Gail A. Shade, M.A. LLC
WV Licensed Professional Counselor
WV Licensed Social Worker

(304) 258-5353
NOTICE OF PRIVACY PRACTICES

 

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.

 

My Commitment to Your Privacy

 

My practice is dedicated to maintaining the privacy of your personal information. We are required also by law to do this. These laws are complicated, but we must provide you with this important information. This notice is a shorter version of the full, legally required Notice of Privacy Practices (NPP). This complete document is in the waiting area if you choose to review it. We cannot cover all possible situations so please talk with me about any questions or problems.

 

By signing and agreeing to the Informed Consent, you are authorizing me to share certain information with other people in order to provide you with treatment, to arrange payment for my services or for some other business activities, which are called, in the law, health care operations. Please note that this information is very specific. After you have read this NPP, I will ask you to sign a Consent Form to let me use and share this information. If you do not consent and sign this form, I cannot treat you.

 

If I want to use or disclose (send, share, release) your Information for any other purposes I will discuss this with you and ask you to sign a specific authorization for the release of your PHI. I will never use or disclose your PHI for marketing purposes or for any sale of such information.

 

There are some instances, as described in the Informed Consent, when personal information must be divulged: 1) If I suspect that you may do harm to yourself or others, I will share information with a person or organization who is able to help prevent or reduce the threat; 2) If you tell me, or suspect, abuse or molestation to a child, elderly or disabled person; 3) If you choose to waive your right to privacy by written or verbal authorization; or 4) an Order by the Court.

 

Your Rights Regarding Your Health Information

 

  1. You can ask me to communicate with you about your mental health and related issues in a particular way or at a certain place. For example, you can ask me to call you at home and not at work to schedule or cancel an appointment. This is indicated on the Client Information Sheet that you filled out. I will try my best to do as you ask.

  2. You have the right to ask about information that we have about you in your file. We do not store your records electronically at this time. Access to your psychotherapy sessions notes will only be disclosed at our discretion. In some cases, a summary letter of your treatment may be more acceptable. Your psychotherapy notes may be released to the appropriate licensing board in response to a complaint that has been filed against the practice.
  3. If you believe the information in your records is incorrect or incomplete, you can ask me to make some kinds of changes (called amending) to your mental health information. You have to make this request in writing. You must tell me the reasons you want to make the changes. Changes are made at my professional discretion.

  4. I do dictate psychotherapy notes electronically. These notes are transcribed and returned to my computer electronically. All transmissions, both outbound and inbound are encrypted.
  5. We currently do the majority of our insurance billing electronically. We use the government required standards for PCI compliance at all times.

    In regard to the insurance billing and information, you as the client do have the right to restrict certain information to your health care plans where you have paid out-of-pocket. We will not release this information unless you specifically tell us to do so.

  6. At this time, we do not correspond with clients through email. In the event that we would agree to accept emails, it would be for informational purposes only, e.g. receipt of letters, legal documents, etc. In most cases this email may not be encrypted. As a result, the information contained in the email could be at risk. We do accept fax that come directly to my desk.

  7. In the event that any of your PHI has been compromised, you will be notified of such risk and to what degree, e.g., burglary, hacking, etc. We take great precaution to protect all PHI.

    You have the right to file a complaint if you believe your privacy has been violated. You can file a complaint with me and with the Secretary of the Department of Health and Human Services. All complaints must be in writing.

  8. You have a right to a copy of this notice.

 

 

If you have any questions regarding this notice or my information privacy policies, please contact me at 304-258-5353.

 

 

THE EFFECTIVE DATE OF THIS NOTICE IS JANUARY 1, 2015