Notice of Privacy Practices

Notice of Privacy Practices for Noma Therapy of Colorado, P.C. 

THIS NOTICE DESCRIBES HOW MENTAL HEALTH AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations Noma Therapy may use or disclose your protected health information (PHI), for treatment, payment, and health  care operations purposes with your consent. To help clarify these terms, here are some  definitions: 

  •  “PHI” refers to information in your health record that could identify you. 

  • “Treatment, Payment and Health Care Operations” – Treatment is when Noma Therapy provides,  coordinates or manages your health care and other services related to your health care. An example of treatment would be when a Noma Therapy provider consults with another health care provider, such as your family physician or another psychologist. - Payment is when Noma Therapy obtains reimbursement for your healthcare. Examples of payment are when Noma Therapy disclose your PHI to your health insurer to allow you to obtain reimbursement for your health care or to determine eligibility or coverage. - Health Care Operations are activities that relate to the performance and operation of Noma Therapy. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination. 

  • “Use” applies only to activities within the Noma Therapy team such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. 

  • “Disclosure” applies to activities outside of the Noma Therapy team, such as releasing,  transferring, or providing access to information about you to other parties. 

II. Uses and Disclosures Requiring Authorization 

Noma Therapy may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, when Noma Therapy is asked for information for purposes outside of treatment, payment and health care operations,  

Noma Therapy will obtain an authorization from you before releasing this information. Noma Therapy will also need to obtain an authorization before releasing your treatment notes. 

You may revoke all such authorizations (of PHI) at any time, provided  each revocation is in writing. You may not revoke an authorization to the extent that (1) Noma Therapy has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining  insurance coverage, and the law provides the insurer the right to contest the claim under the policy. 

Noma Therapy will also obtain an authorization from you before using or disclosing PHI in a way that is not described in this Notice. 

III. Uses and Disclosures with Neither Consent nor Authorization )

Noma Therapy providers (i.e., psychiatric prescribers and psychotherapists) may use or disclose PHI without your consent or authorization in the following circumstances: 

  • Child Abuse: If a Noma Therapy provider has cause to believe that a child has been, or may be, abused,  neglected, or sexually abused, that provider must make a report of such within 48 hours to the Colorado Department of Human Services, or to any local or state law enforcement agency.  

  • Adult and Domestic Abuse: If a Noma Provider has cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, that provider must immediately report such to the Colorado Department of Human Services. 

  • Health Oversight: If a complaint is filed against Noma Therapy with the Colorado State Board of Examiners of Psychologists or Colorado State Board of Examiners of Psychiatrists, they have the authority to subpoena confidential mental health information  from Noma Therapy relevant to that complaint. 

  • Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records  thereof, such information is privileged under state law, and Noma Therapy will not release information, without written authorization from you or your personal or legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case. 

  • Serious Threat to Health or Safety: If a Noma Therapy provider determines that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to you, that provider may disclose relevant confidential mental health information to medical or law enforcement personnel. 

  • Worker’s Compensation: If you file a worker's compensation claim, Noma Therapy may disclose records relating to your diagnosis and treatment to your employer’s insurance carrier. 

  • Comply with Law: When the use and disclosure without your consent or authorization is allowed under other  sections of Section 164.512 of the Privacy Rule and the state of Colorado’s confidentiality law. This includes certain narrowly-defined disclosures to law enforcement agencies, to a health oversight agency (such as HHS or a state department of health), to a coroner or medical examiner, for public health purposes relating to disease or FDA regulated products, or for specialized government functions such as fitness for military duties, eligibility for VA benefits, and national security and intelligence.

There may be additional disclosures of PHI that Noma Therapy is required or permitted by law to make without your consent or authorization, however the disclosures listed above are the most common.

IV. Patient's Rights and Noma Therapy's Duties 
Patient’s Rights: 

  • Right to Request Restrictions –You have the right to request restrictions on certain uses  and disclosures of PHI about you. However, Noma Therapy is not required to agree to a restriction you request. 

    • If you are not able to tell us your preferences about certain disclosures of PHI, for example if you are unconscious, we may go ahead and share your information if we believe it is within your best interest or is required to lessen a serious or imminent threat to health or safety.

    • Unless you give us written permission, we will not disclose your information for marketing purposes, sell your information, or share your psychotherapy notes in most circumstances. We may contact you for fundraising efforts or for program evaluation purposes, but you can tell us not to contact you again.

  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by reasonable alternative means and at alternative locations. (For example, you may not want a  family member to know that you are seeing Noma. Upon your request, Noma Therapy will send your bills to another address.) 

  • Right to Inspect and Copy Medical Record – You have the right to inspect or obtain a copy (or both) of PHI and progress notes and billing records used to make decisions about you for as long as the PHI is maintained in the record. Noma Therapy will usually respond to such request(s) within thirty (30) days and may charge you a reasonable, cost-based fee for copying your record. Noma Therapy may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, a Noma Therapy team member will discuss with you the details of the request and denial process. 

  • Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record.  Noma Therapy will usually respond to such request(s) within sixty (60) days. Noma Therapy may deny your request. On your request, a Noma Therapy team member will discuss with you the details of the amendment process. 

  • Right to an Accounting – You generally have the right to receive an accounting of  disclosures of PHI for the six years prior to your request, except disclosures related to treatment, payment, health care operations, as well as disclosures made subject to your consent and authorization (as described in Section III of this Notice), will not be included. On your request, a Noma Therapy team member will discuss with you the details of the accounting process. 

  • Right to a Paper Copy of the NPP – You have the right to obtain a paper copy of this Notice of Privacy Practices from Noma Therapy upon request, even if you have agreed to receive the notice electronically. We will respond promptly.

  • Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket – You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of pocket in full for Noma Therapy services, unless such disclosures are required by law. 

  • Right to Be Notified if There is a Breach of Your Unsecured PHI – You have a right to  be notified if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards; and (c) Noma Therapy’s risk assessment fails to determine that there is a low probability that your PHI has been compromised. For more information about about notification of potential PHI breaches please see: https://www.google.com/url?q=https://www.hhs.gov/hipaa/for-professionals/breach-notification/index.html&sa=D&source=docs&ust=1680541146997417&usg=AOvVaw2tSt2xrnDCQ1S5-rhBpfuL 

Noma Therapy Providers’ Duties: 

  • Noma Therapy providers are required by law to maintain the privacy of PHI and to provide you with a notice of  our legal duties and privacy practices with respect to PHI.

  • Noma Therapy will let you know promptly if a breach occurs that may have compromised the privacy and security of your PHI. 

  • Noma Therapy reserves the right to change the privacy policies and practices described in this notice. Unless Noma Therapy notifies you of such changes, however, we are required to abide by the terms currently in effect. 

  • If Noma Therapy revises its policies and procedures, a Noma Therapy team will provide you a copy.

  • Noma Therapy will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

V. Questions and Complaints 

If you have questions about this notice, disagree with a decision, or are concerned that a Noma Therapy provider has  violated your privacy rights, you may contact (via a written complaint) to either of the following:

  • Secretary of the U.S. Department of Health and Human Services by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/  

  • Mental Health Licensing Section of the Division of Registrations / The Board of Psychologist Examiners by sending a letter to 1560 Broadway, Suite 1350, Denver, Colorado 80202 or calling (303) 894-7800)

You have specific rights under the Privacy Rule. Noma Therapy will not retaliate against you for exercising your right to file a complaint. For more information see: Notice of Privacy Practices | HHS.gov. 

VI. Effective Date, Restrictions and Changes to Privacy Policy 

This notice will go into effect on 04/01/2023. Noma Therapy reserves the right to change the terms of this  notice and to make the new notice provisions effective for all PHI that it maintains. Noma Therapy will provide  you with a revised notice at your next visit.