Potomac Psychology Group, PLLC 
1050 17th Street NW, Suite 1000   Washington, DC  20036                                            Phone: 202-496-4971        Fax: 202-728-1196   
                                   
Practice Policies

Notice of Psychological and Medical Policies and Practices to Protect the Privacy of Your Health Care Information

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

Potomac Psychology Group, PLLC is required by law to maintain the privacy of your protected health care information.  This information consists of all records related to your health care, including demographic information, either created by Potomac Psychology Group, PLLC or received by Potomac Psychology Group, PLLC from other health care providers.

We are required by law to provide you with Notice of our legal duties and privacy practices with respect to your protected health information.  These legal duties and privacy practices are described in this Notice.  Potomac Psychology Group, PLLC will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information.

Potomac Psychology Group, PLLC reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain.  Patients will be provided a copy of any revised Notice upon request.  An individual may obtain a copy of the current Notice from our office at any time.

I.      Uses and Disclosures for Treatment, Payment, and Health Care Operations

Potomac Psychology Group, PLLC may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your written authorization.  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 we provide, coordinate, or manage your health care and other services related to your health care.  An example of treatment would be when we consult with another health care provider, such as your family physician, psychiatrist, psychologist, and other licensed health care providers who provide you with health care services, or who are otherwise involved in your care.  Generally, we will not do so without first discussing this with you.

-Payment is when we obtain reimbursement for your health care.  Examples of payment are when we disclose your PHI to your health insurer 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 our practice.  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 our offices, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

"Disclosure" applies to activities outside of our offices, such as releasing, transferring, or providing access to information about you to other parties.

"Authorization" is your written permission to disclose confidential mental health information.  All authorizations to disclose must be on a specific legally required form.

II.      Other Uses and Disclosures Requiring Authorization

Potomac Psychology Group, PLLC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained.  In those instances when we are asked for information for purposes outside of treatment, payment, or health care operations, we will obtain an authorization from you before releasing this information.  We will also need to obtain an authorization before releasing your Psychotherapy Notes.  "Psychotherapy Notes" are notes we have made about our conversation during a private, group, joint, or family counseling session, which we have kept separate from the rest of your record.  These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or Psychotherapy Notes) at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that (1) We have 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.

III.      Uses and Disclosures without Authorization

Potomac Psychology Group, PLLC may use or disclose PHI without your consent or authorization in the following circumstances:

*    Child Abuse - If we know or have reasonable cause to suspect that a child known to us in our professional capacity has been or is in immediate danger or being mentally, or physically abused, or sexually abused, or neglected, we must immediately report such knowledge or suspicion to the Washington, DC Child Protective Agency, or other required state agency and/or division.

*    Adult and Domestic Abuse - If we believe that an adult is in need of protective services because of abuse or neglect by another person, we must immediately report this belief to the appropriate authorities.

*    Health Oversight Activities - If the DC Board of Psychology or Board of Professional Counselors is investigating me or our practice, we may be required to disclose PHI to the Board.

*    Judicial and Administrative Proceedings - If you are involved in a court proceeding and a request is made for information about the professional services we have provided you and/or the records thereof, such information is privileged under DC law, and we will not release information without the written authorization of you or your 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 we believe disclosure of PHI is necessary to protect you or another individual from a substantial risk of imminent and serious physical injury, we may disclose the PHI to the appropriate individuals.

*    Worker's Compensation - If we are treating you for Worker's Compensation purposes, we must provide periodic progress reports, treatment records, and bills upon request to you, the DC Office of Hearings and Adjudication, your employer, or your insurer, or their representatives.

There may be additional disclosures of PHI that we are 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 Psychologist's Duties

Patient's Rights:
*    Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of protected health information.  However, we are not required to agree to a restriction you request.

*    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 alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me.  On your request, we will send your bills to another address).

*    Right to Inspect and Copy - You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record.  We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed.  You may be denied access to Psychotherapy Notes if we believe that a limitation of access is necessary to protect you from a substantial risk of imminent psychological impairment or to protect you or another individual from a substantial risk of imminent and serious physical injury.  We shall notify you or your representative if we do not grant complete access.  On your request, we 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.  We may deny your request.  On your request, we 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.  On your request, we will discuss with you the details of the accounting process.

*    Right to a Paper Copy - You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

Psychologist's and Licensed Professional Counselor's Duties

*    We 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.

*    We reserve the right to change the privacy policies and practices described in this Notice.  Unless we notify you of such changes, however, we are required to abide by the terms currently in effect.

*    If Potomac Psychology Group, PLLC intends to revise the PHI policies and procedures, we must describe in the Notice to patients how we will provide patients with a revised Notice of privacy policies and procedures (e.g., by mail, e-mail, or in our office).

V.    Questions and Complaints

If you have questions about this Notice, disagree with a decision Potomac Psychology Group, PLLC has made about access to your records, or have other concerns about your privacy rights, you may contact Dr. Kenneth Michael Lomas, Clinical Director, at (202) 496-4971.

If you believe that your privacy rights have been violated and wish to file a complaint with our office, you may send your written complaint to Potomac Psychology Group, PLLC, 1050 17th Street, NW, Suite 1000, Washington, DC, 20036.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.  The person(s) listed above can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule.  Potomac Psychology Group, PLLC will not retaliate against you for exercising your right to file a complaint.

VI.    Effective Date, Restrictions and Changes to Privacy Policy

This Notice will go into effect May 1, 2009.

Potomac Psychology Group, PLLC reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain.  We will provide you with a revised Notice by either distributing it to you in our office or mailing it to your home address.  You may obtain a copy of the current Notice from our office at any time.

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Appointments and Fee Schedule

When you make an appointment with either a psychologist or a licensed professional counselor you are reserving that specific time for yourself.  Please understand that if you are late for your session, the session will end on time.  If you cancel your appointment with more than 24 hours notice, this will allow your clinician time to schedule an appointment with a patient/client, and you will not be charged for the appointment.  If you cancel with less than 24 hours notice, you will be responsible for paying for the missed appointment charge, regardless of cause, at our next session.  All late cancellations and missed appointments will result in an $80.00 appointment fee.

Our fee for the initial clinical assessment is $150.00.  Our fee for individual therapy, 45 - 50 minutes in length, is $100.00.  Our fee for couples/family therapy is $125.00.  Psychological testing fees vary according to the level of service needed, however, they are generally billed at $150.00 per clinical unit.  Patients/Clients involved in group therapy are charged $75.00 per session.  All payments or insurance co-payments are due at the start of each appointment.  We accept cash, checks and credit cards.  Make checks payable to Potomac Psychology Group, PLLC.

Office Location

The Potomac Psychology Group, PLLC is located at 1050 17th Street, NW, Suite 1000, Washington, DC, 20036. Public Parking is available within one-half block for a fee.  Metered parking is also available.  You may also reach our office location by traveling on the Red Line to the Farragut North - K Street exit and traveling one-half block east to the 17th Street/K Street intersection (Left on 17th Street). From the Orange Line, take the Farragut West exit.

POTOMAC PSYCHOLOGY GROUP, PLLC
Comprehensive Psychological, Consulting and Counseling Services
1050 17th Street NW, Suite 1000
Washington, DC  20036
Phone: (202) 496-4971     Fax: (202) 728-1196

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