Bernard McDowell, lcsw
Psychotherapist & Licensed Clinical Social Worker   
2700 SE 26th Avenue Suite D, Portland, OR  97202
503-234-9904

NOTICE OF PRIVACY PRACTICES Effective Date: August 16, 2012

THIS NOTICE DESCRIBES HOW CLINICAL INFORMATION ABOUT Clients of Bernard McDowell, L.C.S.W. MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. Please Review It Carefully

For all Health care providers “covered” under a Federal Law, HIPAA, much of the following is required in detail including the exact wording of the heading above. Though commiting to follow this law, this privacy notice does not constitue Bernard McDowell's philosophical agreement. If you have any questions or requests concerning this notice, please contact Bernard McDowell, the “designated privacy contact” at 2700 SE 26th Ave Suite D, Portland, OR 97202. Any changes to this Notice will be posted will be posted on his website which is currently at www.PortlandTherapist.com. Please note that though this notice lists a great many instances when your private information could be released by law without a client’s permission, such instances have been extremely rare in my practice—e.g, with clients numbering in the thousands through my career, I’ve only had to report child abuse and/or plans to commit suicide three or four times to date. In practical terms, you get the greatest confidentiality when there is no third party, such as an insurer, is involved.

 WHO THIS NOTICE APPLIES TO: This notice describes the practices for the privacy of his clients’ information followed by Bernard McDowell, lcsw, also referred to here by “I”, “me”, “my”, “he”, or “his”. “You”, “your”, “her/himself” or “client” refer to the client(s) receiving this notice. YOUR “PROTECTED HEALTH INFORMATION”: This notice applies to certain information, called “protected health information” [PHI] containing identifiers such as name, social security number, etc that could be traced to you. PHI includes oral communications made and records maintained about your health, health status, and the services you receive from Bernard McDowell. This further includes but is not limited to any diagnosis, assessment data, or background information. HOW INFORMATION ABOUT YOU MAY BE USED AND/OR DISCLOSED: Federal Law doesn’t require your consent to release information for the purposes of “treatment, payment, and health care operations” as specified below. However, the law and ethics of my Licensed Clinical Social Worker status does require your consent for the use and disclosure of your protected health information. This is spelled out in a separate “consent” form you will be asked to sign and, in other more unusual circumstances, you will be required to sign an “authorization” before I can release any PHI about you.

For Treatment. Under HIPAA, this includes providing care, coordinating or managing your care with third parties, and consultations with other health care professionals, for example, your primary care physician. [However, State laws and professional ethical standards are more stringent. Therefore, though permitted under Federal Law, Bernard McDowell will not share any “individually identifiable information” with other professionals unless he has your written authorization or in case of other legal exceptions noted in the Notice of Privacy Practices—such as required by child abuse laws. The consent does include treatment provided by any professional who covers this practice on an on-call basis or to telephone clients in case Bernard McDowell would ever have a emergency of his own. Treatment alternatives: I may use and/or disclose medical information about you in order to inform you of or recommend new treatment or different methods for treating you or to inform you of other health related benefits and services that may be of interest to. For Payment. Under HIPAA, health information about you may be used and disclosed to bill and collect payment from you including, for example, an insurance company or another third party without your consent. [However, under State laws and professional ethics standards that Mr. McDowell follows, a consent is required to bill insurers or a third parties. Generally, he will only release name, social security, policy numbers, other basic identifying information, diagnosis, date of service, and type of service. If your insurer asks for more information, he will discuss that issue with you but not generally require any further consent or authorization for information your insurer claims is necessary for payment.] For Health Care Operations. Under HIPAA, health information about you in order to run Mr. McDowell’s business and make sure you receive quality care may be used and disclosed. For example, some insurers hire auditing firms to review medical records. Also, he may, for example, write you to notify you that your case is officially on “inactive status” or to confirm what your intentions are concerning further treatment if there has been a gap since your last appointment, no response to a phone call, or to find out how you are doing since the last appointment.

Concerning the Consent: You may revoke your Consent at any time by giving me written notice except to the extent that action has already been taken in reliance on the Consent. Clearly, in the case of billing to insurance, if you decide you no longer wish me to do that, you will still be responsible for any unpaid charges.

Substance Abuse Treatment If you are receiving Substance Abuse Treatment Federal and State law require your written Authorization each time I release health information. The Authorization will specify who is to receive the information, the purpose of the release of information, and a time period after which the Authorization will terminate. You may modify or revoke an authorization at any time. However, if I are unable to fulfill my requirements related to treatment, payment or health care operations, I may choose to discontinue providing you with health care treatment and services.

SPECIAL SITUATIONS Your protected health information may be used or disclosed without your permission for the following purposes, subject to all applicable legal requirements and limitations (1-5):

1) Serious Threat to Health or Safety: Based on professional judgment, I may disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. If a therapist is convinced that a client has specific plans to hurt or kill another person(s) or her/himself (suicidal feelings are relatively common and not a reason, in and of itself, to break confidentiality); if a client reveals they have abused a child, an elderly person, or a developmentally disabled person; or if someone under 18 reveals they’ve been abused;

2) Required By Law.: Protected health information about you may be released when Mr. McDowell is required to do so by federal, state or local law. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, health information about you will be released in response to a court order. Subject to all applicable legal requirements, health information about you may be released in response to a subpoena or an administrative order. Law Enforcement: Federal Law permits release of health information to a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

3) Family and Friends: In situations where you are not capable of giving authorization (e.g., you are not present due to disability or medical emergency), health information about you may be disclosed to your family member or friend if, in professional judgment, it is in your best interest. In that situation, I would disclose only health information relevant to the person's involvement in your care. For example, if one of my clients were to commit suicide, I might involve a family member to get that client to a hospital.

4) Parents and Children: While both the custodial and non-custodial parents/guardians have the right to be informed about the therapy of their children (under 18), it is often impossible to establish the rapport necessary to help teenagers if the parents don’t agree to forego that right and, thus, allow their teenagers the same confidentiality afforded adults. Further, by law a therapist may refuse to divulge information to parents or guardians if they believe that it would be deleterious to the treatment.

5) Couples Counseling: While most couples counseling takes place with both partners present, there may be times when one person communicates with the therapist alone, e.g., phoning in for an appointment. Therefore, as explained in my “General Practice Policies”, I require both parties of a couple in counseling together, to agree that I have the right to reveal to one party what has been told by the other. This will be done at my discretion.

6) In case of illness or disability incurred by Mr. McDowell, he has named another Licensend Clinical Social Worker as the guardian of his record as per the requirement of the Oregon Board of Licensed Clinical Social Workers 877-030-0100, Disposition of Client Records in Case of Death or Incapacity of Licensee. Only in such emergencies would that person have access to your records or contact you. To date in Mr. McDowell’s private practice, no one has ever had access to my records other than me or in instances requested by the client, e.g., to an insurer.

Additional disclosures are permitted under HIPAA regulation but may be contrary to state law These additional disclosures will not be made by me without your authorization. However, once information leaves this practice and becomes part of any data resource beyond my control, HIPAA permits disclosure in the following circumstances (1-6):

1) Research. Health information about you can be used for research projects that are subject to a special approval process. You may be asked for your permission, if the researcher will have access to your name, address or other information that reveals who you are. 2) Military, Veterans. National Security and 3) Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, military command or other government authorities may require the release of health information about you. HIPAA also permits release of information about foreign military personnel to the appropriate foreign military authority.

3) Workers' Compensation. Health information about you may be released for workers' compensation or similar programs as far as HIPAA is concerned. These programs provide benefits for work-related injuries or illness. [However, in Oregon when you sign a workers’ comp claim, you are giving your permission for the release of your medical records. Without that authorization, Bernard McDowell will not release your record unless State Laws change and force him to do so.] 4) Public Health Risks. Health information about you may be disclosed for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products. 5) Health Oversight Activities. Health information about you may be disclosed to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws. 6) Information Not Personally Identifiable. Health information about you may be disclosed in a way that does not personally identify you or reveal who you are. For example, Bernard McDowell, typically discusses cases in consultation groups with peers by discussing the outline or critical issues of a case but without using any identifiable information. This provides invaluable feedback for any professional therapist and is often recommended practice.

OTHER USES AND DISCLOSURES OF HEALTH INFORMATION::AUTHORIZATIONS

I will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization. I must obtain your Authorization separate from any Consent I may have obtained from you. If you give me Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, I will no longer use or disclose information about you for the reasons covered by your written Authorization, but I cannot take back any uses or disclosures already made with your permission prior to your revocation. If I have HIV or substance abuse information about you, I cannot release that information without a special signed, written authorization (different than the Consent mentioned above) from you. In order to disclose these types of records for purposes of treatment, payment or health care operations, I will require a special written authorization that complies with the law governing HIV or substance abuse records.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU I agree to grant the following rights which apply to PHI I maintain about you. These rights parallel those require under HIPAA. In the event, you exercise any of these rights, I agree to respond within the timelines specified in the HIPAA law.:

Right to Inspect and Copy: You have the right to inspect and copy your protected health information in your “medical record”, such as clinical and billing records. You do not have the right to inspect and copy “psychotherapy notes” as defined by HIPAA or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. Here conforming to the definition under HIPPA, “psychotherapy notes” specifically excludes any summary of symptoms, diagnosis, progress, treatment plan, functional status, prognosis, results of clinical tests, modalities and frequency of treatment, start and stop times of each session, medication prescriptions and monitoring, any other information necessary for treatment or payment”. All of that information belongs information in your medical record. You must submit a written request to me in order to inspect and/or copy your protected health information in your medical record. If you request a copy of the information, I may charge a fee for the costs of copying, mailing or other associated supplies. I may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed. If such review is required by law, I will consult with a licensed health care professional to review your request and my denial. If you give your permission, I may select another licensed health care professional to give a second opinion on your request and my denial. Mr. McDowell agrees to comply with the recommendations of the reviewer.

Right to Amend: I agree you may have your medical record amended (which means correct or supplement). If you believe that I have information that is either inaccurate or incomplete, I may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like me to amend information, you must provide me with a request in writing and explain why you would like me to amend the information. I may deny your request in certain circumstances. If I deny your request, I will explain my reason for doing so in writing by referencing the criteria specified by HIPAA but you still have the opportunity to send me a statement explaining why you disagree with my decision to deny your amendment request and I will share your statement if ever I disclose the information in the future, e.g. to an insurer you were asking me to bill. Right to an Accounting of Disclosures: I agree you may have an "accounting of disclosures." This is a list of the disclosures, usually very rare, I made of clinical information about you for purposes other than treatment, payment and health care operations. To obtain this list, you must submit your request in writing to me. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). Following the procedure identified in HIPAA, the first list you request within a 12-month period will be free. For additional lists, I may charge you for the costs of providing the list. I will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.  

Right to Request Restrictions: I agree you may request a restriction or limitation on the health information I use or disclose about you for treatment, payment or health care operations. Normally, I am prohibited from even acknowledging whether you are a client or not; however, if a family or friend is involved in your care, e.g., drives you to your appointment, or makes payment for you, you also have the right to request a limit on the health information I disclose about you to those persons. Just as for providers covered by HIPAA, I will not be required to agree to your request. If I do agree, I will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you may simply advise me in writing of specific limitations or restrictions you want placed on my use of health information for treatment, payment or healthcare operations. I will accommodate all reasonable requests.

Right to Request Confidential Communications: You have the right to request that I communicate with you about clinical matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or by mail or not to leave a message at your voice mail. My client intake form already asks you to specify some of this type of information. To request confidential communications, you may simply advise me in writing of specific limitations or restrictions you want placed on my communications with you. I will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask me to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact Bernard McDowell.

Right To File A Complaint: If you believe your privacy rights have been violated, please file a complaint with my office. I have procedures documented requiring me to follow protocol for handling complaints that may include consulting with other professionals. I also agree that you may file a complaint with the Secretary of the Department of Health and Human Services if you believe any of your PHI has been handled in violation of your privacy rights or this notice. If you were to chose to file a complaint, I will agree to open your file and my policies and procedures to the Secretary of DHHS if they chose to address that complaint. To file a complaint with his office, write to Bernard McDowell, lcsw at 2700 SE 26th Ave Suite D, Portland, OR 97202. By my policy and procedures, you can not be penalized for filing a complaint. Changes to this Notice: I reserve the right to change this notice, and to make the revised or changed notice effective for clinical information I already have about you as well as any information I receive in the future. I will post a summary of the current notice in the office with its effective date clearly shown at the top. You are entitled to a copy of the notice currently in effect.