Rebecca J. Hubbard
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HIPPA Document for Rebecca J. Hubbard PLLC




Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The following notice informs you of Rebecca J. Hubbard, PLLC’s duty to protect your health information, your privacy rights, how we may use or disclose your health information and how you can gain access to your health information. Although your file belongs to Rebecca J. Hubbard, PLLC, the health information in the file belongs to you.

 Health information includes any information that relates to your past, present, or future mental health condition and the health care provided to you at Rebecca J. Hubbard, PLLC such as treatment plans, progress information, and termination summaries.

 Rebecca J. Hubbard PLLC’s Duty to Protect Your Health Information

We are required to:

·      Maintain the privacy to all clients and to protect the confidentiality of health information. We are required to inform you of legal duties and privacy practices and is mandated to notify you if any health information is breached. 

·     Safeguard the privacy of your health information. This means that we will not use or disclose your health information without your authorization except in the ways we explain to you in this notice.

·      Obtain written authorization to use or disclose health information that is not mandated by federal or state law. If you give such an authorization you may revoke it at any time, in writing, but we will not be liable for uses or disclosures made before you revoked your authorization.

·       If the content of this notice changes, the new notice will be made available at our facilities within 30 days of the effective date of the changed notice. The new notice will apply to all health information maintained by us, no matter when we received or created the information.

·       Protect the privacy of your health information as part of our jobs. We do not let our employees see your health information unless they need it as part of their jobs.

·       Comply with federal and state laws. Federal laws and regulations do not protect any information regarding suspected child abuse or neglect, or reported harm to self or others. The employee will only disclose this information to appropriate authorities.

 Your Privacy Rights at Rebecca J. Hubbard, PLLC

You have the right to:

·      Inspect and obtain a copy of your health record. In some cases, we may deny access in accordance with state or federal law. If we deny your request, we will tell you why. You can choose to get a summary of your health information instead of a copy. The summary will include information about symptoms and treatment plans. Request for records must be made in writing.

·      Request a restriction on certain uses and disclosures of your information. We will consider your request, but the law does not require us to agree to the request. If we do agree, we will put the agreement in writing and follow it, except in case of emergency. We cannot agree to limit the use of sharing of information that is required by law.

·      Receive confidential communications of protected health information.     

·      If you believe the information in your record is incorrect, you can request amendments to your health record. We will not destroy or change our records, but we will add the correct information to your records and make a note in your records that you have provided the information. Requests for changes must be in writing.

·      Obtain a document that records when and to whom disclosures were made regarding your treatment.         

·      Request communications of your health information by alternative means.

·     Withdraw your authorization to use or disclose health information except to the extent that action has already been taken. Withdrawals must be in writing.

·       Get a paper copy of this notice anytime you ask for it.

·       Request additional information about privacy practices at any time.

 How Rebecca J. Hubbard, PLLC Uses and Discloses Your Information

·       Treatment- We may use or disclose your health information to provide, coordinate, or manage health care or related services. This includes providing care to you, consulting with another health care provider about you, and referring you to another health care provider.  We can disclose health information to refer you to a high-risk clinic or a hospital for services.

·       Clinical Consultation- Clinical consultation serves the purpose of improving services to clients. When required for state licensure, staff members consult with their clinical supervisors. Identifying health information is kept confidential.

·       Family Member/Other Relative- We may disclose health information, with a signed Release of Information, about you to a family member or other relative when the health information is related to that person’s involvement with you or your treatment.

·     Victims of Abuse, Neglect, or Domestic Violence- We may disclose health information to a governmental agency that requires reports of abuse, neglect, or domestic violence if we suspect any abuse, neglect, or domestic violence. We are mandated by law to report suspicions of abuse, neglect, or domestic violence.

·     Serious Threat to Health or Safety- We may use or disclose health information about you if we believe the use or disclosure is needed to prevent a serious and immediate threat to the health and safety of a person or the public.

·     As Required by Texas Law- We may use or disclose health information about you when a law requires the use or disclosure.

·       In Judicial Proceedings- We may disclose your or your child’s health information in any criminal or civil proceeding if a court or judge has issued a court order or subpoena that requires us to disclose it.

 Complaints Process

If you believe that we have violated your privacy rights, you have the right to file a complaint within 180 days of when you learned of the violation. There will be no retaliation for filing a complaint. Complaint can be filed with any of the agencies listed below:

Rebecca J. Hubbard, PLLC

Privacy Officer and Custodian of Records

P.O. Box 941

Georgetown, TX 78626


Region VI, Office of Civil Rights, U.S. Department of Health and Human Rights

Regional Manager

1301Young Street, Suite 1169

Dallas, TX 75202

Phone 214-767-4056

FAX 214-767-0432