Notice of HIPAA Privacy Policy

This Notice describes how medical information about you may be used and disclosed and how you get access to such information.

 

Commitment to Your Privacy

 Lori Moussapour, LCSW, PLLC, also doing business as To Empower U (TEU), is dedicated to protecting the privacy of your protected health information (“PHI”).  PHI is information about you that may be used to identify you (such as your name, social security number, email address, mobile telephone number, address, or date of birth), and that relates (a) to your past, present, or future payment for the provision of healthcare; (b) to the provision of healthcare to you; or (c) to your past, present, or future payment for the provision of healthcare.  In conducting its business we will receive and create records containing your PHI.  We are required by law to maintain the privacy of your PHI and provide you with notice of our legal duties and privacy practices with respect to your PHI.  Healthcare providers involved in your care may have different policies or notices regarding their use and disclosure of your PHI.

 We must maintain the privacy of your PHI, give you this Notice of its legal duties and privacy practices, notify you if you are affected by a breach of unsecured PHI, and abide by the terms of this Notice while it is in effect.  TEU and its employees, volunteers, and other personnel must also abide by this Notice.

 This current Notice will take effect on November 18, 2022, and will remain in effect until we replace it.  We reserve the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law.  If we change the terms of this Notice, the new terms will apply to all PHI we maintain, including PHI that was created or received before such changes were made.  If we change this Notice, we will post the new Notice on Lori Moussapour, LCSW, PLLC (TEU)’s website (the “Site”), and will make the new Notice available upon request.  Your continued use of the Site after changes to this Notice have been made shall constitute your consent to the new Notice.

Use and Disclosures of PHI

To the extent applicable, TEU may use and disclose your PHI for the following purposes:

 Treatment, Payment, and Healthcare Operations.  We are permitted to use and disclose your PHI for purposes of (a) treatment; (b) payment; and (c) healthcare operations.  For example:

  • Treatment: We may disclose your PHI to a physician or healthcare provider for purposes of a visit or in connection with the provision of follow-up treatment.

  • Payment: We may use and disclose your PHI to your health insurer or health plan in connection with the processing and payment of a claim and other charges.

  • Healthcare operations: We may use and disclose your PHI in connection with  healthcare operations, such as providing customer services and conducting quality review assessments.  We may engage third parties to provide various services.  If any such third party must have access to your PHI in order to perform its services, we may require that third party to enter into an agreement that binds the third party to the use and disclosure restrictions provided in this Notice.

Authorization.  We are permitted to use and disclose your PHI upon your written authorization to the extent such use or disclosure is consistent with your authorization.  You may revoke such authorization at any time.  To authorize us to disclose your PHI to a third party, please contact Therapy Collective through the Site.

 

As Required by Law.  We may use and disclose your PHI to the extent required by law.

 

Special Circumstances.  The following categories describe unique circumstances in which we may use or disclose your PHI:

 

Public Health Authorities: TEU may disclose your PHI to public health authorities or other governmental authorities for purposes including preventing and controlling disease, reporting child abuse or neglect, reporting domestic violence, and reporting to the Food and Drug Administration regarding the quality, safety, and effectiveness of a regulated product or activity.  We may, in certain circumstances, disclose PHI to persons who have been exposed to communicable disease or may otherwise be at risk of contacting or spreading a disease or condition.

 

Workers’ Compensation.  We may disclose your PHI as authorized by, and to the extent necessary to comply with, workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.

 

Health Oversight Activities.  We may disclose your PHI to a health oversight agency for authorized activities such as audits, investigations, inspections, licensing, and disciplinary actions relating to the healthcare system or government benefits programs.

 

Judicial and Administrative Proceedings.  We may disclose your PHI in certain circumstances, as permitted by applicable law, in response to an order from a court or administrative agency, or in response to a subpoena or discovery request.

 

Law Enforcement.  We may disclose your PHI to a law enforcement official, such as for purposes of identifying or locating a suspect, fugitive, material witness, or missing person.

 

Decedents.  We may, under certain circumstances, disclose PHI to coroners, medical examiners, and funeral directors for purposes such as identification, determining the cause of death, and fulfilling duties related to decedents.

 

Organ Procurement. We may, under certain circumstances, use or disclose PHI for the purposes of organ donation and transplantation.

 

Research.  We may, under certain circumstances, use or disclose PHI in a limited data set that does not include direct identifiers such as your name, address, social security number, phone number, and email address, for research purposes.  Such uses may include activities that are preparatory to research or informing you of research studies that may be of interest to you.  You will not be enrolled in a research study without your prior voluntary informed consent, unless an institutional review board has waived the need to obtain informed consent.

 

Threat to Health or Safety.  We may, in certain circumstances, use or disclose PHI, if necessary, to prevent or lessen a serious imminent threat to the health or safety of a person or the public.

 

Specialized Government Functions.  We may, in certain circumstances, use and disclose PHI of persons who are, or were, in the Armed Forces for purposes such as ensuring proper execution of a military mission or determining entitlement to benefits.  We may also disclose PHI to federal officers for intelligence and national security purposes.

 

Marketing and Sale.  Most uses and disclosures of PHI for marketing purposes or that constitute a sale of medical information require your prior express authorization.  TEU will obtain your written permission for (1) most uses and disclosures of PHI for marketing purposes, as defined by HIPAA; and (2) disclosures that constitute a sale of PHI, as defined by HIPAA.  If you provide us permission to use or disclose your PHI, you may revoke that permission in writing at any time.  If you revoke your permission, your revocation will be effective upon receipt, but will not be effective to the extent that we or others have acted in reliance upon such permission.

Your Rights Regarding Your PHI

 

You have the following rights regarding the PHI maintained by Lori Moussapour, LCSW, PLLC also known as To Empower U (TEU):

 

Confidential Communications.  You have the right to receive confidential communications of your PHI.  You may request that we communicate with you through alternate means or at an alternate location, and we will accommodate your reasonable requests.  You must submit your request in writing through the Site.

 

Restrictions.  You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment, or healthcare operations.  You also have the right to request that TEU restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care.  You must submit your request in writing through the Site.  We are not required to comply with your request.  However, if we agree to comply with your request, we will be bound by such an agreement, except when otherwise required by law or in the event of an emergency.

 

Inspection and Copies.  You have the right to inspect and copy your PHI.  You must submit your request in writing to us.  We may impose a fee for the costs of copying, mailing, labor, and supplies associated with your request.  We may deny your request to inspect and/or copy your PHI in certain limited circumstances.  If that occurs, we will inform you of the reason for the denial, and you may request a review of the denial.

 

Amendment.  You have the right to request that we will amend your PHI if you believe that it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by TEU You must submit a request in writing through the Site and provide a reasonable to support the requested amendment.  We may, under certain circumstances, deny your request by sending you a notice of denial.  If TEU denies your request, you will be permitted to submit a statement of disagreement for inclusion in your records.

 

Accounting of Disclosures.  You have a right to receive an accounting of all disclosures TEU has made of your PHI.  However, that right does not include (1) disclosures made for treatment, payment, or healthcare operations; (2) disclosures made pursuant to an authorization; and (3) certain other disclosures.  You must submit your request in writing through the Site and you must specify the time period involved (which must be for a period of time of less than six years from the date of disclosure).  Your first accounting will be free of charge. However, we may charge you for the costs involved in fulfilling any additional request made within a period of 12 months.  We will inform you of such costs in advance, so you may withdraw or modify your request to save costs.

  • Breach Notification.  You have the right to be notified in the event that TEU discovers a breach of unsecured PHI.

  • Paper Copy.  You have the right to obtain a paper copy of this Notice at any time upon request.

  • Complaint.  You may complain to TEU, and/or the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated.  To file a complaint with TEU, you must submit a statement in writing.  We will not retaliate against you for filing a complaint.

  • Further Information. If you would like more information about your privacy rights, please contact us through the Site.

Effective date of this Notice: November 18, 2022