Privacy/HIPPA Statement


HIPAA & RECIPIENT RIGHTS: A federal act called the Health Insurance Portability and Accountability Act (HIPAA) gives you some additional rights to what you have through state laws. This notice gives you information on these additional rights through HIPAA.

UNDERSTANDING THE TYPE OF INFORMATION WE HAVE: We obtain information about you when you receive services with Suzanne Cavalier -Dorsett LCSW. It includes your date of birth, gender, Social Security Number and other personal information. I care about your privacy. The information I collect about you is private. I am  required to give you a notice of my privacy practices. Only people who have both the need and legal right may see your information. Unless you give me permission in writing, I will only disclose your information for purposes of treatment/services, payment, business operations or when I am required by law to do so. I am required by law to maintain the privacy and security of your protected health information. I will promptly let you know if a breach occurs that may have compromised the privacy or security of your information. Treatment/Services: I may disclose information about you with your written consent to coordinate your services. For example, I may give information to your other healthcare providers. Payment: We may also use and disclose information so the care you get can be properly billed and paid for. For example, we If I submit bills to your credit or debit card provider. Business Operations: I may need to use and disclose information for my business operations. For example, I may use information to review the quality of the services you receive. 

EXCEPTIONS: For certain kinds of records, your permission may be needed even for release for treatment, payment, and business operations. As Required By Law: I will release information when I am required by law to do so. Examples of such releases would be for law enforcement or national security purposes, workers’ compensation claims, medical examiner or funeral director if an individual dies, subpoenas or other court orders, communicable disease reporting, review of activities by government agencies, to avert a serious threat to health or safety, reporting suspected abuse, neglect, or domestic violence, or in other kinds of emergencies. With Your Permission: If you give permission in writing, I may use and disclose your personal information. If you give permission, you have the right to change your mind and revoke it. This must be in writing also. I cannot take back any uses or disclosures already made with your permission. 

YOUR PRIVACY RIGHTS: You have the following rights regarding the health information that we have about you. Your requests must be made in writing. Your Right to Inspect and Copy: In most cases, you have the right to look at or get copies of your paper or electronic health records. We I can provide a copy or a summary of your health information, usually within 30 days of your request. You may be charged a fee for the cost of copying records. Your Right to Amend: You may ask us to change your records if you feel that there is a mistake. I can deny your request for certain reasons, but I will give you a written reason for denial within 60 days. 

YOUR RIGHT TO A LIST OF DISCLOSURES: You have the right to ask for a list of disclosures or your health information for six years prior to the date you ask, who we shared it with and why. This list will not include the times that information was disclosed for treatment, payment, or business operations. This list will not include information provided directly to you or your family, or information that was sent with your authorization. 

YOUR RIGHT TO REQUEST RESTRICTIONS ON OUR USE OR DISCLOSURE OF INFORMATION: You have the right to ask for limits on how your information is used or disclosed. I am not required to agree to your request if it would affect your care. If you pay for your services out-of-pocket in full, you can request that I not share that information for the purpose of payment or our operations with your health insurer unless a law requires us to share that information. 

YOUR RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to ask that I share information with you in a certain way or in a certain place. For example, you may ask me to send information to your work address instead of your home address. You do not have to explain the basis for your request. 

YOUR RIGHT TO CHOOSE SOMEONE TO ACT ON YOUR BEHALF: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. I will make sure that person has this authority and can act for you before we take any action. 

YOUR RIGHT TO SHARE HEALTH INFORMATION: You have both the right and choice for me to share information with your family, close friends, or others involved in your care or share information in a disaster relief situation. We never share psychotherapy notes unless you give us written permission. We never market or share personal information. 

CHANGES TO THIS NOTICE: We reserve the right to revise this notice. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be published on our website. Go to the website and all changes will be updated in the sight. 

HOW TO USE YOUR RIGHTS UNDER THIS NOTICE: If you have questions or would like more information, you may ask any questions when we speak. If you believe your privacy rights have been violated, you can file a complaint with:  The Board of Social Work. You will not be penalized for filing a complaint. You may write or speak to me as well.