Privacy Policy

ACHIEVER MAPS Educational Psychology

1317 Oakdale Rd, Modesto, CA 95355

(209) 850-3068

jasmin@achievermaps.com

NOTICE OF PRIVACY PRACTICES

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

I. MY PLEDGE REGARDING HEALTH INFORMATION

I am committed to protecting your health information. I create a record of the care and services you receive from me, which may include personal, educational, and health information. This notice applies to all records generated by this practice and informs you about the ways in which I may use and disclose your health information. I am required by law to maintain the privacy of your Protected Health Information (PHI), give you this notice, follow its terms, and inform you of your rights and how you may exercise them. Licensed Educational Psychologists are required by law to disclose this information related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

In most situations, information regarding services/treatment can only be released by providing a written authorization form that meets certain legal requirements imposed by state law or HIPAA. Clients who are 13 or older must also sign the written authorization form.

II. PROTECTED HEALTH INFORMATION (PHI)

At each meeting, information is collected about the client's educational functioning; family history; and physical, adaptive, emotional, or mental health. This may include information about the client's past, present, or future health or condition; the treatment or services received; or payment for health care. This information is called Protected Health Information (PHI). The information obtained from the client or parent/guardian is maintained (via paper and/or electronic) in a secure office location. It is likely to include the following:

• Personal and educational history
• Reasons for educational testing/treatment: problems, symptoms, needs, goals
• Diagnoses: medical terms for client presenting problems, symptoms, disabilities
• Treatment plan: services/interventions/accommodations for intervention
• Testing/interview notes
• Treatment or evaluation records from other providers/school
• Psychological test scores, protocols, school records, and the like
• Health history and medications
• Legal documentation and matters
• Billing information

This information is used for many purposes including, but not limited to:

1. Treatment Plan
2. Evaluation plan
3. Psychoeducational reports and recommendations
4. Communication with other health care professionals (current/past) providing treatment (e.g., primary care physician)
5. Billing and services rendered documentation

Although health records and documentation are the physical property collected by the treating health care practitioner, the information belongs to you. You can inspect, read, or review all records (parent of a child under the age of 18; child, if over 12 years of age; and/or child under 12, if the child is lawfully in treatment without parental consent).

Copies of records will be made available for you upon written request, and reasonable fees for the cost of copying and mailing may be charged. In some rare situations, you will be prevented from seeing all of what is in the records. Records will not be released in circumstances where it is deemed that disclosure of the contents of that file could reasonably be expected to be life threatening, endanger the safety of the client or another, or where disclosure could reasonably be expected to lead to your identification of the person who provided confidential information.

Records may include components that are of a professional and technical nature and may be misinterpreted or prove to be upsetting to an untrained reader. For this reason, it is recommended that records initially be reviewed with the LEP or forwarded to another mental health professional to discuss the contents. If your request for record review is denied, you have a right to review the reason for that denial. Anything in the records that may be incorrect or missing can be amended within the record, with agreement from both parties.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke such authorization at any time, except to the extent that action has already been taken.

IV. USES AND DISCLOSURES NOT REQUIRING YOUR CONSENT OR AUTHORIZATION

Disclosure of your PHI without your consent may occur in the following circumstances:

• Child abuse or neglect
• Adult and domestic abuse
• Health oversight activities
• Judicial and administrative proceedings
• Worker's compensation
• When required by law

V. YOUR RIGHTS REGARDING YOUR PHI

You have the right to:

• Inspect and obtain a copy of your records
• Request amendments to your record
• Request restrictions on certain uses and disclosures
• Request confidential communications
• Receive an accounting of disclosures
• Receive a copy of this notice
• File a complaint if you believe your privacy rights have been violated

Jasmin Loza is the designated privacy officer for this practice and can be reached at 209-850-3068 and jasmin@achievermaps.com.

This notice went into effect on June 06, 2024.