Forms & Documents

FEE NOTICE

Missed New Client Fee - $100
Missed Appointment Fee - $75

Livingston Psychological Services


Health Information Portability and Accountability Act (HIPAA)
Notice of Privacy Practices


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.


We may use and disclose your mental health information:


For Treatment: for example, we may give your information about your psychological condition to other health care providers to facilitate your treatment, referrals, or consultations.

For Payment: for example, we may contact your insurer to verify your eligible benefits, to obtain prior authorization, and to receive payment from your insurance carrier.

For Appointments and Services to remind you of an appointment or tell you about treatment alternatives or health related benefits or service.

To Individuals Involved in Your Care: such as your parents (if you are a minor), or your conservator.

With Your Written Authorization, we may use or disclose mental health information for purposes not described in this notice only with your written authorization.

We may use your mental health information for other purposes without your written authorization:

As Required by Law when required or authorized by other laws such as: reporting of child abuse, elder abuse, or dependent adult abuse.

For Health Oversight Activities to government, licensing auditing and accrediting agencies as authorized or required by law including audits, civil, administrative, or criminal investigations, licensure or disciplinary actions, and monitoring of compliance with law.

In Judicial Proceedings in response to court/administrative orders, subpoenas, discovery requests, or other legal processes.

To Public Health Authorities to prevent control communicable disease, injury, or disability, or ensure the safety of drugs and medical devices.