Kimberly Brooks Mazella LPC
Individual & Couples Therapy
6723 Whittier Avenue, Suite 206
McLean, VA 22101
NOTICE OF PRIVACY PRACTICES
This notice describes how medical and mental health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
During the process of providing services to you, Kimberly M. Brooks, LPC, PLLC, will obtain, record, and use mental health and medical information about you that is protected health information. Ordinarily that information is confidential and will not be used or disclosed, except as described below. This Notice is required by a federal law known as HIPAA and describes how your protected health information may be used and disclosed in accordance with that law. Kimberly M. Brooks, LPC, PLLC is required to abide by the terms of this Notice, or any amended Notice that may follow.
This Notice is effective September 23, 2013.
My Obligations. Kimberly M. Brooks, LPC, PLLC is required by State and Federal law to maintain the privacy of protected health information. Kimberly M. Brooks, LPC, PLLC is required by law to provide clients with notice of my legal duties and privacy practices with respect to protected health information. There are circumstances where other state and federal laws are more stringent (strict) than HIPAA, and in such cases, I will follow those laws with respect to the limitation on uses and disclosures of your information. I will notify you of a breach of your unsecured protected health information.
Uses and Disclosures. Kimberly M. Brooks, LPC, PLLC may use and disclose protected health information without your consent in the following ways:
Treatment. Kimberly M. Brooks, LPC, PLLC will use and disclose your health information to provide, coordinate, or manage health care (including mental health care) and related services. For example, staff involved with your care may use your information to plan your course of treatment and consult with your psychiatrist or primary care physician to ensure the most appropriate methods are being used to assist you.
Payment. Kimberly M. Brooks, LPC, PLLC will use and disclose your health information for payment purposes. For example, Kimberly M. Brooks, LPC, PLLC will use your information to develop accounts receivable information, bill you, and with your consent, provide information to your insurance company for services provided. The information provided to insurers and other third party payers may include information that identifies you, your diagnosis, type of service, date of service, provider name/identifier, and other information about your condition and treatment.
Health Care Operations. Health Care Operations refers to activities undertaken by Kimberly M. Brooks, LPC, PLLC that are regular functions of management and administrative activities. For example, Kimberly M. Brooks, LPC, PLLC PLLC may use and disclose your health information in monitoring of service quality, staff training and evaluation, medical reviews, legal services, auditing functions, compliance programs, business planning, and accreditation, certification, licensing and credentialing activities.
Contacting the Client. I may contact you to remind you of appointments and to tell you about treatments or other services that might be of benefit to you.
Required by Law. Kimberly M. Brooks, LPC, PLLC will disclose protected health information when required by law or necessary for health care oversight. This includes, but is not limited to: (a) reporting child abuse or neglect; (b) when court ordered to release information; (c) when there is a legal duty to warn or take action regarding imminent danger to others; (d) when required to report certain communicable diseases and certain injuries; and (e) when a coroner is investigating a client’s death.
Health Oversight Activities. Kimberly M. Brooks, LPC, PLLC will disclose protected health information to health oversight agencies for oversight activities authorized by law and necessary for the oversight of the health care system, government health care benefit programs, regulatory programs, or determining compliance with program standards.
Family Members. Except for certain minors, incompetent clients, or involuntary clients, protected health information cannot be provided to family members without the client’s consent. In situations where family members are present during a discussion with the client, and it can be reasonably inferred from the circumstances that the client does not object, information may be disclosed in the course of that discussion. However, if the client objects, protected health information will not be disclosed.
Crimes on the premises or observed by Kimberly M. Brooks, LPC, PLLC. Crimes that are observed by staff, that are directed toward staff, or occur on Kimberly M. Brooks, LPC, PLLC’s premises will be reported to law enforcement.
Business Associates. Some of the functions of Kimberly M. Brooks, LPC, PLLC are provided by contracts with business associates. For example, some administrative, clinical, quality assurance, billing, legal, auditing, and practice management services may be provided by contracting with outside entities to perform those services. Business associates are required to enter into an agreement maintaining e privacy of protected health information.
Research. Kimberly M. Brooks, LPC, PLLC may use or disclose protected health information for research purposes if the review board has a granted a waiver of the authorization requirement or the information is de-identified.
Involuntary Clients. Pursuant to state law, information regarding clients who are being treated involuntarily will be shared with other treatment providers, legal entities, third party payers, and others as necessary to provide care and case management coordination.
Emergencies. In life threatening emergencies I may disclose information necessary to avoid serious harm or death.
Authorizations. Kimberly M. Brooks, LPC, PLLC may not disclose protected health information in any way other than described in this Notice without written authorization. Examples include certain disclosures of psychotherapy notes, marketing communications, and disclosures that constitute a sale of your information. You may revoke authorizations at any time except to the extent Kimberly M. Brooks, LPC, PLLC has already used or disclosed such information.
Your Privacy Rights. You have rights with respect to your protected health information. To exercise any of these rights, contact Kimberly Brooks at 703-238-2499.
Access to Your Information. You have the right to inspect and obtain a copy of the protected health information we maintain about you. There are some limitations to this right, which will be explained to you at the time of your request, if applicable.
Amendment of Your Record. You have the right to request that Kimberly M. Brooks, LPC, PLLC amend (correct) your protected health information. I am not required to amend the record if it is determined that the record is accurate and complete. There are other exceptions, which will be explained to you at the time of your request, if relevant, along with the appeal process available to you.
Accounting of Disclosures. You have the right to know when I have disclosed your information without your consent for purposes other than treatment, payment, and health care operations. There are other exceptions that will be explained to you, if applicable.
Request Restrictions. You have the right to request additional restrictions on the use or disclosure of your health information. Kimberly M. Brooks, LPC, PLLC does not have to agree to that request unless you ask us to restrict disclosure to a health plan that 1) is for payment or health care operations purposes and is not otherwise required by law, and 2) the protected health information relates solely to a health care item or service for which you paid us in full.
Confidential Communications. You have the right to request that I communicate with you by alternative means or at alternative locations. For example, if you do not want Kimberly M. Brooks, LPC, PLLC to mail bills or other materials to your home, you can request that this information be sent to another address. There are limitations to the granting of such requests, which will be explained to you at the time of the request process, if applicable.
Copy of this Notice. You have a right to obtain a copy of this Notice upon request.
Complaints. If you believe Kimberly M. Brooks, LPC, PLLC has violated your privacy rights, you have the right to file a complaint. Please contact Kimberly M. Brooks, LPC, PLLC for information on how to file a complaint. You may also complain to the United States Secretary of Health and Human Services.
Changes to this Notice. Kimberly M. Brooks, LPC, PLLC reserves the right to change the terms of this Notice and to make the new provisions effective for all protected health information that we maintain. When the Notice is revised, the revised Notice will be posted on my website.