343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
Notice of Privacy Practices and HIPAA Compliance
Introduction
I am required by the Federal Health Insurance Portability and Accountability Act (HIPAA) to
issue this official Notice of Privacy Practices. This notice describes how medical information
about you is protected, may be used and disclosed, and how you can access this information.
Please review it carefully.
Who Will Follow This Notice
By law I am required to insure that your PHI is kept private. The PHI constitutes information
created or noted by me that can be used to identify you. It contains data about your past,
present, or future health or condition, the provision of health care services to you, or the
payment for such health care.
Definitions
• PHI (Personal Health Information) refers to information in your health record that could
identify you. For example, it may include your name, the fact you are receiving treatment here,
and other basic information pertaining to your treatment.
• Use of PHI means when I share, apply, utilize, examine, or analyze information within my
practice.
• Disclosure means that I release, transfer, give, or otherwise reveal PHI to a third party outside
my practice.
• Authorization is your written permission to disclose PHI to a specific party for a specific
treatment reason.
• Treatment is when I provide, coordinate, or manage your health care and other services
related to your health care. For example, with your written authorization I may exchange
information with your medical doctor to assist in the prescription and monitoring of
medications or treatments.
• I may not use or disclose more of your PHI than is necessary to accomplish the purpose for
which the use or disclosure is made; however, I am always legally required to follow the privacy
practices described in this Notice.
• I maintain the right to change the terms of this Notice and my privacy policies at any time,
applicable to PHI already on file. All such changes will be communicated to all current clients. A
copy of the new Notice will be available on the website and at my office. Clients may always
request a current copy of this notice.
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343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
Acceptable Use and Disclosure
Uses and Disclosures that do not require prior written consent:
Payment: Your PHI may be used in obtaining payment for services rendered to you. This may be
providing you with documentation of your care so that you may obtain reimbursement from
your insurer. I may also provide your PHI to business associates, such as billing companies,
claims and payment processing companies, and others that process health care claims or
payments for my office. I may disclose PHI to your employer if the employer is paying for your
treatment either directly or through the employer’s insurer.
Treatment: I may disclose your PHI to physicians, psychiatrists, psychologists, and other
licensed health care providers who provide you with health care services or are otherwise
involved in your care. Example: If a psychiatrist is treating you, I may disclose your PHI to
her/him in order to coordinate your care. I may disclose your PHI to persons you identify as
being actively involved in your mental, emotional, physical, or spiritual care, including but not
limited to: relatives, friends, clergy, and patient advocates/representatives.
Health Care Operations: I may disclose your PHI to correctly operate of my practice. I might use
your PHI in the evaluation of the quality of health care services that you have received or to
evaluate my own performance. I may also provide your PHI to my attorneys, accountants,
consultants, and others to ensure that I am in compliance with applicable laws and rules and
codes of ethics.
Other disclosures/emergencies: Your consent isn't required if you need emergency treatment
provided that I attempt to obtain your consent after treatment is rendered. In the event that I
try to obtain your consent but you are unable to communicate with me (for example, if you are
unconscious or in severe pain) but I believe that you would consent to such treatment if you
could, I may disclose your PHI.
In most situations, I can only release information about your treatment to others if you sign a
written authorization. With some exceptions, I may not use or disclose more of your PHI than is
necessary to accomplish the purpose for which the use or disclosure is made; however, I am
always legally required to follow the privacy practices described in this Notice. This
Authorization will remain in effect until and unless you revoke your authorization in writing.
You may revoke your authorization at any time, in writing, except to the extent that I have
already taken action in reliance on it. However, there are some disclosures that do not require
your Authorization.
I may use or disclose PHI without your consent in the following circumstances:
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343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
I am permitted to contact you, without your prior authorization, to provide appointment
reminders or information about alternative or other health-related benefits and services that
may be of interest to you.
Child Abuse: If disclosure is mandated by Louisiana law. If I have reasonable cause to suspect or
believe a child may be abused or neglected, I must report this to the appropriate authorities
(L.S.A-R.S. 14:403; LA. CHILDREN’S CODE ARTS. 601-616).
Threat of harm to others: If disclosure is compelled or permitted by the fact that you inform me
of a serious/imminent threat of physical harm by you against a reasonably identifiable victim or
victims. I am mandated by Louisiana law to disclose PHI “when a communication reveals the
intended commission of a crime or harmful act and such disclosure is determined to be
necessary by the social worker to protect any individual or person from a clear, imminent risk of
serious mental or physical harm or injury, or to forestall a serious threat to the public safety”
(La. R.S. 37:2718 (3).
Risk of harm to yourself: If I believe that you present an imminent, serious risk of injury or death
to yourself, I may make disclosures I consider necessary to protect you from harm.
Elder Abuse: If disclosure is mandated by Louisiana law. If I have reason to believe that an
individual such as an elderly or disabled person protected by state law has been abused,
neglected, or financially exploited, I must report this to the appropriate authorities (R.S.
14:403.2, 15:1501 et.seq.).
When disclosure is required by federal, state, or local law; judicial, board, or administrative
proceedings; or law enforcement if disclosure is required by a search warrant/affidavit lawfully
issued to a governmental law enforcement agency. Example: I may make a disclosure to the
appropriate officials when a law requires me to report information to government agencies,
law enforcement personnel and/or in an administrative proceeding.
To avoid harm: I may provide PHI to law enforcement personnel or persons able to prevent or
mitigate a serious threat to the health or safety of a person or the public.
If disclosure is compelled or permitted by the fact that you are in such mental or emotional
condition as to be dangerous to yourself or the person or property of others, and if I determine
that disclosure is necessary to prevent the threatened danger.
For public health activities: Example: In the event of your death, if a disclosure is permitted or
compelled, I may need to provide PHI to the parish coroner.
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343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
For health oversight activities: I may disclose your PHI to a health oversight agency for oversight
activities authorized by law, including licensure or disciplinary actions. If a client files a
complaint or lawsuit against me, I may disclose relevant information regarding that client in
order to defend myself.
Legal or Judicial Proceedings: If you are involved in a court proceeding and a request is made
for information by any party about your treatment and the records thereof, such information is
privileged under state law, and is not to be released without a court order. Information about
all other psychological services (e.g. psychological evaluation) is also privileged and cannot be
released without your authorization or a court order. The privilege does not apply when you
are being evaluated for a third party or where the evaluation is court ordered. You must be
informed in advance if this is the case.
For research purposes: In certain circumstances, I may provide PHI in order to conduct medical
research.
Crimes on the premises or observed by the provider: Crimes that are observed by the provider
or the provider’s staff, crimes that are directed toward the provider or the provider’s staff or
crimes that occur on the premises will be reported to law enforcement.
Involuntary clients: Information regarding clients who are being treated involuntarily pursuant
to law, will be shared with other treatment providers, legal entities, third party payers and
others as necessary to provide the care and management coordination needed.
If disclosure is otherwise specifically required by law.
Special Authorizations
Certain categories of information have extra protections by law, and thus require special
written authorizations for disclosures.
Psychotherapy Notes: I will obtain a special authorization before releasing your Psychotherapy
Notes. "Psychotherapy Notes" are notes I have made about our conversation during a private,
group, joint, or family counseling session, which I have kept separate from the rest of your
record. These notes are given a greater degree of protection than PHI.
HIV Information: Special legal protections apply to HIV/AIDS related information. I will obtain a
special written authorization from you before releasing information related to HIV/AIDS.
Alcohol and Drug Use Information: Special legal protections apply to information related to
alcohol and drug use and treatment. I will obtain a special written authorization from you
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343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
before releasing information related to alcohol and/or drug use/treatment. You may revoke all
such authorizations (of PHI, Psychotherapy Notes, HIV information, and/or Alcohol and Drug
Use Information) at any time, provided each revocation is in writing, signed by you, and signed
by a witness. You may not revoke an authorization to the extent that (1) I have already acted in
reliance on that authorization; or (2) if the authorization was obtained as a condition of
obtaining insurance coverage, law provides the insurer the right to contest the claim under the
policy.
Client rights
Right to Request Restrictions: You have the right to request restrictions on certain
uses/disclosures of PHI. However, I am not required to agree to the request.
Right to Receive Confidential Communications by Alternative Means: You have the right to
request and receive confidential communications by alternative means and locations. (For
example, you may not want a family member to know that you are seeing me. On your request,
I will send correspondence to another address.)
Right to Inspect and Copy: In general, you have the right to see your PHI that is in my
possession, or to obtain copies of information suitable to be released; however, you must
request it in writing. You will receive a response from me within 30 days of my receiving your
written request. It is my policy to not release an entire record, even with your consent. Instead,
I may summarize the content related to the request. You will be granted reasonable access
to your record, but not my psychotherapy notes. It is my policy that clients review their PHI in
my presence so that I may respond to questions and clarify the content. Under certain
circumstances, I may feel I must deny your request, but if I do, I will provide, in writing, the
reasons for the denial. I will also explain your right to have my denial reviewed. Reasons for
denial include: Risk that the content would damage you because of the frank documentation of
mental health diagnoses and the nature of your issues, if the release of information would pose
a threat to me or my practice, or if the release of information would put others who are in
therapy with you at risk of having their confidentiality violated. Copies of your record are
provided at a charge of $1.00 per page released and postage, if mailed. Accordingly, I may see
fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well
as to the cost, in advance.
Right to Amend: If you believe that there is some error in your PHI or that important
information has been omitted, it is your right to request that I correct the existing information
or add the missing information. Your request and the reason for the request must be made in
writing. I may deny your request if I find that: the PHI is (a) correct and complete, (b) forbidden
to be disclosed, (c) not part of my records, or (d) written by someone other than me.
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343 3rd Street, Suite 300
Baton Rouge, LA 70801
Elizabeth Walters, LPC , NCC
Phone: (225) 933-2373
Fax: (225) 456-2892
Accounting: You generally have the right to receive an accounting of all disclosures of PHI. I can
discuss with you the details of the accounting process.
Complaints
If you believe your privacy rights have been violated, you may send a written complaint to the
Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W.,
Washington, D.C. 20201. All complaints must be submitted in writing. You will not be penalized
or discriminated against for filing a complaint. If you have any questions about this Notice,
please contact me: Elizabeth Walters, LPC, 343 3rd Street, Suite 300, Baton Rouge, LA 70801.
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