HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED,
DISCLOSED AND SAFEGUARDED, AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.  You can download a copy of this document for your files
here.
 

I. Who is Subject to This Notice
Robin Casey MD, PLLC and their staff/employees
 

 
II. Our Responsibility
The confidentiality of your personal health information is very important to us. Your 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, insurance claims, 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.
 
Generally speaking, we are required to:
- Maintain the privacy of your health information as required by law;
- Provide you with this Notice of our duties and privacy practices regarding the health information
about you that we collect and maintain;
- Follow the terms of our Notice currently in effect.
 

III. Contact Information
After reviewing this Notice, if you need further information or want to contact us for any reason
regarding the handling of your health information, please direct any communications to the following
contact person: Robin Casey MD, 117 Hidden Valley Drive, Chapel Hill NC 27516; phone 919-998-
6463, fax 844-433-3838.
 

IV. Uses and Disclosures of Information
Under federal law, we are permitted to use and disclose personal health information without
authorization for treatment, payment, and health care operations. However, the American Psychiatric
Association's Principles of Medical Ethics or state law may require us to obtain your express consent
before we make certain disclosures of your personal health information. The staff in this office also
share health information with each other, as necessary to carry out treatment, payment, or health care
operations.

A. Example of using or disclosing health information for treatment:
A nurse takes your pulse and blood pressure, records it in the medical record, and informs your doctor
of the results.

B. Example of using or disclosing health information for payment:
We submit a bill to your health insurer to receive payment for your care; the insurer asks for health
information (for example, your diagnosis and what care we provided) in order to pay us. In such
situations, we will disclose only the minimum amount of information necessary for this purpose.

 
C. Example of using or disclosing health information for health care operations:
In the course of providing treatment to patients, we perform certain important functions such as quality
assessment, training programs, credentialing, medical review, etc. In performing such functions, we
may rely on certain business associates to assist us. We will share with our business associates only the
minimum amount of personal health information necessary for them to assist us.
 
 
V. Other Uses and Disclosures
In addition to uses and disclosures related to treatment, payment, and health care operations, we may
also use and disclose your personal information without authorization for the following additional
purposes:

A. Abuse, Neglect, or Domestic Violence
As required or permitted by law, we may disclose health information about you to a state or federal
agency to report suspected abuse, neglect, or domestic violence. If such a report is optional, we will use
our professional judgment in deciding whether or not to make such a report. If feasible, we will inform
you promptly that we have made such a disclosure.

B. Appointment Reminders and Other Health Services
We may use or disclose your health information to remind you about appointments or to inform you
about treatment alternatives or other health-related benefits and services that may be of interest to you,
such as case management or care coordination.

C. Business Associates
We may share health information about you with business associates who are performing services on
our behalf. For example, we may contract with a company to service and maintain our computer
systems, or to do our billing. Our business associates are obligated to safeguard your health
information. We will share with our business associates only the minimum amount of personal health
information necessary for them to assist us.

D. Communicable Diseases
To the extent authorized by law, we may disclose information to a person who may have been exposed
to a communicable disease or who is otherwise at risk of spreading a disease or condition.

E. Communications with Family and Friends
We may disclose information about you to persons who are involved in your care or payment for your
care, such as family members, relatives, or close personal friends. Any such disclosure will be limited
to information directly related to the person's involvement in your care.
If you are available, we will provide you an opportunity to object before disclosing any such
information. If you are unavailable because, for example, you are incapacitated or because of some
other emergency circumstance, we will use our professional judgment to determine what is in your best
interest regarding any such disclosure.

F. Coroners, Medical Examiners, and Funeral Directors
We may disclose health information about you to a coroner or medical examiner, for example, to assist
in the identification of a decedent or determining cause of death. We may also disclose health
information to funeral directors to enable them to carry out their duties.

G. Disaster Relief
We may disclose health information about you to government entities or private organizations (such as
the Red Cross) to assist in disaster relief efforts.
If you are available, we will provide you an opportunity to object before disclosing any such
information. If you are unavailable because, for example, you are incapacitated, we will use our
professional judgment to determine what is in your best interest and whether a disclosure may be
necessary to ensure an adequate response to the emergency circumstances.
 
H. Food and Drug Administration (FDA)
We may disclose health information about you to the FDA, or to an entity regulated by the FDA, in
order, for example, to report an adverse event or a defect related to a drug or medical device.

I. Health Oversight
We may disclose health information about you for oversight activities authorized by law or to an
authorized health oversight agency to facilitate auditing, inspection, or investigation related to our
provision of health care, or to the health care system.

J. Judicial or Administrative Proceedings
We may disclose health information about you in the course of a judicial or administrative proceeding,
in accordance with our legal obligations.

K. Law Enforcement
We may disclose health information about you to a law enforcement official for certain law
enforcement purposes. For example, we may report certain types of injuries as required by law, assist
law enforcement to locate someone such as a fugitive or material witness, or make a report concerning
a crime or suspected criminal conduct.

L. Minors
If you are an unemancipated minor, there may be circumstances in which we disclose health
information about you to a parent, guardian, or other person acting in loco parentis, in accordance with
our legal and ethical responsibilities.

M. Notification
We may notify a family member, your personal representative, or other person responsible for your
care, of your location, general condition, or death.
If you are available, we will provide you an opportunity to object before disclosing any such
information. If you are unavailable because, for example, you are incapacitated or because of some
other emergency circumstance, we will use our professional judgment to determine what is in your best
interest regarding any such disclosure.

N. Parents
If you are a parent of an unemancipated minor, and are acting as the minor's personal representative, we
may disclose health information about your child to you under certain circumstances. For example, if
we are legally required to obtain your consent as your child's personal representative in order for your
child to receive care from us, we may disclose health information about your child to you.
In some circumstances, we may not disclose health information about an unemancipated minor to you.
For example, if your child is legally authorized to consent to treatment (without separate consent from
you), consents to such treatment, and does not request that you be treated as his or her personal
representative, we may not disclose health information about your child to you without your child's
written authorization.

O. Personal Representative
If you are an adult or emancipated minor, we may disclose health information about you to a personal
representative authorized to act on your behalf in making decisions about your health care.

P. Public Health Activities
As required or permitted by law, we may disclose health information about you to a public health
authority, for example, to report disease, injury, or vital events such as death.

Q. Public Safety
Consistent with our legal and ethical obligations, we may disclose health information about you based
on a good faith determination that such disclosure is necessary to prevent a serious and imminent threat
to the public or to identify or apprehend an individual sought by law enforcement.

R. Required By Law
We may disclose health information about you as required by federal, state, or other applicable law.

S. Research
We may disclose health information about you for research purposes in accordance with our legal
obligations. For example, we may disclose health information without a written authorization if an
Institutional Review Board (IRB) or authorized privacy board has reviewed the research project and
determined that the information is necessary for the research and will be adequately safeguarded.

T. Specialized Government Functions
We may disclose health information about you for certain specialized government functions, as
authorized by law. Among these functions are the following: military command; determination of
veterans' benefits; national security and intelligence activities; protection of the President and other
officials; and the health, safety, and security of correctional institutions.

U. Workers' Compensation
We may disclose health information about you for purposes related to workers' compensation, as
required and authorized by law.

Any Other Use or Disclosure -- Authorization Required
- Before using or disclosing your personal health information for any other purpose not identified
above, we will obtain your written authorization. Unless action has already been taken in reliance on
the authorization, you have a right to revoke such authorization by submitting your request in writing to
us (see section III above for contact information).
 

VI. Psychotherapy Notes
In the course of your care with us, you may receive treatment from a mental health professional (such
as a psychiatrist) who keeps separate notes during the course of your therapy sessions about your
conversations. These notes, known as "psychotherapy notes", are kept apart from the rest of your
medical record, and do not include basic information such as your medication treatment record,
counseling session start and stop times, the types and frequencies of treatment you receive, or your test
results. They also do not include any summary of your diagnosis, condition, treatment plan, symptoms,
prognosis, or treatment progress. Psychotherapy notes may be disclosed by a therapist only after you
have given written authorization to do so. (Limited exceptions exist, e.g. in order for your therapist to
prevent harm to yourself or others, and to report child abuse/neglect). You cannot be required to
authorize the release of your psychotherapy notes in order to obtain health-insurance benefits for your
treatment, or enroll in a health plan. Psychotherapy notes are also not among the records that you may
request to review or copy (see discussion of your rights in section VII below). If you have any
questions, feel free to discuss this subject with your therapist.
 

VII. Your Health Information Rights
Under the law, you have certain rights regarding the health information that we collect and maintain
about you.
 
This includes the right to:
- Request that we restrict certain uses and disclosures of your health information; 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 you at an alternative address, such as a P.O. Box. We will accommodate
reasonable requests for such confidential communications.
- Request to review, or to receive a copy of, the health information about you that is maintained in our
files and the files of our business associates (if applicable). 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 the
decision.
- Request that we amend the health information about you that is maintained in our files and the files of
our business associates (if applicable). Your request must explain why you believe our records about
you are incorrect, or otherwise require amendment. If we are unable to satisfy your request, we will tell
you in writing the reason for the denial and tell you how you may contest the decision, including your
right to submit a statement (of reasonable length) disagreeing with the decision. This statement will be
added to your records.
- Request a list of our disclosures of your health information. This list, known as an "accounting" of
disclosures, will not include certain disclosures, such as those made for treatment, payment, or health
care operations. We will provide you the accounting free of charge, however if you request more than
one accounting in any 12 month period, we may impose a reasonable, cost-based fee for any
subsequent request. Your request should indicate the period of time in which you are interested (for
example, "from May 1, 2003 to June 1, 2003"). We will be unable to provide you an accounting for any
disclosures made before April 14, 2003, or for a period of longer than six years.
- Request a paper copy of this Notice. In order to exercise any of your rights described above, you must
submit your request in writing to our contact person (see section III above for information). If you have
questions about your rights, please speak with our contact person, available in person or by phone,
during normal office hours.
 

VIII. To Request Information or File a Complaint
If you believe your privacy rights have been violated, you may file a written complaint by mailing it or
delivering it to our contact person (see section III above). You may complain to the Secretary of Health
and Human Services (HHS) by writing to Office for Civil Rights, U.S. Department of Health and
Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C.
20201; by calling 1-(800) 368-1019; or by sending an email to [email protected] We cannot, and
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.
 

IX. Revisions to this Notice
We reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms
shall apply to all health information 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
use 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 area(s) of our office/clinic, make copies available to our patients and others at their verbal
or written request, and post it on our website.
 

X. Effective Date of this Notice
April 14, 2003

Chapel Hill - Chatham North Office
117 Hidden Valley Drive
Chapel Hill, NC 27516

phone 919-998-6463

North Raleigh Mental Health and Wellness
920 Paverstone Dr, Suite D
Raleigh NC 27615
 
phone 919-896-6998