Notice of EMH Privacy Practices
Effective on 17 August 2023
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.
Equilibria Mental Health LLC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you and relates to your health, the provision of health care, or payment for the provision of health care. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain. This Notice also briefly addresses confidentiality under Massachusetts law.
YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
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You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.
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The Practice may deny your request if your therapist has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger the life or physical safety of you or another person. You may have a right to have this decision reviewed by a licensed health care professional designated by the Practice to act as a reviewing official.
To amend PHI.
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You can ask to correct PHI you believe is incorrect or incomplete, as long as the Practice created the information you wish to amend. We will not make changes to PHI created by another provider or changes that would make your record inaccurate or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
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The Practice may deny your request to amend PHI. In this event, the Practice will send you a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
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You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.
To limit what is used or shared.
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You can ask the Practice not to use or share PHI for treatment, payment, or health care operations. The Practice will consider your request; however, we are not required to agree to the restriction, with the following exception:
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If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
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You can ask for the Practice not to share your PHI with family members or friends involved with your care or with payment related to your care by submitting to the Practice in writing the specific restriction requested and to whom you want the restriction to apply.
To obtain a list of those with whom your PHI has been shared.
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You can ask for a list, called an accounting, of how and to whom certain of your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
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You can ask for a paper copy of this Notice, even if you agreed to receive this Notice electronically.
To choose someone to act for you.
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If you have given someone medical power of attorney or if someone is your legal guardian or other Personal Representative under Massachusetts law, that person can exercise the rights described above on your behalf.
To file a complaint if you feel your rights are violated.
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You can file a complaint by contacting the Practice using the following information:
Equilibria Mental Health LLC
222 Forbes Rd Suite 207
Braintree, MA 02184
781-990-5310
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You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Rm. 509F, HHH Building, Washington, D.C. 20201, calling 1-877-696-6775, emailing ocrprivacy.@hhs.gov, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
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The Practice will not penalize you or otherwise retaliate against you for filing a complaint or otherwise exercising your rights.
OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal and state law to use and disclose PHI, without your written authorization (unless otherwise noted), for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you.
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The Practice can use PHI to provide treatment and other services to you. With your consent, the Practice can share PHI with other professionals who are treating you.
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Example: Your primary care doctor asks about your mental health treatment – with your consent, the Practice can share your information with your primary care doctor.
To engage in our health care operations.
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The Practice can use, and with your consent, share PHI to support the day-to-day activities and management of the Practice.
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Example: The Practice uses and discloses PHI to engage in quality review and improvement and conduct business planning and development.
To seek payment for your services.
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The Practice can use, and with your consent, share PHI to bill and get payment from you, health plans or others for the services provided to you.
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Example: The Practice gives PHI to your health insurance plan so it will pay the Practice for your services.
2. Uses and Disclosures of PHI That May Be Made Without Your Authorization, Consent or Opportunity to Object
Information related to your care: The Practice may use your PHI to communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings. The Practice also may use your PHI to identify health-related services and products provided by the Practice that may be beneficial to your health and then contact you about the services and products. The Practice will not use or disclose your PHI for purposes of marketing (as defined by federal privacy laws) without first obtaining your prior authorization.
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Public health: Your PHI may be disclosed for public health purposes as required by law. For instance, the Practice is required to: (1) report cases of child abuse and neglect, elder abuse, disabled persons abuse, rape, and sexual assault; (2) report medical information for the purpose of preventing or controlling disease, injury or disability; (3) report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) report information to your insurer and/or the Massachusetts Industrial Accident Board (and any party involved in the Workers’ Compensation matter) as required under laws addressing work-related illnesses and injuries or workplace medical surveillance; (5) if we know or have reason to believe that you are infected with a venereal disease, to alert your fiancée, if you are engaged, or your spouse, if you are married; and (6) file a death certificate.
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Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the federal laws and regulations that protect the privacy of your PHI.
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Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
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Serious threat to health or safety: To prevent or lessen a serious and imminent danger to you or to others if the disclosure is to a person who is reasonably able to lessen or prevent the threat, including the target of the threat, and the disclosure otherwise meets the requirements of applicable state law.
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Required by law: If required by federal, state or local law.
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Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request or other lawful process in the course of a judicial or administrative proceeding.
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Law enforcement: To the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena accompanied by a court order.
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Specialized Government Functions: to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances as required by law.
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Workers' Compensation: To comply with workers' compensation laws.
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Coroners, Medical Examiners and Funeral Directors: As required or permitted by law, to enable them to perform their legally authorized duties.
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Organ Donation and Tissue Procurement: To facilitate organ, eye or tissue donation, procurement, banking or transplantation if you are an organ donor.
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Research: For research that has been approved by an institutional review board if the board has approved a waiver of authorization for such use or disclosure.
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Inmates: The Practice may disclose PHI to a correctional institution or a law enforcement official having lawful custody of an inmate if the correctional institution or such law enforcement official represents that such PHI is necessary for certain reasons.
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Ordered examinations: The Practice may release your PHI when required to report findings from an examination ordered by a court or detention facility.
Business Associates: To organizations that need PHI to perform certain functions, activities or services on our behalf, provided that we have entered into a Business Associate Agreement with such organization.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object Unless you object:
The Practice may disclose PHI to your family, friends, or others if PHI directly relates to that person's involvement in your care or payment for your care.
If you are incapacitated or in an emergency circumstance, the providers at the Practice may exercise their professional judgment to determine whether a disclosure is in your best interest. If the Practice discloses PHI in such event, the Practice would disclose only PHI that we believe is directly relevant to the person’s involvement with your health care or with payment related to your health care. The Practice also may disclose your PHI in order to notify (or assist in notifying) such persons of your location, general condition or death.
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
Marketing, sale of PHI, and psychotherapy notes.
The Practice will not sell your PHI or otherwise use or disclose it for purposes of marketing (as defined by federal privacy laws) without obtaining your prior written authorization. Furthermore, use or disclosure of your PHI for any purpose other than those listed above requires your written authorization or that of your legal representative. We will not deny treatment if you do not sign the authorization. Furthermore, you may revoke the authorization at any time, in writing. If you revoke your authorization, we will no longer use or disclose information about you for the reason covered by your written revocation.
Highly Confidential Information – Federal and state law require special privacy protections for certain highly confidential information about you (“Highly Confidential Information”), including: (1) your HIV/AIDS status; (2) genetic testing information; (3) substance use disorder information protected under 42 CFR Part 2; (4) confidential communications with a psychotherapist, psychologist, social worker, sexual assault counselor, domestic violence counselor, or other allied mental health professional, or human services professional; (5) venereal disease information; (6) mammography records; (7) mental health community program records; (8) research involving controlled substances; (9) abortion consent form(s); and (10) family planning services. In order for us to disclose your Highly Confidential Information, we must obtain your separate, specific written consent and/or authorization unless we are otherwise permitted by law to make such disclosure. Most uses and disclosures involving Psychotherapy Notes (as defined in the Federal privacy regulations) require your authorization. If you are an emancipated minor, certain information relating to your treatment or diagnosis may be considered “Highly Confidential Information” and as a result will not be disclosed to your parent or guardian without your consent. Your consent is not required, however, if a physician reasonably believes your condition to be so serious that your life or limb is endangered. Under such circumstances, we may notify your parents or legal guardian of the condition, and will inform you of any such notification. Please note that if you are a parent or legal guardian of an emancipated minor, certain portions of the emancipated minor’s record (or, in certain instances, the entire record) may not be accessible to you.
OUR RESPONSIBILITIES
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The Practice is required by law to maintain the privacy and security of PHI.
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The Practice is required to provide you with this Notice of our legal duties and privacy practices and abide by the terms of the Notice currently in effect. Where more stringent state or federal law protects PHI, the Practice will abide by the more stringent law that is applicable to the Practice.
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The Practice reserves the right to change its privacy policies and practices, including this Notice. All changes are applicable to all PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the contact information above, or by viewing a copy on the Practice’s website: equilibriamentalhealth.com.
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The Practice will inform you if your PHI is compromised in a breach, in accordance with all applicable state and federal laws.
If you have questions regarding information contained in this Notice, if you would like to obtain additional information about our privacy practices, or if you wish to exercise your rights as listed in this Notice, you may contact us using the contact information above.
If you would like additional details about your confidentiality rights (and the limitations on those rights) under state law applicable to social workers, please see 258 CMR 22.00, et seq. at: https://www.mass.gov/doc/258-cmr-22-confidentiality-of-client-communications-and-records/download