Notice of Privacy Practices

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.

Our responsibilities

Crosstides Psychology (Dr. Cross, PsyD., L.L.C.) is required by law to protect the privacy of your health information. We will follow this notice, tell you promptly if a breach affects your information, and not use or share it in ways not described here without your written permission. You can revoke that permission in writing at any time.

How we use and share your information

• Treatment: to provide and coordinate your care, for example with a prescriber you ask us to work with.
• Payment: to bill you and to prepare superbills you choose to submit to your insurer.
• Operations: to run the practice, for example scheduling and quality review.
• Psychotherapy notes: kept separate from your record; most uses require your written authorization.

When we may share information without your authorization

If you're located outside Florida during sessions, the reporting laws of that state also apply.

• Abuse or neglect: Florida law requires reporting suspected abuse, neglect, or abandonment of a child, and abuse, neglect, or exploitation of a vulnerable adult.
• Serious threat to safety: if you make a specific threat to seriously injure or kill an identifiable person, Florida law requires us to notify law enforcement, and we may warn that person. We may also act to protect you if you are at serious risk.
• As required by law: including court orders and properly issued subpoenas.
• Health oversight: for example, a Florida Board of Psychology investigation.
• Other limited cases allowed by law, such as coroners or law enforcement in specific circumstances.

Minors

Parents or legal guardians usually act for a minor client, and Florida law gives parents rights to their child's health records. Dr. Cross explains how information is shared in each family's confidentiality agreement.

Your rights

• Get a paper or electronic copy of your record, usually within 30 days, for a reasonable cost-based fee.
• Ask us to correct your record.
• Ask us to contact you in a specific way, such as a certain phone or address.
• Ask us to limit what we share. If you pay in full out of pocket, you can require that we not share that care with your health plan.
• Get a list of certain disclosures we have made.
• Get a paper copy of this notice at any time.
• Name someone to act for you, such as a legal guardian or health care surrogate.
• File a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you.

Changes

We may change this notice. The new notice will apply to all information we hold and will be posted on our website.

Privacy Officer

Dr. Courtney Cross, PsyD
15044 Sandpiper Ln, Ste 7 PMB 1028, Naples, FL 34114
(201) 321-8300
[email protected]

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