THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW CAREFULLY:

We are required by the Health Insurance Portability & Accountability Act of 1996 (HIPAA) to provide confidentiality for all medical/mental health records and other individually identifiable health information in my possession. This Notice is to inform you of the uses and disclosures of confidential information that may be made by La Lune Integrative Psychiatry PLLC (LLIP) and of your individual rights and LLIP’s legal duties with respect to confidential information.

Ways in which LLIP may use and disclose your protected health information: LLIP may use and disclose at my discretion your medical records for each of the following purposes only: treatment, payment and health care operations.

● Treatment means providing, coordinating or managing mental health care and related services.
● Payment means activities such as obtaining payment for the mental health care services LLIP provide for you from your insurance or another third party payer.
● Health care operations include the business aspects of running a practice. LLIP may contact you to provide appointment reminders or other services that may be of interest to you. LLIP will disclose your protected health information to any person you identify that is involved in payment for your care. LLIP will use and disclose your protected health information when required by federal, state or local law.

There are certain situations in which as a therapist, LLIP is required by ethical standards to reveal information obtained during therapy to persons or agencies even if you do not give permission. These situations are as follows: (a) If you threaten grave bodily harm or death to yourself or another person, LLIP is required by ethical standards to inform the intended victim and/or appropriate law enforcement agencies; (b) if you report to LLIP your knowledge of physical or sexual abuse of a minor child or of an elder (over 65) or any sexual conduct/contact with a minor, LLIP is required by law to inform the appropriate child welfare or social agency which may then investigate the matter; (c) if LLIP is required by a court of law (court order) to turn over records to the court or if LLIP is ordered to testify regarding those records.

Any other uses and disclosures will be made only with your written authorization. You will be provided with an authorization form upon request. A separate form will be needed for each request for release of information. The authorization for release of records is valid until it expires or is revoked. You may revoke authorization in writing a LLIP is required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.