• Judicial or Administrative Proceedings: If you are involved in a court
  

proceeding and a request is made for information about the professional

services that I have provided you and/or the records thereof, such information is privileged under state law, and I must not release this information without your  written authorization, or a court order.  This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered.  I must inform you in advance if this is the case.

• Serious Threat to Health or Safety: I may disclose your confidential
  

        information to protect you or others from a serious threat of harm by you.

• Worker's Compensation: If you file a worker's compensation claim, and I am treating you for the issues involved with that complaint, then I must furnish to the chairman of the Worker's Compensation Board records which contain information regarding your psychological condition and treatment.
  

IV.  Patient's Rights and Psychologist's Duties

Patient's Rights:

• Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.
  

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations - You have the right to request and receive
  

confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me.  Upon your request, I will send your bills to another address.)

• Right to Inspect and Copy - You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is
  

maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, I will discuss with you the details of the request and denial

        process.

• Right to Amend - You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request.  On your request, I will discuss with you the details of the amendment
  

        process.

• Right to an Accounting - You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided
  

        consent nor authorization (as described in Section III of this Notice).  On       your request, I will discuss with you the details of the accounting process.

• Right to a Paper Copy - You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.
  

Psychologist's Duties:

• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
  

• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
  

• If I revise my policies and procedures, I will notify patients in person and on my website.
  

V.  Complaints

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may contact Dr.

Howard Gurr or Dr. Robbin Gurr, as appropriate.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.  The person listed above can provide you with the

appropriate address upon request.

VI. Effective Date, Restrictions and Changes to Privacy Policy

This notice will go into effect on April 14, 2003.

I reserve the right to change the terms of this notice and to make the new notice

provisions effective for all PHI that I maintain.  If such a change is made I will

provide patients with a revised  written notice and a change on the website.