HIPAA Notice of Privacy Practices


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This notice describes how medical information about clients may be used and disclosed and how clients can get access to this information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by the therapist in any form, whether electronically, on paper, or orally, are kept properly confidential. This act gives the client significant new rights to understand and control how their health information is used. “HIPAA” penalizes covered entities that misuse personal health information.

Therapists are required by law to maintain the privacy of the client’s Protected Health Information (PHI). This notice applies to all records of the health care and services the client receives at your office. This notice tells the client about the ways in which a therapist may use and disclose the client’s PHI. This notice also describes the client’s rights and certain obligations of the therapist regarding the use and disclosure of the client’s PHI.

The therapist and client should sign this form in each other’s presence to ensure that there are no questions about the client’s intent to authorize disclosure of the information. If the client is a minor child, the child’s parent or guardian should sign on their behalf. Keep a copy of the form in the client’s permanent file, and provide a copy to the client if requested.

This form is also a part of the INTAKE AND HIPAA FORMS set. If you’re buying multiple forms save money by buying them together!

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About Therapist 2 Go

At Therapist 2 Go we create organization and information management tools for psychotherapists that are straightforward and easy to use. We believe that forms do not have to be complicated to be functional and efficient and to capture the client information that you need to provide effective therapeutic treatment. Our goal is to help you run an efficient, profitable business, allowing you to spend more time focused on the therapeutic process and less time on routine administrative tasks.