NOTICE OF POLICIES AND PRACTICES UTILIZED BY THE
CLINICAL PSYCHOLOGY CENTER
TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION
(continued)

II.  Uses and disclosures requiring authorization.

The CPC may use or disclose PHI for purposes outside of treatment, payment, and 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 the CPC is asked for information for purposes outside of treatment, payment, and health care operations, we will obtain an authorization from you before releasing this information.  The CPC will also need to obtain an authorization before releasing your psychotherapy notes.  Psychotherapy notes are notes made about your converation during private, family, or group counseling sessions, and when these exist, they are kept separate from the rest of your clinical record.  These notes are given a greater degree of protection than the PHI.  Further, the CPC will need to obtain an authorization from you before using or disclosing PHI in a way that is not described in this Notice.

You may revoke all authorizations regarding PHI and/or psychotherapy notes at any time, provided such revocation is in writing.  You may not revoke an authorization to the extent that (1) the CPC has relied on that authorization, or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.  However, remember that the CPC does not currently accept insurance.

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