Business Associate involves the use or disclosure of your Information, we will have a written contract that contains terms that will protect the privacy of your Information.
Health Care Services. Your Information may be used and disclosed to contact you
and to give you information about treatment alternatives or other health benefits and services that may be of interest to you.
Uses and Disclosures With Your Verbal Consent
Your Information may be disclosed to a family member, friend, or other person designated
by you or as designated by the law, if you verbally agree.
Uses and Disclosures with Your Written Authorization
Except as provided below, your Information will not be used for any non-routine
purposes unless you give your written authorization to do so. If you give written
authorization to use or disclose your Information for a purpose that is not described in
this Notice, then, with certain exception, you may revoke it in writing at any time. Your
revocation will be effective for the Information I maintain, unless Glaser LLC has taken action in reliance on your authorization.
Uses and Disclosures Without Your Consent
As required by law;
-
To comply with legal proceedings, such as a court or administrative order or subpoena;
-
To law enforcement officials for limited law enforcement purposes;
-
To a coroner, medical examiner, or funeral director about a deceased person;
-
To avert a serious threat to your health or safety or the health or safety of others;
-
To a governmental agency authorized to oversee the mental health care system or
-
government programs;
-
To federal officials for lawful intelligence, counterintelligence, and other national
-
security purposes; and
-
To public mental health authorities for public health purposes.
Your Rights
You may make a written request to Glaser LLC to do one or more of the following concerning
your Information:
-
Put additional restrictions on use and disclosure of your Information.
-
Communicate with you in confidence about your Information by a different means than I am currently doing.
-
See and get copies of your Information.
-
Receive a list of disclosures of your Information that Glaser LLC has made for certain purposes for six (6) years prior to your request (after January 2013), with
-
certain exceptions permitted by law, which includes exceptions for disclosure made directly to you or made pursuant to your authorization.
If you want to exercise any of these rights or require further information about privacy practices, please contact me at the address below. In certain instances, Glaser LLC is not required to agree to your request. Glaser LLC will give you the necessary information and forms for you to complete and return to request your Information. Glaser LLC is permitted, by law, to charge you a fee for copying any documents requested in accordance with your rights as listed above. (Fee $1.00 per page.)
Complaints
If you believe that Glaser LLC violated your privacy rights, you have the right to complain to me or to the Secretary of the U.S. Department of Health and Human Services (DHHS). You may file a written complaint with me at the address below. An individual must file a complaint within 180 days of when he/she knew or should have known that the act or omission occurred, unless the time limit is waived by the Secretary of DHHS. Glaser LLC will not retaliate against you if you choose to file a complaint.
Contact Address
Jamie M Glaser LLC
1809 E. Joppa Road
Parkville, MD 21234