This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This notice follows the HIPAA Privacy Rule, which applies to this practice because it bills insurers electronically through Grow Therapy. It is written for clients in Maine and Florida. Clients in Ontario are covered by the Personal Health Information Protection Act (PHIPA); section 10 explains what differs.
1. Who this notice covers
This notice applies to Sabrina Duong PLLC, the practice of Sabrina Duong, LCSW, RSW, and to anyone who assists with your care or billing on the practice’s behalf. The practice is the “we” in this notice. Sabrina Duong is the privacy officer.
2. Our duties
We are required by law to keep your protected health information private, to give you this notice of our legal duties and privacy practices, to follow the notice currently in effect, and to tell you if a breach occurs that may have compromised the privacy or security of your information. We may change this notice at any time. A changed notice applies to all information we hold, and the current version is always posted on this page and available on request.
3. How we may use and share your information without your written permission
- Treatment. To provide, coordinate, or manage your care. For example, we may consult your physician or psychiatric prescriber about your care, with your knowledge.
- Payment. To bill and collect payment, including sending claims to your health plan through Grow Therapy, confirming coverage, and responding to the plan’s requests for information about services you received.
- Health care operations. To run the practice: quality review, clinical supervision or consultation, training, licensing, audits, and legal or accounting services. Consultants and vendors who see your information sign agreements requiring them to protect it.
- Appointment reminders and care information. To contact you about appointments or about services that may help you. Tell us if you prefer a particular phone number, email address, or no voicemail.
4. Other uses and disclosures the law allows or requires
- When required by law. When a federal, state, or provincial law requires it.
- To prevent a serious threat. When we believe disclosure is necessary to prevent a serious and imminent threat to your health or safety or that of another person, as permitted by law.
- Abuse or neglect. Maine and Florida require licensed clinical social workers to report suspected abuse or neglect of a child, and of an incapacitated or dependent adult, to the appropriate authority.
- Health oversight. To licensing boards, auditors, or other agencies authorized by law to oversee health care.
- Legal proceedings. In response to a court order, or to a subpoena or discovery request when the law’s conditions are met. We will tell you about such a request where the law permits so you can object.
- Law enforcement, coroners, and medical examiners. In the limited circumstances the law allows, such as identifying a person or reporting a death.
- Public health. To public health authorities for purposes such as reporting disease or adverse events.
- Military, national security, and correctional settings. As authorized by law when you are a member of the armed forces, in custody, or when national security requires.
- Workers’ compensation. As authorized by workers’ compensation laws.
- Business associates. With companies that provide services to us, such as our telehealth platform, electronic record system, and billing partner, under contracts that require them to protect your information.
5. Uses and disclosures that require your written authorization
- Psychotherapy notes. Notes Sabrina keeps separately from your clinical record about the content of sessions. These receive extra protection and are almost never disclosed without your written authorization, with narrow legal exceptions such as oversight of the therapist or a court order.
- Marketing. We do not use your information for marketing. Signing up for a free guide or email list on our website is separate from your care, and we never add clients to a list without their consent.
- Sale of information. We will never sell your information.
- Anything else not described in this notice. We will ask for your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already relied on it.
6. Your rights
You have the right to:
- See and get a copy of your record. Ask in writing. We will respond within 30 days and may charge a reasonable, cost-based fee for copies. Under HIPAA we may decline to release psychotherapy notes, and you may ask for a review of other denials.
- Ask us to correct your record. Ask in writing and tell us why. We may decline, and if we do we will tell you why in writing and you may add a statement of disagreement to your record.
- Get a list of disclosures. An accounting of disclosures we made in the past six years, other than for treatment, payment, operations, or ones you authorized. The first request in a 12-month period is free.
- Ask us to limit what we use or share. We will consider every request but are not required to agree, except one: if you pay for a service in full yourself, you may ask us not to share information about that service with your health plan, and we must agree.
- Ask for confidential communications. You may ask us to contact you in a specific way or at a specific place, for example only by text, or not at your home number. We will honor reasonable requests.
- Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Be told about a breach of your unsecured information.
- Choose someone to act for you. If you have given someone a health care power of attorney or that person is your legal guardian, they may exercise these rights for you. We will confirm their authority first.
7. Minors
For clients under 18, a parent or guardian generally has these rights, with exceptions set by Maine and Florida law for minors who can consent to certain care on their own. Sabrina will discuss with you and your child, before treatment begins, what will and will not be shared with parents.
8. Telehealth
Sessions take place by secure video through [TELEHEALTH PLATFORM], which has signed a business associate agreement with the practice. Sessions are not recorded. We ask that you join from a private space and do not record sessions yourself.
9. Complaints
If you believe your privacy rights have been violated, you may file a complaint with us by contacting Sabrina Duong at [EMAIL] or [PHONE], or with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr/privacy/hipaa/complaints, by phone at 1-800-368-1019, or by mail at 200 Independence Avenue SW, Washington, DC 20201. We will not retaliate against you for filing a complaint.
10. Clients in Ontario
If you receive services in Ontario, Sabrina Duong, RSW, is a health information custodian under PHIPA. Your personal health information is collected, used, and shared for the same purposes described above, with your knowledge and consent or as PHIPA permits or requires. Ontario law requires reporting of a child in need of protection and permits disclosure to reduce a significant risk of serious bodily harm. You may ask to see or correct your record, and you may complain to the practice or to the Information and Privacy Commissioner of Ontario, 2 Bloor Street East, Suite 1400, Toronto, ON M4W 1A8, 1-800-387-0073, www.ipc.on.ca. Records of Ontario clients are stored on servers that may be located in the United States; tell us if you have concerns about this.
11. Contact
Sabrina Duong, LCSW, RSW, Privacy Officer Sabrina Duong PLLC, [MAILING ADDRESS] [EMAIL] · [PHONE]
12. Acknowledgment
You will be asked to sign an acknowledgment that you received this notice at your first session. Your care does not depend on signing it.