Notice of Provider’s Policies and Practices to Protect the Privacy of Your Health Information
THIS NOTICE DESCRIBES HOW HEALTH, PSYCHOLOGICAL, AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our pledge regarding health, psychological, and medical information
We understand that health, psychological, and medical information about you and your health is personal. We are committed to protecting medical information about you. It is our duty to safeguard your Protected Health Information (PHI). Your personal doctor or other community-based providers may have different policies or notices regarding their use and disclosure of your medical information or PHI created in their offices, clinics, or facilities.
This Notice will tell you about ways in which Cape Clarity Integrative Psychology, LLC may use and disclose health, psychological, and medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. If we significantly change our privacy practices, we will revise this Notice and make it available to you at your next appointment.
We are required by law to:
- Make sure that health, psychological, and medical information that identifies you is kept private (with certain exceptions)
- Give you this notice of our legal duties and privacy practices with respect to medical information about you
- Follow the terms of the Notice that are currently in effect
How Cape Clarity Integrative Psychology, LLC may use and disclose psychological or treatment information
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
We may use or disclose or be required to disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
- “PHI” refers to information in your health record that could identify you.
- “Treatment, Payment, and Health Care Operations”: Treatment is 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. Payment is when I or you obtain reimbursement from your healthcare provider for my services. Examples of payment are when I disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage. Health Care Operations 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.
- “Use” applies only to activities within my office such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- “Disclosure” applies to activities outside of my (office, clinic, practice group, etc.), such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures Requiring Authorization
We may use or disclose PHI for purposes outside of treatment, payment, and health care operations only when your appropriate authorization is obtained. An “authorization” is written permission that permits only specific disclosures above and beyond your general consent. In those instances when we are asked for information for purposes outside of treatment, payment and health care operations, we will obtain an authorization from you before releasing this information. We will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes we have made about our conversation during a private, group, joint, or family counseling session, which we have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insure the right to contest the claim under the policy.
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
III. Uses and Disclosures with Neither Consent nor Authorization
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html We may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse: If we know, or have reasonable cause to suspect that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver or other person responsible for the child’s welfare, the law requires that we report such knowledge or suspicion to the Florida Department of Child and Family Services.
- Adult and Domestic Abuse: If we know, or have reasonable cause to suspect, that a vulnerable adult (disabled or elderly) has been or is being abused, neglected, or exploited, we are required by law to immediately report such knowledge or suspicion to the Central Abuse Hotline.
- Health Oversight: If a complaint is filed against us with the Florida Department of Health on behalf of the Board of Psychology, the Department has the authority to subpoena confidential mental health information from us relevant to that complaint.
- Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis or treatment and the records thereof, such information is privileged under state law, and we will not release information without the written authorization of you or your legal representative, or a subpoena of which you have been properly notified and you have failed to inform us that you are opposing
- Subpoena or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. You will be informed in advance if this is the case.
- Serious Threat to Health or Safety: When you present a clear and immediate probability of physical harm to yourself, to other individuals, or to society, we may communicate relevant information concerning this to the potential victim, appropriate family member, or law enforcement or other appropriate authorities.
- Worker’s Compensation: If you file a worker’s compensation claim, we must, upon request of your employer, the insurance carrier, and authorized qualified rehabilitation provider, or the attorney for the employer or insurance carrier, furnish your relevant records to those persons.
- Coroners, Medical Examiners, and Funeral Directors: Work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- For special government functions such as military, national security, and presidential protective services
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If the Disclosure is Otherwise Specifically Required By Law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
IV. Patient’s Rights and Provider’s Duties
Patient’s Rights:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- The Right to See and Get Copies of Your PHI either in paper or electronic format: In general, you have the right to see your PHI that is in This Practice’s possession or to get copies of it. You will also be allowed to inspect your PHI in person and take notes or photographs of your PHI. However, you must request the above in writing. On your request, we will discuss with you the details of the request process. Requests must be made in writing and will be responded to within 30 days. Under certain circumstances, we may feel that we must deny your request, but if we do, we will give you, in writing, the reasons for the denial. We will also explain your right to have its denial reviewed. If you ask for copies of your PHI, you will be charged a reasonable cost-based fee.
- Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may say “no” to your request, but we’ll tell you why in writing within 60 days. On your request, we will discuss with you the details of the amendment process.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations (for example, home or office phone or to send mail to a different address). We will say “yes” to all reasonable requests. There may be an additional charge if we comply with your request.
- Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request and may be unable to abide by it in emergency situations. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. We cannot agree to limit uses/disclosures that are required by law.
- Right to Get a List of Disclosures: You generally have the right to receive an accounting of disclosures of PHI regarding you . On your request, we will discuss with you the details of the accounting process. We may require requests for accountings to be in writing. The request must be in writing and state the time period desired for the accounting, which must be less than a 6-year period prior to the date of your request. The list will not include uses or disclosures to which you have specifically authorized (i.e., those for treatment, payment, or health care operations, sent directly to you or to your family; neither will the list include disclosures made for national security purposes or to corrections or law enforcement personnel.
- Right to Choose Someone to Act for You: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
- The Right to Get This Notice by Email: You have the right to get this notice by email. You have the right to request a paper copy of it as well
Psychologist’s Duties:
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.htmlChanges to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
V. Complaints
If you are concerned that we have violated your privacy rights, or if you are dissatisfied with our privacy policies or procedures, you may file a complaint with our practice in writing. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. This Practice will provide you with the address upon request. You will not be retaliated against for filing a complaint
Additional Information
- Effective Date of this Notice: 06/08/2025
- Name or title of the privacy official, e-mail address, and phone number: Liana K. Preudhomme, PhD, Licensed Psychologist and owner/founder of Cape Clarity Integrative Psychology, LLC; email: l.preudhomme@capeclarity.hush.com
- We never market or sell personal information.•Florida law requires retention of records for a period of 7 years from the date of the record. It also provides for an earlier destruction, if certain requirements are met, including notice to the patients, either directly or by publication.
- If you so choose, the electronic medical record (EMR) used at Cape Clarity Integrative Psychology, LLC, will allow you to receive automated reminders about appointments
Please discuss any questions or concerns with your therapist.
