NOTICE OF PRIVACY PRACTICES

This notice describes how medical and psychological information about you may be used and disclosed by me, Stephen C. Fisher, Ph.D., as well as how you can get access to this information. Please review it carefully.

How your Protected Health Information (PHI) may be used or shared:

 

  1. For treatment purposes, such as coordinating with your physician or consulting with another psychotherapist.

  2. For payment activities, such as billing services or checking your insurance benefits.

  3. For business operations, such as a business audit or administrative tasks.

  4. In the event I receive information suggesting that you are in imminent danger of harming yourself or others.

  5. In the event I receive information regarding current abuse or neglect of a child, elder, or disabled person

  6. In the event I am court-ordered by a judge to provide information for a legal proceeding

  7. I may contact you for scheduling purposes and or appointment reminders

  8. In the event you file a worker's compensation claim

  9. While the above are the most common disclosures, others may be required or permitted by law.

 

If there are two laws that pertain to the use or disclosure of your Protected Health Information, I will follow the stricter law.

 

Except as described above, I will not share your Protected Health Information with anyone without your written permission. You can cancel your permission at any time in writing. Please note that information already shared when your permission was in effect cannot be taken back.

You have the right to:

 

  1. Inspect and copy your Protected Health Information by written request.

  2. Ask to change Protected Health Information you think is incorrect. You must tell me in writing what you'd like to be changed and why. If I deny your request, you may write a Statement of Disagreement that I will include in any future disclosures of your disputed information

  3. Request a restriction on certain uses and disclosures of your Protected Health Information by written request. I may or may not be able to comply with your request.

  4. Ask me to contact you via the telephone number and/or address of your choice

  5. Get a list, by written request, of when and with whom I've shared your Protected Health Information

  6. Be notified in the event I or a business associate of mine discovers a breach of your Protected Health Information

  7. Restrict certain disclosures of PHI to a health insurance company when you pay for services in full out-of-pocket

  8. Get a paper copy of this Privacy Notice at any time.

 

I take your privacy seriously. I am required by law to maintain the privacy of your Protected Health Information, to give you this notice, and to abide by it.

 

This notice is effective as of May 1, 2014. I reserve the right to change the terms of this notice. If changes are made you will be provided an updated notice in writing and also find the update on my website.

If you would like to exercise any of the rights described above, or if you feel that your privacy rights have been violated, you may contact me in writing at this address.

 

Stephen C. Fisher, Ph. D.

87 Stony Brook Rd
Westford, MA 01886

 

I will not retaliate against you for filing a complaint.
 

You may also file a complaint with the U.S. Secretary of Health and Human Services at:

 


The U.S. Department of Health and Human Services

200 Independence Avenue

SW Washington, DC 20201

Telephone: 202-619-0257, 877-696-6775