This notice describes how psychological and medical information about you may be used and disclosed an how you can get access to this information.  Please review it carefully.

Shelly L. Curran, PhD, LP/Behavioral Medicine Associates, PLLC, (BMA) has established a policy to guard against unnecessary disclosure of your health information. BMA and providers providing care at BMA may use/disclose your personal health information (PHI) as defined in the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) with your consent, for the following purposes:

Providing treatment: When I provide, coordinate, or manage your health care and other services related to your health care.  An example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist.

Obtaining Payment: I do not accept insurance for payment of services and therefore do not submit your PHI or any information to your insurance company etc...  However, if you request a receipt/documentation in order for you to request possible out-of-network benefits, HSA payments etc.. that documentation will include some of your PHI (such as diagnosis and type of psychological services etc...).

Conducting Health Care Operations: These are activities that relate to the performance and operation of my practice.  Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

Uses and Disclosures Requiring Authorization

I may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained.  An "authorization" is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when I am asked for information for purposes outside of treatment, payment or health care operations, I will obtain a written authorization from you before releasing this information.

You may revoke all such authorizations at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining reimbursement for insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

Uses and Disclosures with Neither Consent nor Authorization: I may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse: If I have reasonable cause to suspect that a child seen in the course of my professional duties has been abused or neglected, or have reason to believe that a child seen in the course of my professional duties has been threatened with abuse or neglect, and that abuse or neglect of the child will occur, I must report this to the relevant county department, child welfare agency, police, or sheriff's department.

Adult and Domestic Abuse: If I have reason to believe that a vulnerable adult is being or has been maltreated, or if I have knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained, I must immediately report the information to the appropriate agency in this county.  I may also report the information to a law enforcement agency.

"Vulnerable adult" means a person who, regardless of residence or whether any type of service is received, possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction: (i) that impairs the individual's ability to provide adequately for the individual's own care without assistance, including the provision of food, shelter, clothing, health care, or supervision; and (ii) because of the dysfunction or infirmity and the need for assistance, the individual has an impaired ability to protect the individual from maltreatment.

Health Oversight: The Minnesota Board of Psychology may subpoena records from me if they are relevant to an investigation it is conducting.

Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law and I will not release the information without written authorization from you or your personal or legally-appointed representative, or a court order.  The privilege does not apply when you are being evaluated for a third party or where the evaluation is court orders. You will be informed in advance, if this is the case. 

Serious Threat to Health or Safety: If you communicate a specific, serious threat of physical violence against a specific, clearly identified or identifiable potential victim, I must make reasonable efforts to communicate this threat to the potential victim or to a law enforcement agency.  I must also do so if a member of your family or someone who knows you well has reason to believe you are capable of and will carry out the threat.  I also may disclose information about you necessary to protect you from a threat to commit suicide.

Worker's Compensation: If you file a worker's compensation claim, a release of information from me to your employer, insurer, the Department of Labor and Industry, or you will not need your prior approval.

Other: When the use and disclosure without your consent or authorization is allowed under other sections of Section 164.512 of the Privacy Rule and the MN state confidentiality law.  This includes certain disclosures to law enforcement agencies, a coroner or medical examiner, for public health purposes relating to disease or FDA regulated products, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligence.

There may be additional disclosures of PHI that I am required or permitted by law to make without your consent or authorization, however the disclosures listed about are the most common.

Patient Rights:

Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.

Right to Restrict Disclosures When you have Paid Out-of-Pocket: You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket in full for my services.

Receive Confidential Communications: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.  (For example, you may not want a family member to know that you are seeing me.  Upon your request, I will send your bills to another address.)

Inspect and Copy (paper or electronic): You have the right to inspect or obtain a copy (or both) of PHI in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record.  On your request, I will discuss with the details of the request process.

Amend your PHI: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record.  I may deny your request.  On your request, I will discuss with you the details of the amendment process.

Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI regarding you.  On your request, I will discuss with you the details of the accounting process.

Right to a paper copy: You have the right to obtain a paper copy of this notice from me upon request, even if you have received this notice previously.

Right to be Notified if there is a Breach of Your Unsecured PHI: You have the right to be notified if (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards; and (c) my risk assessment fails to determine that there is a low probability that your PHI has been compromised.

Questions and Complaints:

If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact the Privacy Officer, Shelly L. Curran, PhD, LP at 612-400-7460

If you believe that your privacy rights have been violated and wish to file a complaint with me, you may send your written complaint to Shelly L. Curran, PhD, LP, 3209 W. 76th Street, Suite 202A, Edina, MN 55435

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.  The person listed above can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule.  I will not retaliate against you for exercising your right to file a complaint.

Shelly L. Curran, PhD, LP/ BMA, PLLC is required by law to maintain the privacy for your PHI, to abide to the terms of the notice and reserves the right to change the terms of its notice and make the new noticeprovisions effective for all PHI that it maintains.  If there is a material change to this notice, you can obtain a copy of the revised notice at my office or on my website.  This notice is effective September 27, 2017 unless and until revised by BMA. Any questions regarding this notice, please contact Privacy Officer: Shelly L. Curran, PhD, LP (612) 400-7460.