HIPAA Compliance
Your rights as a patient and how we handle, protect, and disclose your protected health information.
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This Notice Describes How Medical Information About You May Be Used and Disclosed
Please review it carefully.
Riverside Psychology is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of this notice while it is in effect.
[CLIENT TO CONFIRM: This is a placeholder Notice of Privacy Practices. A legally compliant NPP should be reviewed and approved by a healthcare attorney familiar with Illinois law and HIPAA requirements before publishing.]
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your health information to provide, coordinate, or manage your evaluation and related services. For example, we may share information with your referring physician to coordinate your care.
Payment
We may use and disclose your health information to bill and receive payment for services rendered. This may include submitting claims to your insurance company and verifying coverage.
Healthcare Operations
We may use your health information for our own internal operations, including quality assessment, training, and legal and compliance activities.
Other Permitted Uses and Disclosures
We may also disclose your information without your authorization in specific circumstances permitted by HIPAA, including:
- When required by law (e.g., court orders, subpoenas)
- To public health authorities for disease reporting
- To report suspected abuse or neglect as required by law
- For research purposes under strict privacy protections
- To avert a serious and imminent threat to health or safety
All other uses and disclosures of your PHI require your written authorization, which you may revoke at any time in writing.
Your Rights
You have the following rights with respect to your protected health information:
Right to Access
You have the right to inspect and receive a copy of your health information. Requests may be subject to a reasonable fee. [CLIENT TO CONFIRM: specify your process and any applicable fees.]
Right to Amend
You have the right to request that we correct or amend your health information if you believe it is inaccurate or incomplete. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your health information in the past six years.
Right to Request Restrictions
You may request that we limit how we use or disclose your health information. We are not required to agree to all restrictions, but we will accommodate reasonable requests where possible.
Right to Confidential Communications
You may request that we communicate with you in a specific way or at a specific location. For example, you may ask that we only contact you at a particular phone number or address.
Right to a Paper Copy of This Notice
You have the right to request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Our Duties
Riverside Psychology is required to:
- Maintain the privacy of your protected health information
- Provide you with this notice of our privacy practices
- Follow the terms of this notice while it is in effect
- Notify you if there is a breach of your unsecured PHI
Changes to This Notice
We reserve the right to change the terms of this notice at any time. Changes will apply to health information we already hold as well as information we receive in the future. The current version of this notice will always be available on this page and in our office.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.
To file a complaint with HHS: hhs.gov/ocr/privacy/hipaa/complaints
Contact Our Privacy Officer
[CLIENT TO CONFIRM: Designate a Privacy Officer if required. Update name and contact below.]
Riverside Psychology — Privacy Officer
[CLIENT TO CONFIRM: Street address, River Forest, IL XXXXX]
(708) 762-9602
admin@riversidepsychology.net