HIPAA Notice of Privacy Practices

Practices to Protect the Privacy of Your Health Information

This Notice of Privacy Practices describes how River Oaks Psychology may use and disclose your protected health information (PHI) for purposes of treatment, payments, and health care operations, and for other purposes that are permitted or required by law.

We are legally required to provide you with this HIPAA Notice and obtain your signature on this document electronically in your secure patient portal prior to the onset of treatment.  We welcome any questions about you might have about it. We understand some of the legal language here may be confusing, so please let us know if we can help clarify anything.

We take the privacy of your / your child’s health information seriously. We are required by law to maintain the privacy of your health information and provide you with this Notice of Privacy Practices. We will abide by the terms of this Notice of Privacy Practices. We reserve the right to change this Notice of Privacy Practices and to make any new Notice of Privacy Practices effective for all protected health information that we maintain. When this notice is updated, River Oaks Psychology will provide an updated copy to all patients.

Protected health information (PHI) is demographic and individually identifiable health information that will or may identify the patient and relates to the patient’s past, present or future physical or mental health or condition and related health care services.

Under federal law, we are permitted to use and disclose personal health information without authorization for treatment, payments, and health care operations.

Health care operations include activities such as communications among health care providers, conducting quality assessment and improvement activities; evaluating the qualifications, competence, and performance of health care professionals; training future health care professionals; other related services that may be a benefit to you such as case management and care coordination; contracting with insurance companies: conducting medical review and auditing services; compiling and analyzing information in anticipation of or for use in legal proceedings; and general administrative and business functions.

We use medical records as a way of recording health information, planning care and treatment and as a tool for routine health care operations. Your insurance company may request information such as procedure and diagnosis information that we are required to submit in order to bill for treatment we provide to the patient. Other health care providers or health plans reviewing your records must follow the same confidentiality laws and rules required of us. Patient records are also a valuable tool used by researchers in finding the best possible treatment for diseases and medical conditions. All researchers must follow the same rules and laws that other health care providers are required to follow to ensure the privacy of patient information. Information that may identify patients will not be released for research purposes to anyone without written authorization from the patient or the patient’s parent or legal guardian.

• Medical information may be used to justify needed patient care services.
• We will use medical information to establish a treatment plan.
• We may disclose protected health information to another provider for treatment (i.e. referring physicians, specialists and providers, therapists, etc.)
• We may submit claims to your insurance company containing medical information and we may contact their utilization review department to receive pre-certification (prior approval for treatment). We will submit only the minimum amount of information necessary for this purpose.
• We may use the emergency contact information you provided to contact you if the address of record is no longer accurate.
• We may contact you to remind you of the patient’s appointment by an automated call, text, or email.
• We may contact you to discuss treatment alternatives or other health related benefits that may be of interest.

Minors – If you are an unemancipated minor, there may be circumstances in which we disclose health information about you to a parent or guardian in accordance with legal and ethical responsibilities.

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 you 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 unemanciapated 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 authorization.

When you, as the patient or the parent or guardian of a patient, sign a consent form, you are giving us permission to use and disclose protected health information for the purposes of treatment, payment and health care operations. In some instances, this permission does include psychotherapy notes, psychosocial information, alcohol and drug abuse treatment records. You will need to sign a separate Release of Information to have protected health information released for any reason other than treatment, payment or healthcare operations.


A treatment plan outlines the goals, objectives, and strategies for the therapy sessions. The treatment plan typically includes a description of the presenting concerns. Progress notes are records that therapists maintain for each therapy session. These notes document the content of the session, including the topics discussed, interventions used, progress observed, and any significant observations or insights. They are important for continuity of care, as they enable therapists to track the patient’s progress over time and make informed decisions about future sessions and treatment adjustments.


In order to release patient protected health information for any reason other than treatment, payment, and health care operations, we must have a Release of Information signed by the patient or the parent or guardian of the patient that clearly explains how they wish the information to be used and disclosed. The following are some examples of releases of information that require a separate authorization:
• Progress Notes
• Psychosocial information
• Use of information in scientific and educational publications, presentations, and materials.

You may change your mind and revoke a Release of Information, except (1) to the extent that we have relied on it up to that point, (2) the information is needed to maintain the integrity of the research study, or (3) if the Release of Information was obtained as a condition of obtaining insurance coverage. All requests to revoke a Release of Information should be in writing.

There are some services provided through contracts with business associates. Examples include billing services, electronic medical record, laboratory, and transcription services. When these services are contracted, we may disclose your health information to the business associate so that they can perform the job we have contracted them to do.

The law requires that some information may be disclosed without your authorization in the following circumstances:
• In case of a clinical emergency
• When there are communication or language barriers
• When required by law
• When there are risks to public health
• To conduct health oversight activities
• To report suspected child abuse or neglect
• To specified government regulatory agencies
• In connection with judicial or administrative proceedings
• For law enforcement purposes
• To coroners, funeral directors, and for organ donation
• In the event of a serious threat to health or safety

The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect a copy of your health information.
This means you may inspect and obtain a copy of your PHI that is contained in a designated record set for so long as we maintain the PHI. A designated record set contains medical and billing records and any other records that we use in making decisions about your healthcare. You may not however, inspect or copy the following records: psychotherapy and psychosocial notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and certain PHI that is subject to laws that prohibit access to that PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have the right to have this decision reviewed. Please contact us if you have questions about access to your medical record.

You have the right to request a restriction of your health information.
This means you may ask us to restrict or limit the medical information we use or disclose for the purposes of treatment, payment or healthcare operations. We are not required to agree to a restriction that you may request. We will notify you if we deny your request. If we do agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. You may request a restriction by contacting us. If you pay out of pocket for services, you have the right to request that we not disclose PHI related solely to those services in which you paid out of pocket for.

You have the right to request to receive confidential communications by alternative means or at alternative locations.
We will accommodate reasonable requests. We may also condition this accommodation by asking you for an alternative address or other method of contact. We will not request an explanation from you as the basis for the request. Requests must be made in writing to us.

You have the right to request amendments to your health information.
This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of this rebuttal. If you wish to amend your PHI, please contact us. Requests for amendment must be in writing.

You have the right to receive an accounting of disclosures of your health information.
You have the right to request an accounting of certain disclosures of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Privacy Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, to family or friends involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to us. The request should specify the time period sought for the accounting. Accounting requests may not be made for periods of time in excess of six years.

You have the right to receive a paper copy of this Notice of Privacy Practices.
This notice can be printed out anytime to review the notice. If you have difficulty with this, please contact us to request a copy is printed out for you.

You have the right to be notified if there is a breach in your PHI.
If there is a breach of unsecured PHI concerning you, we may be required to notify you of this breach, including what happened and what you can do to protect yourself.

You have the right to opt out of fundraising communications.
If we send any fundraising communications, you have the right to opt out of receiving these. To do so, contact us to make this request.

If you have questions regarding your privacy rights, please contact us. If you believe your privacy rights have been violated, you may file a complaint by us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. The address for the Secretary of the Department of Health and Human Services is: Office of Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70 61 Forsyth St., S.W., Atlanta, GA 30303-8909. (404) 562-7886 (phone). (404) 562-7881 (fax). (404) 331-2867 (TDD). www.hhs.gov/ocr/hipaa

This notice went into effect on June 30, 2020.
This notice does not have an expiration date.
We will notify you if any information changes.