Notice of Privacy Practices

Carla E. Marin, PhD, Licensed Psychologist · 357 Whitney Avenue, Suite 106, New Haven, CT 06511 · 203-675-1093

This notice describes how your medical information may be used and disclosed, and how you can get access to it. Please review it carefully.

Effective Date: July 1, 2019

Our Commitment to Your Privacy

Carla E. Marin, PhD ("Dr. Marin," "I," "my," or "this practice") is required by law to maintain the privacy of your protected health information ("PHI"), to provide you with this notice of my legal duties and privacy practices with respect to your PHI, and to follow the terms of this notice while it is in effect.

How I May Use and Disclose Your Health Information

For Treatment. I may use or disclose your PHI to provide, coordinate, or manage your psychological care, and any related services. This includes communication with other treatment providers involved in your care, such as a psychiatrist, primary care physician, or school personnel, when relevant and, where required, with your authorization.

For Payment. I may use or disclose your PHI to bill and collect payment for the services you receive, including submitting claims to your health plan when I am billing it directly, or sharing limited clinical information with your insurer if you ask me to assist with reimbursement.

For Health Care Operations. I may use or disclose your PHI as necessary for my own practice operations, such as quality assurance, billing and practice management, and consultation with other licensed professionals.

Without Your Authorization. Federal and state law permit or require disclosure of your PHI, without your consent or authorization, in the following circumstances: when required by law; for public health activities; to report suspected abuse, neglect, or domestic violence; for health oversight activities; in connection with judicial or administrative proceedings, including in response to a court order; for law enforcement purposes; to avert a serious threat to your health or safety, or the health or safety of others; to coroners or medical examiners as required; and for other purposes required or permitted by law. Where applicable law permits, I will make reasonable efforts to inform you before or after such a disclosure.

Psychotherapy Notes. Notes I keep during counseling sessions are held to a higher standard of protection than the rest of your record. In most circumstances, I must obtain your written authorization before releasing psychotherapy notes, including to your insurer.

All Other Uses and Disclosures. Any use or disclosure of your PHI not described above, including for marketing purposes or the sale of PHI, will be made only with your written authorization. You may revoke that authorization in writing at any time, except to the extent I have already relied on it.

Your Rights Regarding Your Health Information

Right to Request Restrictions. You may ask me not to use or disclose certain PHI for treatment, payment, or operations. I am not required to agree, except where you have paid for a service in full, out of pocket, and ask that it not be disclosed to your health plan.

Right to Confidential Communications. You may ask to be contacted in a specific way or at a specific location (for example, a personal rather than shared email or phone number), and I will accommodate reasonable requests.

Right to Inspect and Copy. With limited exceptions, you have the right to inspect and receive a copy of your PHI. Requests should be made to me in writing; I may charge a reasonable, cost-based fee for copies. Connecticut law recognizes that psychological records warrant additional sensitivity: if I believe that reviewing the raw record directly would be harmful to you, I may, consistent with professional and legal standards, offer a written summary or arrange to review the record together with you in person, rather than provide unrestricted copies of the full record.

Right to Amend. You may ask me to amend your health information if you believe it is incorrect or incomplete. I may decline the request in certain circumstances, and will explain my reasons in writing.

Right to an Accounting of Disclosures. You may request a list of certain disclosures of your PHI that I have made, other than for treatment, payment, operations, or disclosures you separately authorized.

Right to a Paper Copy. You have the right to receive a paper copy of this notice at any time, even if you agreed to receive it electronically.

Right to be Notified of a Breach. You have the right to be notified if a breach of your unsecured PHI occurs.

Record Retention

I retain client records for a minimum of 7 years from the date of last service.

Changes to This Notice

I reserve the right to change this notice and to make the revised notice effective for PHI I already have as well as any I receive in the future. A copy of the current notice will be available from me on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with me directly at the contact information at the top of this document, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.