The Health Insurance Portability and Accountability Act (HIPAA) provides you with several new or expanded rights with regard to your Clinical Record and disclosures of protected health information. These rights include requesting that I amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of Protected Health Information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about my policies and procedures recorded in your records; and the right to a paper copy of this Agreement, including the Notice form, and my privacy policies and procedures. I am happy to discuss any of these rights with you.

In most situations, I can only release information about your treatment to others if you sign a written Authorization Form that meets certain legal requirements imposed by HIPAA. However, there may be certain situations that I will be obligated to disclose information without your written person. For example, if you threaten to harm yourself or others I may be obligated to seek hospitalization for you or to contact your family members or others who can help provide protection.