HIPPA Privacy policy:

HIPPA Notice of Privacy Practices. Updated January 2, 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 this document carefully.

This HIPPA Notice of Privacy Practices is drawn from other legal documents and created by Karisa Quick, the founder, owner, and CEO of Karisa Quick Licenced Professional Clinical Counselor (Karisa Quick L.P.C.C.), DBA That Gay Therapist. I will use the word “I” to describe myself as the spokesperson and point of contact for Karisa Quick L.P.C.C. and please note that this document is for all clients at our practice, regardless of your therapist, as we do have multiple therapists. 

I have a legal duty to safeguard your protected health information (PHI) I am legally required to protect the privacy of your PHI, which includes information that can be used to identify you that I’ve created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. I must provide you with this Notice of Privacy Practice. This Notice must explain how, when, and why I will “use” and “disclose” your PHI. A “use” occurs when I share, examine, utilize, apply or analyze such information within my practice; PHI is “disclosed” when it is released, transferred, has been given to, or is otherwise divulged to a third party outside of my practice. With some exceptions, I may not use or disclose any more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made. And, I am legally required to follow the privacy practices described in this notice. This Notice will be available upon request. 

I reserve the right to change the terms of this Notice and my privacy policies at any time. Any changes will apply to PHI on file with me already. Before I make any important changes to my policies, I will promptly change this Notice and inform you of the change. You can also request a copy from me at any time. 

How I may use and disclose your PHI

I will use and disclose your PHI for many different reasons. For some of these uses or disclosures, I will need your prior authorization; for others, however, I do not. Listed below are the different categories of my uses and disclosures along with some examples of each category.

Uses and Disclosures Relating to Treatment, or Health Care Operations Do Not Require Your Prior Written Consent. I can use and disclose your PHI without your consent for the following reasons: 

For your treatment.

Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. I may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed healthcare providers who provide you with healthcare services or are involved in your care. For example, if you are being treated by a psychiatrist, I can disclose your PHI to your psychiatrist to coordinate your care. 

To obtain payment for treatment. 

I may use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. For example, I might send your PHI to your insurance company or health plan to get paid for the health care services that I have provided to you. I may also provide your PHI to my business associates, such as billing companies, claims processing companies, and others that process my health care claims. 

For healthcare operations. 

I may disclose your PHI to operate my practice. For example, I might use your PHI to evaluate the quality of healthcare services that you received or to evaluate the performance of the healthcare professionals who provided such services to you. I may also provide your PHI to our accountants, attorneys, consultants, and others to make sure I’m complying with applicable laws. 

Required by Law. 

Under the law, we must disclose your PHI to you upon your request. In addition, I must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule. 

Other disclosures. 

I may also disclose your PHI to others without your consent in certain situations. For example, your consent isn’t required if you need emergency treatment, as long as I attempt to get your consent after treatment is rendered or if I try to get your consent but you are unable to communicate with me (ie. if you are unconscious or in severe pain) and I think that you would consent to such treatment if you were able to do so. 

Certain Uses and Disclosures Do Not Require Your Consent. 

I can use and disclose your PHI without your consent or authorization for the following reasons:

1. When Disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement. For example, I may disclose to applicable officials when a law requires me to report information to government agencies and law enforcement personnel about victims of abuse or neglect; or when ordered in a judicial or administrative proceeding.

2. For public health activities, including audits and investigations.

3. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so. 

4. For health oversight activities. For example, I may have to provide information to assist the government when it conducts an investigation or inspection of a healthcare provider or organization. 

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition. 

8. To avoid harm. In order to avoid a serious threat to the PHI to law enforcement personnel or persons able to prevent or lessen such harm.

9. For specific government functions. I may disclose PHI to military personnel and veterans in certain situations. And I may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations. 

10. For workers’ compensation purposes. I may provide PHI in order to comply with worker’s compensation laws.

11. Appointment reminders and health-related benefits or services. I may use PHI to provide appointment reminders or give you information about treatment alternatives,  other health care services or benefits offered, or what we discuss. 

Marketing. 

As a psychotherapist, I will NOT use or disclose your PHI for marketing purposes. 

Sale of PHI. 

I will NOT sell your PHI in the regular course of my business.

Certain Uses and Disclosures Require You to Have the Opportunity to Object.

Disclosures to family, friends, or others. 

I may provide you PHI to a family member, friend, or another person that you indicate is involved in your care or the payment for your health care unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergencies. 

Other Uses and Disclosures Require Your Prior Written Authorization. 

In any situation not described in the sections above, I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke such authorization in writing to stop any future uses and disclosures (to the extent

Your Rights Regarding Your PHI. 

You have the following rights with respect to your PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI. 

You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may not be able to accommodate this request if I believe it would affect your health care.

The Right to Choose How I Send PHI to You. 

You have the right to ask me to contact you in a specific way or to send mail to a different address, and I will agree to all reasonable requests.

The Right to See and Get Copies of Your PHI. 

You have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your records, or a summary of them. You must submit a written request for a copy of this summary and I may charge a reasonable fee for doing so.

The Right to Get a List of the Disclosures I Have Made. 

You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided me with Authorization. I will respond to your request for an accounting of disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable fee for each additional request.

The Right to Correct or Update Your PHI. 

If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may deny this request if I believe it would be unhelpful or detrimental to your care. I would tell you why in writing within 60 days of receiving your request.

The Right to Get a Paper of Electronic Copy of this Notice. 

You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy.

How to complain about my Privacy Practices. 

If you think I may have violated your privacy rights, you may file a complaint with me, as the Privacy Officer for my practice.

You may also 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. Washington, D.C. 20201

Calling 1-877-696-6775

Or visiting www.hhs.gov/ocr/privacy/hippa/complaints

I will not retaliate against you if you file a complaint about my privacy practices. 

The effective date of this Notice is May 6, 2021. 

Electronic Signature 

I hereby acknowledge that I received and have been given an opportunity to read a copy of Karisa Quick, LPCC’s Notice of Privacy Practices / HIPPA. I understand that if I have any questions regarding the Notice or my privacy rights, I may contact Karisa Quick M A. ED, LPCC, Privacy Officer at 909-808-9607