Notice of Psychologists' Policies and Practices to Protect the Privacy of Your Health Information

Please Note-Dr. Howard Gurr and Dr. Robbin Gurr comply with the following Federal Guidelines and are responsible for their own patient's information and records. Therefore, the following information independently applies to each of the Doctors .

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL

INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

I.  Uses and Disclosures for Treatment, Payment, and Health Care Operations 

I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help

clarify these terms, here are some definitions:

• "PHI" refers to information in your health record that could identify you.
  

• "Treatment, Payment and Health Care Operations"
  

- Treatment is when I provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist.

• Payment is when I obtain reimbursement for your healthcare. 
  

Examples of payment are when I disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

• Health Care Operations are activities that relate to the performance and operation of my practice.  Examples of health care
  

operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

• "Use" applies only to activities within my [office, clinic, practice group, etc.] such as sharing, employing, applying, utilizing, examining, and
  

        analyzing information that identifies you.

• "Disclosure" applies to activities outside of my [office, clinic, practice group, etc.], such as releasing, transferring, or providing access to
  

       information about you to other parties.

II.  Uses and Disclosures Requiring Authorization

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An "authorization" is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when I am asked for information for purposes outside of treatment, payment and health care

operations, I will obtain an authorization from you before releasing this information.  I will also need to obtain an authorization before releasing your

psychotherapy notes. "Psychotherapy notes" are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record.  These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III.  Uses and Disclosures with Neither Consent nor Authorization

I may use or disclose PHI without your consent or authorization in the

following circumstances:

• Child Abuse: If, in my professional capacity, a child comes before me which I have reasonable cause to suspect is an abused or maltreated child, or I have reasonable cause to suspect a child is abused or maltreated where the parent, guardian, custodian or other person legally responsible for such child comes before me in my professional or official capacity and states from personal knowledge facts, conditions or circumstances which, if
  

correct, would render the child an abused or maltreated child, I must report such abuse or maltreatment to the statewide central register of child abuse and maltreatment, or the local child protective services agency.

• Health Oversight: If there is an inquiry or complaint about my professional conduct to the New York State Board for Psychology, I must furnish to the New York Commissioner of Education, your confidential
  

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