Terms & Conditions

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.

MY PLEDGE REGARDING MEDICAL INFORMATION: I understand that medical information about you and your health is personal. I am committed to protecting medical information about you. It is my duty to safeguard your Protected Health Information (PHI). Your personal doctor or other community-based providers may have different policies or notices regarding their use and disclosure of your medical information or PHI created in their offices, clinics, or facilities.

This Notice will tell you about ways in which I may use and disclose medical information about you. I also describe your rights and certain obligations I have regarding the use and
disclosure of medical information. If I significantly change my privacy practices I will revise this Notice and make it available to you online at buddocs.org/terms .

Contents of this Notice:

  1. Introduction to Notice and PHI
  2. How Your Protected Health Information (PHI) Can Be Used and Shared

III. Your Rights Regarding PHI About You

  1. If You Have Questions or Problems
  2. Effective Date, Restrictions, and Changes to Privacy Policy

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  1. Introduction to Notice and PHI

This Notice will tell you how I handle information about you.  It tells how I use this information here in this office, how I share it with other professionals and organizations, and how you can see it.  I want you to know all of this so that you can make the best decisions for yourself and your family.  I am also required to tell you about this because of the privacy regulations of a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Each time you visit this practice or any doctor’s office, hospital, clinic, or any other “healthcare provider,” information is collected about you and your physical and mental health. It may be information from your past, present, or future health/conditions. It may also be information of the treatment or other services you received from your therapist or from others or about payment for healthcare. The information collected from you is called, in the law, Protected Health Information (PHI).  This information goes into your medical or healthcare record or file.  At this clinic, this PHI is likely to include these kinds of information:

  1. Your History – as a child, in school, at work, marital, and other personal history.
  2. Reasons you came for treatment (i.e., problems, complaints, symptoms, and/or goals).

III. Diagnoses – medical terms for your symptoms.

  1. A treatment plan for therapy.
  2. Progress notes – written account of what occurs during our sessions.
  3. Records obtained from other providers.

VII. Educational or Psychological testing – results and interpretations.
VIII. Information about medications you took or are taking.

  1. Billing information. 

This information is used:
To plan your care and treatment.

To decide how well the treatments are working for you.