Notice of Privacy Practices

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. 

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This Notice of Privacy Practices (the “Notice”) describes how your information is used. Specifically, how, CKG PRACTITIONER IN PSYCHIATRY, PLLC d/b/a Flow State Psych, may use and disclose your protected health information to carry out treatment, payment, or business operations and for other legally permissible purposes.

 

“Protected health information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition, treatment, or payment for health care services. This Notice also describes your rights to access and control your protected health information.

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How Flow State Psych May Use and Disclose Your Protected Health Information

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Flow State Psych may use and disclose your medical records for the following purposes only: treatment, payment, and health care operations.

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• Treatment involves providing, coordinating, or managing mental health care and related services.

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• Payment includes activities such as obtaining payment for the mental health care services Flow State Psych provides to you from your insurance or another third-party payer.

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• Health care operations encompass the business aspects of running a practice. Flow State Psych may contact you to provide appointment reminders or other services that may interest you. Flow State Psych will disclose your protected health information to any person you identify as being involved in the payment for your care. Flow State Psych will also use and disclose your protected health information when required by federal, state, or local law.

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In certain situations, ethical standards require Flow State Psych to reveal information obtained during therapy to other persons or agencies, even without your permission. These situations include:

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(a) If you threaten serious bodily harm or death to yourself or another person, Flow State Psych must inform the intended victim and/or appropriate law enforcement agencies.
(b) If you report knowledge of physical or sexual abuse of a minor child or an elder (over 65), or any sexual conduct/contact with a minor, Flow State Psych is required by law to inform the appropriate child welfare or social agency, which may then investigate the matter.
(c) If Flow State Psych is mandated by a court order to turn over records to the court or to testify regarding those records.

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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 is needed for each request for the release of information. The authorization for the release of records is valid until it expires or is revoked. You may revoke authorization in writing, and Flow State Psych is required to honor and abide by that written request, except to the extent that actions have already been taken based on your authorization.

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This notice fulfills the requirements laid out in 45 CFR 164.520(b).
version 05.25.2024
 

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