intensive trauma therapy, inc.
Outpatient Treatment for Post-Traumatic Stress Disorder & Dissociation
NOTICE OF PRIVACY PRACTICES
Protected Health Information (P.H.I.) Policies and Procedures
Updated January 1, 2012
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.
New laws have been instituted under the Health Insurance Portability and Accountability Act (HIPAA) of 1966 to protect
patient and clients who are being treated by health care practitioners, including licensed counselors and art therapists. On
April 14, 2003, all health care providers must notify their clients or patients of their rights to insure medical privacy,
especially if health information is being shared with other health care providers, insurance companies or the courts.
Intensive Trauma Therapy, Inc. covered entity (“ITT”) is required by law to maintain the privacy of your medical
information and to provide you with notice of its legal duties and privacy practices with respect to this information. The
purpose of this notice is to provide you with that information.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all medical
information that we maintain. We will post a copy of the current notice in our office and on the website. In addition,
each time you come to ITT for treatment or health care services, you may request a copy of the current notice in
We are bound by a professional code to maintain the confidentiality of your treatment. All of the ITT personnel are required
to keep client/patient treatment and all records associated with client/patient treatment confidential and will only reveal the
contents of client/patient treatment with expressed written consent from the client/patient or legal guardian. The following
circumstances might require ITT to disclose information about your treatment, but only with your written consent:
Collaboration with a physician or psychiatrist who is also treating you
Collaboration with a consulting colleague obligated to the law under HIPAA
Court ordered information required by litigation in which you are involved
Record requests from Social Security Disability or VA Administration to determine disability benefits
There are situations in which ITT is legally obligated to take actions which we believe are necessary to attempt to protect
others from harm, in which case we may have to reveal some information about a client’s treatment. The following is a
description of ways in which we may use and disclose your information for which an authorization or an opportunity to agree
or object is not required:
If ITT has reasonable cause to believe that a child under age 18 known to them in their professional capacity may be
an abused or neglected child, the law requires that they file a report with Child Protective Services. Once a report is
filed, they may be required to provide additional information.
If ITT has reason to believe that an adult over the age of 60 living in a domestic situation has been abused or
neglected in the preceding 12 months, the law requires that ITT file a report with Adult Protective Services. Once a
report is filed, ITT may be required to provide additional information.
If you have made a specific threat of violence or acted violently against another or if ITT staff believes that you
present a clear, imminent risk of serious physical harm to another, ITT may be required to disclose information to
take protective action. These actions may include notifying the potential victim, contacting the police, or seeking
If ITT believes that you present a clear, imminent risk of serious physical or mental injury or death to yourself, ITT
may be required to disclose information in order to take protective actions. These actions may include seeking your
hospitalization or contacting family members or others who can assist in protecting you.
If there is evidence of malpractice on the part of any provider who has treated you, ITT Personnel’s ethical standards
require them to report this to a national governing body.
ITT is required to supply information about you as necessary to comply with laws relating to Workers’
Compensation or similar programs that are established by the law to provide benefits for work-related injuries or
illness without regard to fault.
We may disclose your information to a person who has the authority, under the law, to act on our behalf in making
decisions related to health care.
If a situation, as described above, arises, ITT will make every effort to fully discuss it with you before taking any action, and
they will limit their disclosure to what is necessary.
The HIPAA regulations require that ITT keeps Protected Health Information (P.H.I.) about you in your Clinical Record. You
have a right to receive a copy of your Clinical Records if you provide a written request.
Your artwork and video recordings are considered a part of the clinical record and are subject to the same disclosure
regulations. Usually, all artwork completed in art therapy is kept until the termination of therapy at which time it is returned
to you. Video recordings are typically sent to you a few weeks after the completion of therapy. You may also request
individual pictures or artwork before your last session. In order to photograph your artwork, ITT must obtain written
permission from you.
HIPAA provides you with several new or expanded rights with regard to your Clinical Records and disclosures of protected
health information. These rights include requesting that ITT amends your record, requesting restrictions on what information
from your Clinical Records is disclosed to others, determining to whom your PHI is sent, having any complaints you make
about ITT policies and procedures recorded in your records, and the right to a paper copy of this agreement and copy of this
Notice of My Privacy Policies and Procedures. ITT is, of course, happy to discuss any of these rights with you.
You have the right to inspect and obtain a copy of most of your medical information maintained at ITT; you must submit
your request in writing to our Privacy Officer. We may charge a fee for the costs of copying, mailing or other supplies
associated with your request. We may deny your request to inspect and obtain a copy in certain limited circumstances. If you
are denied access, you may have the right to request that the denial be reviewed. Another licensed health care professional
chosen by ITT will review your request and the denial. The person conducting the review will not be the person who denied
your request. We will comply with the outcome of the review.
Minors and Parents
Patients under 12 years of age and their parents should be aware that the law allows parents to examine their child’s treatment
records. Parents of children between 12 and 18 cannot examine the child’s records unless the child consents. Parents are
entitled to information concerning their child’s current physical and mental condition, diagnosis, treatment needs, services
provided, and services needed. Although what the child between 12 and 18 discusses with ITT therapists is in confidence
and cannot be revealed without his or her consent, it will be important for parents to have general information about the
progress of their child’s treatment and his or her attendance at scheduled sessions. Any other communications will require
the child’s authorization, unless the ITT therapist feels that the child is in danger or is a danger to someone else. Under those
circumstances, we would notify a parent. We would make every effort to inform the child of the necessity of ITT revealing
this particular information before we do so.
Health Care Operations
We may use or disclose your medical information for our activities and operations in regards to continuity of care and staff
development. These uses and disclosures are necessary to run our practice and to make sure that all of our patients receive
quality care. To maintain Quality Improvement we may use or disclose your medical information to review quality of care or
competence of health care providers.
ITT does not bill insurance and therefore requires that all payments for treatment be paid prior to the first day of treatment.
We may release relevant medical information about you to a friend or family member who is involved in your care or
payment for your care. We may also notify these individuals of your location, general condition, or death.
We may also release relevant information about you to an outside collection agency in order to collect an outstanding balance
on your account.
Copy of this Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you
have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may view an
electronic copy of this notice on our website, www.traumatherapy.us. To obtain a paper copy of this notice, you may print
one from the website, ask for a copy at the front desk when you visit ITT for services, or you may contact our Privacy
If you believe your privacy rights have been violated, you may file a complaint with ITT or with the Secretary of the
Department of Health and Human Services. To file a complaint with Intensive Trauma Therapy, Inc. you must submit a
complaint in writing to our Privacy Officer at:
Intensive Trauma Therapy
1102 About Town Place
Morgantown, WV 26508