THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
ALL CONSUMERS OF MY SERVICES SHOULD READ THIS NPP BEFORE RECEIVING ANY OF MY SERVICES. A PRINTABLE COPY OF
THIS NOTICE IS AVAILABLE FOR DOWNLOAD AT THE
BOTTOM OF THIS PAGE.
Privacy is a very important concern for all those who come to my office. It is also complicated because of the many federal
and state laws and my professional ethics. Because the rules are so complicated some parts of this Notice are
very detailed and you probably will have to read them several times to understand them. If you have any questions,
I, R. Trent Codd, III, LPC will be happy to help you understand my procedures and your rights. My contact information
is listed at the end of this notice.
This Notice will tell you how I handle your medical information. It tells how I use this information here in this office,
how I share it with other professionals and organizations, and how you can see it. I want you to know all of
this so that you can make the best decisions for yourself and your family. Because the laws of this state and
the laws of the federal government are very complicated and I don’t want to make you read a lot that may not
apply to you, I have removed a few small parts. If you have any questions or want to know more about anything
in this Notice, please ask me for more explanations or more details.
Each time you visit me or any doctor’s office, hospital, clinic, or any other what are called “healthcare providers” information
is collected about you and your physical and mental health. It may be information about your past, present or
future health or conditions, or the tests and treatment you got from me or from others, or about payment for
healthcare. The information I collect from you is called, in the law, PHI which stands for
Protected Health Information. This information goes into your
medical or healthcare record or file at my office. In my office this PHI is likely to include these kinds
This list is just to give you an idea and there may be other kinds of information that go into your healthcare record here.
I use this information for many purposes. For example, I may use it:
When you understand what is in your record and what it is used for you can make better decisions about who, when, and why
others should have this information. Although your health record is the physical property of the healthcare practitioner
or facility that collected it, the information belongs to you. You can read it and if you want a copy I can make
one for you (but may charge you for the costs of copying and mailing, if you want it mailed to you). In some
very rare situations you cannot see all of what is in your records. If you find anything in your records that
you think is incorrect or believe that something important is missing you can ask me to amend (add information
to) your record although in some rare situations I don’t have to agree to do that. If you want, I can explain
more about this.
I am also required to tell you about privacy because of the privacy regulations of a federal law, the Health Insurance Portability
and Accountability Act of 1996 (HIPPA). The HIPPA law requires me to keep your Protected Healthcare Information
(or PHI) private and to give you this notice of my legal duties and my privacy practices which is called the
Notice of Privacy Practices (or
NPP). I will obey the rules of this notice as long as it is in effect but if I change it the rules of
the new NPP will apply to all the PHI I keep. If I change the NPP I will post the new Notice in my office where
everyone can see. You or anyone else can also get a copy from me at any time and it will be posted on my website
When your information is read by me in this office that is called, in the law, “
use.” If the information is shared with or sent to others outside this office, that is called, in the
disclosure.” Except in some special circumstances, when I use your PHI here or disclose it to others I
share only the
minimum necessary PHI needed for those other people to do their jobs. The law gives you rights to know
about your PHI, how it is used and to have a say in how it is disclosed (shared) and so I will tell you more
about what I do with your information. I use and disclose PHI for several reasons. Mainly, I will use and disclose
it for routine purposes and I will explain more about these below. For other uses I must tell you about them
and have a written Authorization from you unless the law lets or requires me to make the disclosure without your
authorization. However, the law also says that there are some uses and disclosures that don’t need your consent
1. Uses and disclosures of PHI in healthcare with your consent
After you have read this Notice you will be asked to sign a separate
Consent form to allow me to use and share your PHI. In almost all cases I intend to use your PHI here
or share your PHI with other people or organizations to provide
treatment to you, arrange for
payment for my services, or some other business functions called health care
operations. Together these routine purposes are called TPO and the Consent form allows me to use and disclose
your PHI for TPO. Take a minute to re-read that last sentence until it is clear because it is very important.
Next I will tell you more about TPO.
1a. For treatment, payment, or health care operations.
I need information about you and your condition to provide care to you. You have to agree to let me collect the information
and to use it and share it to care for you properly. Therefore you must sign the Consent form before I begin
to treat you because if you do not agree and consent I cannot treat you. When you come to see me, I will collect
information about you and all of it may go into your healthcare records here. Generally, I may use or disclose
your PHI for three purposes: treatment, obtaining payment, and what are called healthcare operations. Let’s see
what these mean.
I use your medical information to provide you with psychological treatment or services. These might include individual, family,
or group therapy, psychological, educational, or vocational testing, treatment planning, or measuring the benefits
of my services. I may share or disclose your PHI to others who provide treatment to you. I am likely to share
your information with your personal physician. If you are being treated by a team they can share some of your
PHI with them so that the services you receive will work together. The other professionals treating you will
also enter their findings, the actions they took, and their plans into your medical record and so we all can
decide what treatments work best for you and make up a Treatment Plan. I may refer you to other professionals
or consultants for services I cannot provide. When I do this I need to tell them some things about you and your
conditions. I will get back their findings and opinions and those will go into your records here. If you receive
treatment in the future from other professionals I can also share your PHI with them. These are some examples
so that you can see how I use and disclose your PHI for treatment.
I may use your information to bill you, your insurance, or others so I can be paid for the treatments I provide to you. I
may contact your insurance company to check on exactly what your insurance covers. I may have to tell them about
your diagnoses, what treatments you have received, and the changes I expect in your conditions. I will need to
tell them about when we met, your progress, and other similar things.
For health care operations
There are a few other ways I may use or disclose your PHI for what are called health care operations. For example, I may
use your PHI to see where I can make improvements in the care and services I provide. I may be required to supply
some information to some government health agencies so they can study disorders and treatment and make plans
for services that are needed. If I do, your name and personal information will be removed from what I send.
1b. Other uses in healthcare
Appointment Reminders. I may use and disclose medical information to reschedule or remind you of appointments
for treatment or other care. If you want me to call or write to you only at your home or your work or prefer
some other way to reach you, I usually can arrange that. Just tell me.
Treatment Alternatives. I may use and disclose your PHI to tell you about or recommend possible treatments
or alternatives that may be of help to you.
Other Benefits and Services. I may use and disclose your PHI to tell you about health-related benefits
or services that may be of interest to you.
Research. I may use or share your information to do research to improve treatments. For example, I may
use it when comparing two treatments for the same disorder to see which works better or faster or costs less.
In all cases your name, address and other personal information will be removed from the information given to
researchers. If they need to know who you are I will discuss the research project with you and you will have
to sign a special Authorization form before any information is shared.
Business Associates. There are some jobs I hire other businesses to do for me. In the law, they are called
my Business Associates. Examples include a copy service I use to make copies of your health records and a billing
service who figures out, prints, and mails my bills. These business associates need to receive some of your PHI
to do their jobs properly. To protect your privacy they have agreed in their contract with me to safeguard your
2. Uses and disclosures that require your Authorization
If I want to use your information for any purpose besides the TPO or those I described above I need your permission on an
Authorization form. I don’t expect to need this very often. If you do authorize me to use or disclose
your PHI, you can revoke (cancel) that permission, in writing, at any time. After that time I will not use or
disclose your information for the purposes that we agreed to. Of course, I cannot take back any information I
had already disclosed with your permission or that I had used in my office.
3. Uses and disclosures of PHI from mental health records that don’t require a Consent or Authorization
The law lets me use and disclose some of your PHI without your consent or authorization in some cases. Here are examples
of when I might have to share your information.
When required by law
There are some federal, state, or local laws which require me to disclose PHI.
For Law Enforcement Purposes
I may release medical information if asked to do so by a law enforcement official to investigate a crime or criminal.
For public health activities
I might disclose some of your PHI to agencies which investigate diseases or injuries.
Relating to decedents
I might disclose PHI to coroners, medical examiners or funeral directors, and to organizations relating to organ, eye, or
tissue donations or transplants.
For specific government functions
I may disclose PHI of military personnel and veterans to government benefit programs relating to eligibility and enrollment.
I may disclose your PHI to Workers Compensation and Disability programs, to correctional facilities if you are
an inmate, and for national security reasons.
To Prevent a Serious Threat to Health or Safety
If I come to believe that there is a serious threat to your health or safety or that of another person or the public I can
disclose some of your PHI. I will only do this to persons who can prevent the danger.
4. Uses and disclosures where you have an opportunity to object
I can share some information about you with your family or close others. I will only share information with those involved
in your care and anyone else you choose such as close friends or clergy. I will ask you about who you want me
to tell what information about your condition or treatment. You can tell me what you want and I will honor your
wishes as long as it is not against the law. If it is an emergency – so I cannot ask if you disagree – I can
share information if I believe that it is what you would have wanted and if I believe it will help you if I do
share it. If I do share information, in an emergency, I will tell you as soon as I can. If you don’t approve
I will stop, as long as it is not against the law.
5. An accounting of the disclosures
When I disclose your PHI I may keep some records of whom I sent it to, when I sent it, and what I sent. You can get an accounting
(a list) of many of these disclosures.
If you need more information or have questions about the privacy practices described above please speak to me. My telephone
number is listed below. If you have a problem with how your PHI has been handled or if you believe your privacy
rights have been violated, contact me. You have the right to file a complaint with me and with the Secretary
of the federal Department of Health and Human Services. I promise that I will not in any way limit your care
here or take any actions against you if you complain. If you have any questions regarding this Notice or my health
information privacy policies, please contact me, R. Trent Codd, III, by phone at 828‑350‑1177 or by eMail at
The effective date of this notice is April 14, 2003
You may download a printable copy of this Notice of Privacy Practices by clicking
…or you may request a copy by contacting us at: 828‑350‑1177