Extending Care to Underserved Areas

Notice of Privacy Practices

 
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
 
    1. We understand that medical information about you and your health is personal and we are committed to protecting that information. We create a record of the care and services you receive at My Psychiatrist in order to provide you with quality care and to comply with certain legal requirements.
 
    1. Changes to this Notice
      We may change the terms of our Notice, at any time. The new Notice will be effective for all medical information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices.
 
    1. The following categories describe the different ways that the Medical Practice may use and disclose your medical information. Other uses and disclosures of your medical information that are not listed or described below will be made only with your written authorization. You may revoke this authorization, at any time, in writing, but it will not apply to any action we have already taken.
       
        • For your treatment: Your medical information may be used and disclosed by us for the purpose of providing medical treatment to you for another health care provider providing medical treatment to you
       
        • To obtain payment for our services: Your medical information may be used and disclosed by us to obtain payment for your health care bills or to assist another health care provider in obtaining payment for their health care bills.
       
        • For our health care operations: Your medical information may be used and disclosed by us to support our daily operations. These health care operation activities include, but are not limited to, quality assessment activities, employee review activities, training of health care professionals and students, licensing, and conducting or arranging for other business activities.
       
        • For appointment reminders: We may use or disclose your medical information to contact you to remind you of your appointment, by mail or by telephone. Our message will include the name of our practice or the name of our physician as well as the date and time for your appointment or a reminder that an appointment needs to be scheduled.
       
        • To our business associates: We will share our medical information with third party "business associates" that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your medical information, we will have a written agreement that contains terms that will protect the privacy of your medical information.
       
        • As required by law: We may use or disclose your medical information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
       
        • As required by the Food and Drug Administration: We may disclose your medical information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.
       
        • To your employer: We may disclose your medical information concerning a work-related injury or illness to your employer if you are covered under your employer's policy in order to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related injury, in accordance with the law.
       
        • For abuse or neglect: We may disclose your medical information to a public health authority that is authorized by law to receive reports of child or adult abuse or neglect. In addition, we may disclose your medical information if we believe that you have been a victim of abuse, neglect or domestic violence as may be required or permitted by Virginia and/or federal law.
       
        • For health oversight: We may disclose your medical information to a health oversight agency for activities authorized by law.
       
        • In legal proceedings: We may disclose your medical information in the course of any judicial or administrative proceeding, in response to an order of a court of administrative tribunal (to the extent such disclosure is expressly authorized), and in certain cases in response to a subpoena or other lawful request.
       
        • For law enforcement: We may also disclose your medical information, so long as all legal requirements are met, for law enforcement purposes.
       
        • Due to criminal activity: Consistent with applicable federal and state laws, we may disclose your medical information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
       
        • For worker's compensation: Your medical information may be disclosed by us as authorized to comply with worker's compensation laws and other similar legally established programs.
       
        • Regarding inmates: We may use or disclose your medical information if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.
 
    1. Your Rights
      You have the right to inspect and copy your medical information. You may inspect and obtain a copy of your medical information that we maintain. The information may contain medical and billing records and any other records that we use for making decisions about you.

      However, under federal law, you may not inspect or copy the following records: psychotherapy notes; information compiled related to a civil, criminal, or administrative action; and medical information that is subject to law that prohibits access to medical information in certain circumstances.

      We may deny your request to inspect your medical information. In some circumstances, you may have a right to have this decision reviewed.

      You have the right to request a restriction of your medical information. This means you may ask us not to use or disclose any part of your medical information for the purposes of treatment, payment or health care operations. You may also request that any part of your medical information not be disclosed to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to your request. If we agree to the requested restriction, we may not use or disclose your medical information in violation of that restriction unless it is needed to provide emergency treatment or unless we otherwise notify you that we can no longer honor your request. With this in mind, please discuss any restriction you wish to request with your physician.
 
    1. Complaints
      You may complain to us if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our CEO of your complaint. We will not retaliate against you for filing a complaint. If you do not wish to file a complaint with us, you may contact the Secretary of Health and Human Services.

 
 
For Your Convenience
Forms
When you arrive at our clinic for the first time you will be required to fill out several forms. To expedite your waiting time you may choose to complete these before your appointment and bring with you when you arrive.
When You Arrive
We ask that you show up 20 minutes before your scheduled appointment. When you do, make sure to have the following with you:
  • Any medications or herbal supplements that you are currently taking
  • Your insurance card
  • Your photo ID, such as a driver's license or passport
  • Any previous medical or laboratory records
Clinic Policy
Please review the following documents to understand our clinic policy and procedures:

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