Pamela G. Tinoco, MA, LMFT
Licensed Marital and Family Therapist

HIPAA

Notice of Privacy Practicies
This notice describes how medical information about you and/or your child may be used and disclosed and how you can gain access to this information. Please review it carefully. If you have any questions, please write to our privacy officer at the address noted at the end of this notice.

I). OUR RESPONSIBILITY
The confidentiality of your Personal Health Information (PHI) is very important to us. You health information includes records that we create and obtain when we provide you care, such as a record of your symptoms, examination and test results, diagnoses, treatments and referrals for further care. It also includes bills and/or other payment information that we maintain related to your care.

This notice describes how we handle your health information and your rights regarding this information. We are required to: Maintain the privacy of your health information as required by law Provide you with our current Notice of Privacy Practices Follow the terms of the Notice of Privacy Practices currently in effect

II). USES & DISCLOSURES OF INFORMATION
Under federal law, we are permitted to use and disclose PHI without prior authorization for treatment, to obtain payment for treatment (including the use of collection services) and to support our healthcare operations (however, the American Psychiatric Association's Principles of Medical Ethics may require us to obtain your express consent before we make certain disclosures regarding your PHI). Other examples of such uses and disclosures include contacting you for appointment reminders and telling you about or recommending possible treatment options, alternatives, health-related benefits or services that may be of interest to you. We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give our medical information about you, without your prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, medical examiners, funeral arrangements and organ donation, workers' compensation purposes, emergencies, national security and other specialized government functions, and for members of the Armed Forces as required by Military Command authorities. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders or other legal process. Under certain circumstances, we may use and disclose health information about you for research purposes, subject to a special approval process. We may also allow potential researchers to review information that may help them prepare for research, so long as the health information they review does not leave our group, and so long as they agree to specific privacy protections. We may disclose medical information about you to a friend or family member whom you designate or in appropriate circumstances, unless you request a restriction. We may also disclose information to disaster relief authorities so that your family can be notified of your location and condition.

Other uses of Medical Information: In any other situation not covered by this notice, we will ask you for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.

III). PHI RIGHTS
Under federal law, you have certain rights regarding the PHI we collect and main about you: Request that we restrict certain uses and disclosures of your PHI; we are not, however, required to agree to a requested restriction. Request that we communicate with you by alternative means, such as making records available for pick-up or mailing them to an alternative address. If we are unable to satisfy your request, we will tell you in writing the reason for the denial and your right, if any, to request a review of our decision. Request that we amend the PHI about you that is maintained in our files. Your request must explain why you believe our records about you are incorrect, or otherwise require amendment. If we are unable to satisfy your requests, we will tell you in writing the reason for this denial and how you may contest the decision, including your right to submit a statement disagreeing with the decision. This statement will be added to your record. Request an accounting log of requests for your PHI including date of request, information requested, mailing name/address. Request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home (request required in writing). Request a copy of this notice.

IV). TO REQUEST INFORMATION OR TO FILE A COMPLAINT
If you believe your privacy has been violated, you must file a written complaint by mailing it or delivering it in person to: Andrew S. Lustbader, MD c/o The Therapeutic Center for Children and Families 215 Main Street Westport, CT 06880 You may also file a complaint with the Secretary of Health and Human Services by writing to the Office for Civil Rights, US Department of Health and Human Services, 200 Independence Avenue, SW Room 509F HHH Building, Washington DC 20201 or by calling 800-368-1019 or by emailing OCRprivacy@hhs.gov. We will not make you waive your right to file a complaint as a condition of receiving care from us, or penalize you for filing a complaint.

We reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms shall apply to all PHI that we maintain, including information about you collected or obtained before the effective date of the revised Notice. If the revisions reflect a material change to the sue of and disclosure of your information, your rights regarding such information, our legal duties or other privacy practices described in the Notice, we will promptly distribute the revised Notice, post it in the waiting areas of our office and make copies available for you.