NOTICE OF PRIVACY
PRACTICES 

Effective September
2013 

The following is the
Notice of Privacy Practices of OCD DC.
HIPAA is a Federal law that requires us to maintain the privacy of your
protected health information and to provide you with notice of our legal duties
and privacy policies with respect to your protected health information. We are
required by law to abide by the terms of this Notice of Privacy Practices. 

Your Protected Health
Information 

Your "protected
health information" (PHI) broadly includes any health information, oral,
written or recorded, that is created or received by us, other healthcare
providers, and health insurance companies or plans, that contains data, such as
your name, address, social security number, and other information, that could
be used to identify you as the individual patient who is associated with that
health information. This Notice of Privacy Practices describes how we may use
and disclose your PHI in accordance with applicable law, including the Health
Portability and Accountability Act (“HIPAA”), regulations promulgated under
HIPAA including the HIPAA Privacy and Security Rules. It also describes your
rights regarding how you may gain access to and control your PHI. 

We are required by
law to maintain the privacy of PHI and to provide you with the notice of our
legal duties and privacy practices with respect to PHI. We are required to
abide by the terms on this Notice of Privacy Practices. We reserve the right to
change the terms of our Notice of Privacy Practices at any time. Any new Notice
of Privacy Practices will be effective for all PHI that we maintain at that
time. We will provide you with a copy of the revised Notice of Privacy
Practices by posting a copy to our website, sending a copy to you in the mail
upon request or providing one to you at your next appointment. 

Uses or Disclosures
of your Protected Health Information 

Generally we may not
"use" or "disclose" your PHI without your permission, and
must use or disclose your PHI in accordance with the terms of your permission.
"Use" refers generally to activities within our office.
"Disclosure" refers generally to activities involving parties outside
of our office. The following are the circumstances under which we are permitted
or required to use or disclose your PHI. In all cases, we are required to limit
such uses or disclosures to the minimal amount of PHI that is reasonably
required. 

Without Your Written
Authorization 

Without your written
authorization, we may use within our office, or disclose to those outside our
office, your PHI in order to provide you with the treatment you require or
request, to collect payment for our services, and to conduct other related
health care operations as follows: 

Treatment activities
include: (a) use within our office by our professional staff for the provision,
coordination, or management of your health care at our office, this includes
consultation with clinical supervisors or other treatment team members; and (b)
our contacting you to provide appointment reminders or information about
treatment alternatives or other health-related services that may be of interest
to you. 

Payment activities
include: (a) if you initially consent to treatment using the benefits of your
contract with your health insurance plan, we will disclose to your health plans
or plan administrators, or their appointed agents, PHI for such plans or
administrators to determine coverage, for their medical necessity reviews, for
their appropriateness of care reviews, for their utilization review activities,
and for adjudication of health benefits claims; (b) disclosures for billing for
which we may utilize the services of outside billing companies and claims
processing companies with which we have Business Associate Agreements that
protect the privacy of your PHI; and (c) disclosures to attorneys, courts,
collection agencies and consumer reporting agencies, of information as
necessary for the collection of our unpaid fees, provided that we notify you in
writing prior to our making collection efforts that require disclosure of your
PHI. We may contact various credit agencies and consumer reporting agencies,
with information as necessary for the collection of our unpaid fees, provided
that we notify you in writing prior to our making collection efforts that
require disclosure of your PHI. 

Health care
operations include: (a) use within our office for training of our professional
staff and for internal quality control and auditing functions (b) use within
our office for general administrative activities such as filing, typing, etc.;
and (c) disclosures to our attorney, accountant, bookkeeper and similar
consultants to our healthcare operations, provided that we shall have entered
into Business Associate Agreements with such consultants for the protection of
your PHI. 

Required by Law:
Under the law we must disclose your PHI to you upon your request. In addition,
we must make disclosures to the Secretary of the Department of Health and Human
Services for the purpose of investigating or determining our compliance with
the requirements of the Privacy Rule. 

PLEASE NOTE THAT
UNLESS YOU REQUEST OTHERWISE, AND WE AGREE TO YOUR REQUEST, WE WILL USE OR
DISCLOSE YOUR PERSONAL HEALTH INFORMATION FOR TREATMENT ACTIVITIES, PAYMENT
ACTIVITIES, AND HEALTHCARE OPERATIONS AS SPECIFIED ABOVE, WITHOUT WRITTEN AUTHORIZATION
FROM YOU. 

Without
Authorization: Following is a list of the categories of uses and disclosures
permitted by HIPAA without an authorization. Applicable law and ethical
standards permit us to disclose information about you without your authorization
only in a limited number of situations. 

Examples of instances
in which we are required to disclose your PHI include: (a) disclosures
regarding reports of child abuse or neglect, including reporting to social
service or child 

protective services
agencies; (b) health oversight activities including, audits, civil,
administrative, or criminal investigations, inspections, licensure or
disciplinary actions, or civil, administrative, or criminal proceedings or
actions, or other activities necessary for appropriate oversight of government
benefit programs (c) judicial and administrative proceedings in response to an
order of a court or administrative tribunal or other lawful process; (d)
regarding deceased patients as mandated by state law, or to a family member or
friend that was involved in your care or payment for care prior to death, based
on your prior consent. A release of information regarding deceased patients may
be limited to an executor or administrator of a deceased person’s estate or the
person identified as next-of-kin. PHI of persons that have been deceased for
more than fifty (50) years is not protected under HIPAA; (e) in a medical
emergency situation to medical personnel only in order to prevent serious harm.
Our staff will try to provide you a copy of this notice as soon as reasonably
practicable after the resolution of the emergency; (f) close family members or
friends directly involved in your treatment based on your consent or as
necessary to prevent serious harm; (g) to the extent necessary to protect you,
another person or the public from a serious imminent risk of danger presented
by you. If information is disclosed to prevent or lessen a serious threat it
will be disclosed to a person or persons reasonably able to prevent or lessen
the threat, including the target of the threat; (h) a law enforcement official
as required by law, in compliance with subpoena (with your written consent),
court order, administrative order or similar document, for the purpose of
identifying a suspect, material witness or missing person, in connection with
the victim of a crime, in connection with a deceased person, in connection with
the reporting of a crime in an emergency, or in connection with a crime on the
premises; (i) specialized government functions in that we may review requests
from U.S. military command authorities if you have served as a member of the
armed forces, authorized officials for national security and intelligence
reasons and to the Department of State for medical suitability determinations,
and disclose your PHI based on your written consent, mandatory disclosure laws
and the need to prevent serious harm; (j) mandatory public health activities to
a public heath authority authorized by law to collect or receive such
information for the purpose of preventing or controlling disease, injury, or
disability, or if directed by a public health authority, to a government agency
that is collaborating with that public health authority; (k) for research
purposes, PHI may only be disclosed after a special approval process or with
your authorization; (l) fundraising communications may be sent to you, and you
have the right to opt out of such fundraising communications with each
solicitation you receive; (m) information may be disclosed to family members that
are directly involved in your treatment with your verbal permission; (e) for
workers compensation claims, and (f) as required by the secretary of health and
human services to investigate or determine our compliance with federal
regulations, including those regarding government programs providing public
benefits. 

All Other Situations
With Your Specific Written Authorization 

Except as otherwise
permitted or required as described above we may not use or disclose your PHI
without your written authorization. Further we are required to use or disclose
your PHI consistent with the terms of your authorization. You may revoke your
authorization to use or disclose any PHI at any time, except to the extent that
we have taken action in reliance on such authorization, or, if you provided the
authorization as a condition of obtaining insurance coverage, other law
provides the insurer with the right to contest a claim under the policy. 

The following uses
and disclosures will be made only with your written authorization:

(i) Most uses and disclosures of psychotherapy notes. "Psychotherapy
notes" are defined as records of communications during individual or
family counseling which may be maintained in addition to and separate from
medical or healthcare records; (ii) Most uses and disclosures of PHI for
marketing purposes, including subsidized treatment communications; (iii)
disclosures that 

constitute a sale of
PHI; and (iv) other uses and disclosures not described in the Notice of Privacy
Practices. 

YOUR RIGHTS REGARDING
YOUR PHI 

You have the
following rights regarding PHI we maintain about you. To exercise any of these
rights, please submit your request in writing to our Privacy Officer, Hannah Breckenridge at 1104 Carnation Drive, Rockville, MD 20850. 

Right to Access to
Inspect and Copy. You
have the right, which may be restricted only in exceptional circumstances, to
inspect and copy PHI that is maintained in a “designated record set.” A
designated record set contains mental health/medical billing records and any
other records that are used to make decisions about your care. Your right to
inspect and copy PHI will be restricted only in those situations where there is
compelling evidence that access would cause serious harm to you or if the
information is contained in separately maintained psychotherapy notes. We may
charge a reasonable, cost-based fee for copies. If your records are maintained
electronically, you may also request an electronic copy of your PHI. You may
request that a copy of your PHI be provided to another person. 

Right To Amend Your
Protected Health Information. You have the right to request that we
amend your PHI, for as long as your medical record is maintained by us. We have
the right to deny your request for amendment. We require that you submit
written requests and provide a reason to support the requested amendment. 

If we deny your
request, we will provide you with a written denial stating the basis of the
denial and note your right to submit written statement disagreeing with the
denial, and a description of how you may file a complaint with us and/or the
Secretary of the U.S. Department of Health and Human Services (DHHS). If we
accept your request for amendment, we will make reasonable efforts to provide
the amendment within a reasonable to persons identified by you as having
received PHI of yours prior to amendment and persons that we know have the PHI
that is the subject of the amendment and that may have relied, or could
foreseeably rely, on such information to your detriment. All requests for
amendments shall be sent to our Privacy Officer at the mailing address below. 

Right To Receive An
Accounting Of Disclosures Of Your Protected Health Information. 

Beginning April 14,
2003, you have the right to receive a written accounting of all disclosures of
your PHI for which you have not provided an authorization, that we have made
within a six (6) year period immediately preceding the date on which the accounting
is requested. You may request an accounting of such disclosures for a period of
time less than six (6) years from the date of the request. We require that you
request an accounting in writing on a form that we will provide to you. 

The accounting of
disclosures will include the date of each disclosure, the name and, if known,
the address of the entity or person who received the information, a brief
description of the information disclosed, and a brief statement of the purpose
and basis of the disclosure or instead of such statement, a copy of your
written authorization or written request for disclosure pertaining to such
information. We are not required to provide accountings of disclosures for the
following purposes: (a) treatment, payment, and healthcare operations, (b)
disclosures pursuant to your authorization, (c) disclosures to you, (d) to
other health care providers involved in your care, (e) for national security or
intelligence purposes, (f) to correctional institutions, and (g) with respect
to disclosures occurring prior to 4/14/03. We reserve the right to temporarily
suspend your right to receive an accounting of disclosures to health oversight
agencies or law enforcement officials, as required by law. We will provide the
first accounting to you in any twelve (12) month period without charge, but
will impose a reasonable cost-based fee for responding to each subsequent
request for accounting within that same twelve (12) month period. All requests
for an accounting shall be sent to our Privacy Officer at the mailing address
below. 

Right to Request
Restrictions. You
have the right to request a restriction or limitation on the use of disclosure
of you PHI for treatment, payment or health care operations. We are not
required to agree to your request unless the request is to restrict disclosure
of PHI to a health plan for purposes of carrying our payment or health care
operations, and the PHI pertains to a health care item or service that you paid
for out of pocket. In that case, we are required to honor your request for a
restriction. 

Right to Request
Confidential Communication. You have the right to request that we
communicate with you about health matters in a certain way or at a certain
location. We will accommodate reasonable requests. We may require information
regarding how payment will be handled or specification of an alternative
address or other method of contact as a condition for accommodating your
request. We will not ask you for an explanation of why you are making the
request. 

Breach Notification. If there is a breach
of unsecured PHI concerning you, we may be required to notify you of this
breach, including what happened and what you can do to protect yourself. 

Right to Copy of This
Notice. You
have the right to a copy of this notice. 

COMPLAINTS 

You may file a
complaint with us and with the Secretary of DHHS if you believe that your
privacy rights have been violated. Please submit any complaint to us in writing
by mail to our Privacy Officer at the mailing address below. A complaint must
name the subject of the complaint and describe the acts or omissions believed
to be in violation of the applicable requirements of HIPAA or this Notice of
Privacy Practices. A complaint must be received by us or filed with the
Secretary of Health and Human Services at 200 Independence Avenue, S.W.
Washington, DC 20201 or by calling (202) 619-0257 within 180 days of when you
knew or should have known that the act or omission complained of occurred. You
will not be retaliated against for filing any complaint. 

Amendments to this
Notice of Privacy Practices 

We reserve the right
to revise or amend this Notice of Privacy Practices at any time. These
revisions or amendments may be made effective for all PHI we maintain even if
created or received prior to the effective date of the revision or amendment.
Upon your written request, we will provide you with the notice of any revisions
or amendments to this Notice of Privacy Practices, or changes in the law
affecting this Notice of Privacy Practices, by mail or electronically within 60
days of receipt or your request. 

We will provide you
with a copy of the most recent version of this Notice of Privacy Practices at
any time upon your written request sent to our Privacy Officer at the mailing
address below. For any other requests or for further information regarding the
privacy of your PHI, and for 

information regarding
the filing of a complaint, please contact us at the address, telephone number,
or e-mail address listed below. 

The effective date of
this notice is September 2013. 

To Contact Me 

This is my contact
information referred to above. 

Our Privacy Officer
is: Hannah Breckenridge 

Our mailing address
is: 4300 Montgomery Ave., Suite 205, Bethesda, MD 20814 

Our telephone number
is: (240) 618-3581 

Our e-mail address
is: hannah@ocd-dc.com