Privacy Practices


Notice of Privacy Practices

(HIPPA, sec 164.520)

Protecting client privacy is an important element of the trust between CCB and our clients, and an important legal and ethical obligation. We are deeply committed to protecting clients rights to privacy, and to safeguarding client information. 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. (HIPAA, sec 164.520)

Our Responsibilities:

CCB is required to maintain the privacy of your Protected Health Information (PHI). This includes medical information about you that is collected during the course of your treatment, such as your symptoms, examination and test results, diagnoses, treatment, and a plan for future care. Information about care that you have received from other providers may also be included in CCB’s medical record. Health Information also includes demographic information and payment information.

We are required by law to provide you with this Notice of Privacy Practices. This Notice describes how we use your Health Information, and disclose (share) it with others. CCB must abide by the terms of the Notice currently in effect. We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all Health Information that it maintains. We will post our current Notice in a prominent location in each of our practice sites.

I.   Uses and Disclosures of your Health Information:

The following are examples of the types of uses and disclosures of your Health Information that CCB is legally permitted to make.

A. For Treatment, Payment and Operations


CCB may use your Health Information to

provide and manage your health care. If we refer you for other treatment, for example to another clinician or hospital, we will provide that health care provider with the necessary information to diagnose or treat you. In addition, we may share your Health Information with other health care providers who may consult with us about your care. We believe this is critical to provide you the very best in health care and is necessary given the complexities of various illnesses and health conditions.


CCB may use and disclose your Health Information, as needed, to obtain payment for health care services. We may disclose information to your insurance company or third party payer in order to make sure your treatment is approved, to verify eligibility or coverage for insurance benefits, and to permit the payer to review services provided to you for medical necessity. For example, we may need to share relevant Health Information with your health plan to obtain approval for continuing authorizations.

Healthcare Operations:

CCB may use or disclose your Health Information in order to conduct its business of providing health care. These health care operations may include quality assessment, training of students, credentialing and various other activities that are necessary to run our practice and to improve the quality and cost effectiveness of the care that we deliver to you. Some of these business operations may be performed by outside parties (Business Associates) on CCB s behalf. Our Business Associates must agree to maintain the confidentiality of your Health Information.

B. Other Permitted and Required Uses

Involvement of Others in Your Health Care:

CCB will make an effort to ask you if we may share relevant Health Information about you with family members or any other person you identify. If you are not present, unable to communicate, or in an emergency situation, CCB may exercise its professional judgment to determine whether to share this information. In addition, we may need to disclose Health Information to notify a family member or any other person responsible for your care of your location, general condition or death. Finally, CCB may disclose your Health Information to an authorized public or private entity to assist in disaster relief efforts, and to coordinate efforts to notify someone on your behalf. Please be assured we will only do so if absolutely necessary and in the event of an emergency or disaster.

Public Health:

CCB may disclose your Health Information for public health activities, including the following:

- to report Health Information (e.g., infectious diseases, such as chickenpox) to prevent or control disease, injury, or disability

- to report births and deaths

- to report reactions to medications or problems with products

- to notify a person who may have been exposed to a communicable disease, or may be at risk for contracting or spreading the disease

Victims of Abuse. Neglect or Domestic


If CCB reasonably believes you are a victim of abuse, neglect or domestic violence, we may disclose your Health information to an appropriate agency authorized by law to receive such reports.

Health Oversight:

CCB may be required to disclose Health Information to a health oversight agency for audits, investigations, inspections, and other health oversight activities. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Legal Proceedings:

CCB may be required to disclose Health Information in the course of any judicial or administrative proceeding in response to a legal order or other lawful process, including a subpoena.

Law Enforcement:

CCB may be required to disclose Health Information for law enforcement purposes.

Coroners, Funeral Directors, and Organ  Donation:

CCB may be required to disclose Health Information to a coroner or medical examiner to identify a deceased person or to determine the cause of death. We may also disclose Health Information to a funeral director or their designee, as necessary to carry out their duties. Health Information may also be disclosed to organizations that facilitate organ, eye or tissue donation and transplantation.


CCB may use or disclose Health Information for research that is approved by an Institutional Review Board when written permission is not required by Federal or State law. This may include preparing for

research or telling you about research studies in which you might be interested.

To avert a serious threat to health or safety:

CCB may be required to use and disclose Health Information to prevent or lessen a serious threat to a person(s) or the public’s health or safety.

Specialized Government Functions:

Under certain circumstances, CCB may be required to disclose Health Information to units of the government with special functions, such as the U.S. military or the U.S. Department of State.

Workers Compensation:

CCB may use and disclose Health Information as required to comply with workers compensation laws, and other programs that provide benefits for work-related injuries or illnesses.

Required By Law:

CCB may be required to use or disclose your Health Information to the extent that the use or disclosure is required by federal, state or local law. This includes any other law not already referred to in the preceding categories. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

C.     Uses and Disclosures of Health Information Based upon Your Written Authorization

Uses and disclosures of your Health Information, other than those described above, will be made only with your written authorization. For example, you will need to sign an authorization form before CCB can send your Health Information to your life insurance company. We will also obtain your written authorization prior to using your Health Information to send you any marketing materials. You may revoke your authorization at any time, in writing, except to the extent that CCB has taken any action in reliance on the authorization.

In addition, Federal and Massachusetts laws require that we obtain your specific written authorization for the use or disclosure of certain information about you. This information includes psychotherapy process notes as defined by federal law; communications with certain behavioral health professionals; communications between domestic violence victims and domestic violence counselors, and between sexual assault victims and sexual assault counselors; and information related to substance abuse treatment, HIV testing or test results, treatment of sexually transmitted diseases, and genetic testing or test results.

II. Your Individual Rights

Although your medical record is CCB’s property, the Health Information it contains belongs to you. The following is a statement of your rights with respect to your Health information, and a brief description of how you may exercise these rights.

A. You have the right to inspect and copy your Health Information

At any time, you may inspect and obtain a copy of Health Information about you, including your medical and billing record, which may be used to make decisions about your care. Under limited circumstances we may limit your access to all or certain portions of your record. This includes, but is not limited to, psychotherapy process notes, or information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. If you are denied access to portions of your record, in some circumstances you may have a right to have this decision revised. All requests to access your record must be made in writing to your therapist, and will be processed within 30 days. If you request a copy of your records, we may charge you a fee to cover the copying and mailing costs.

B. You have the right to request an amendment of your Health Information.

You may request CCB to amend your treatment and billing information if you think the information is incorrect or incomplete, for as long as we maintain the information. If for some reason we deny your request, we must give you a written statement with the reasons for the denial, and what other steps are available to you. Please don t hesitate to contact your therapist if you have questions about amending your medical record, or office staff to discuss amendments to your billing records.

C. You have the right to request a restriction of your Health Information.

You have the right to ask for restrictions on the use and sharing of your health information for treatment, payment, or health care operations. CCB is not required to agree to your request. If we do, we must put the restriction in writing and abide by it, except if you need to be treated in an emergency. You may not ask us to restrict uses and sharing of information that we are legally required to make. All requests must be in writing to your therapist.

D. You have the right to request to receive communications from us by alternative means or at an alternative location.

We will make every effort to accommodate requests, provided you supply a valid alternative address or other method of contact. In certain cases we may need to contact you and may do so at the original address or phone number if attempts to contact you at the alternative locations are not successful.

E. You have the right to receive an accounting of certain disclosures we have made, if any, of your Health Information.

This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. It does not apply to disclosures we may have made to you, that are authorized by you, information provided to family members or friends about your care, or for notification purposes. You have the right to receive specific information regarding disclosures made by CCB that occurred after April 14, 2003. You can request an accounting of disclosures for a period up to six years, but only for disclosures made after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations. Requests must be made to CCB in writing, and we will respond to your request within 60 days.

F. You have the right to obtain a paper copy of this notice.

We will provide a paper copy of this Notice to you, upon request, even if you have agreed to accept this notice electronically.

III. Effective Date: This Notice is effective on April 14, 2003.

IV. Complaint Process:

If you believe CCB has violated your privacy rights, please communicate your concerns to your therapist or the Director of CCB.  You may also send a written complaint to the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. CCB will not retaliate against you if you file a complaint about our privacy practices, nor will it affect your rights or status as a client with CCB. We will make every effort to respond to your concerns immediately and professionally.