HIPAA Compliance

DNP Psychiatry – A Professional Corporation – www.dnppsychiatry.com

Effective Date: [March 5, 2025]

Health Insurance Portability and Accountability Act (HIPAA) Statement

1.                   How We Use & Disclose Your Health Information

We may use or share your health information for:

·                    Treatment – Coordinating care with psychiatrists, therapists, or other healthcare providers.

·                     Payment – Processing insurance claims and billing.

·                     Healthcare Operations – Ensuring compliance, quality improvement, and security measures.

·                     Legal & Safety Reasons – If required by law, to prevent harm, or in response to legal proceedings.

·                     Your health information will not be shared for marketing or non-healthcare-related purposes without your explicit written consent.

2.                   Telehealth & Virtual Care Privacy

Since our practice operates virtually, we use HIPAA-compliant telehealth platforms to protect your privacy. While we take strict security measures, we cannot guarantee complete confidentiality if you access services from an unsecured network or device.

To protect your privacy during virtual sessions:

·                     Use a private, secure location for appointments.

·                     Avoid public or shared Wi-Fi when accessing our services.

·                     Enable security settings on your devices and applications.

3.                   Your HIPAA Rights

As a patient, you have the right to:

·                     Access and request copies of your medical records.

·                     Request corrections to inaccurate information.

·                     Restrict certain uses or disclosures of your health information.

·                     Request confidential communication methods.

·                     File a complaint if you believe your rights have been violated.

A HIPAA compliant Release of information form is being provided to you today. This form is a legal document that allows a patient to authorize the disclosure of their protected health information (PHI) to a specified individual, organization, or entity. This form is required under the Health Insurance Portability and Accountability Act (HIPAA) to ensure that a patient’s private health information is only shared with their consent, except in cases permitted by law.

Key Elements of a HIPAA Release of Information Form

Patient Information – Name, date of birth, and contact details.
Authorized Recipient – The individual(s) or entity allowed to receive the health information.
Purpose of Disclosure – Why the information is being shared (e.g., treatment, legal, insurance).
Specific Information to Be Released – Details on what PHI can be disclosed (e.g., medical records, mental health notes, lab results).
Expiration Date – When the authorization expires (if applicable).
Right to Revoke – A statement explaining that the patient can withdraw consent at any time.
Patient Signature & Date – Required for authorization to be valid.

Common Uses of a HIPAA Release Form

Transferring medical records between healthcare providers.
Allowing family members or caregivers to access a patient’s health information.
Sharing information with insurance companies, attorneys, or other third parties.
Disclosing records for legal or disability claim purposes. 

Please contact DNP Psychiatry by phone (458) 250–4964 or by mail at 175 W. B St., Springfield, OR 97477 with questions about this terms and conditions of use statement.

Warm Regards,

Don Cleland, DNP, APRN, PMHNP-BC, FNP-BC, PHN, RCP
Director, DNP Psychiatry, PC

Meeting you where you are in mind, body and spirit – guiding along the way.