The Anxiety Institute provides a Secure File Transfer protocol, a secure method for communicating PHI (Protected Health Information) electronically to our clients.
Practices Statement & Acknowledgement
How We Collect Information About You
The Anxiety Institute and its employees and volunteers collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voice mails, and from the submission of applications that is either required by law, or necessary to process applications or other requests for assistance through our organization.
What We Do Not Do with Your Information
Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voice mails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.
We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who apply for or actually receive our services that is considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.
How We Do Use Your Information
Subject to specific limits set forth below, generally information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between The Anxiety Institute and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; or to obtain or purchase any type of medical supplies, devices, medications, insurance, etc.
If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or providers or other legal professionals, as well as any other information as permitted by law.
In addition, information is used internally to provide needed information to our staff and faculty so they can properly maintain client safety, implement the treatment plan and otherwise perform their duties. With the exception of information disclosed during individual and group counseling sessions, The Anxiety Institute operates on the assumption that all staff and faculty, with the exception of maintenance and other support staff, are entitled to a full disclosure of information, including diagnosis, past and current behaviors, risk factors, current and prior assessments, and other similar or pertinent information. Information that is disclosed to other participants during group counseling sessions will not be disclosed, but we cannot guarantee that other participants will maintain strict confidentiality. While specific content in these individual and group sessions are not disclosed, except as otherwise set forth herein, generalized information about the sessions will be used and summarized. Thus, by way of example, a client who discloses that he/she is depressed and is having suicidal ideation because of past abuse involving specific details will not have those details disclosed, but staff and faculty, on the other hand, may be informed that they need to closely monitor the client due to high levels of current depression.
Limited Right to Use Non-Identifying Personal Information from Biographies, Letters, Notes, and Other Sources
Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of The Anxiety Institute. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising and promotional purposes that are directly related to our mission.
Clients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without client’s express advance permission. You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent.
Specific Limits on Confidentiality
The law protects the privacy of all communications between the treatment team at The Anxiety Institute, the child in treatment and their family. In most situations, we can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. The following list includes situations where there are limitations in confidentiality, and where confidentiality can be broken. Your signature on this Agreement provides consent for these activities, and your clear understanding of each limitation, as follows:
- Please be aware that we may occasionally consult with other therapists about some cases to make sure we are providing the best form of clinical practice. This process is referred to as peer supervision. Other mental health professionals are bound by the same rules of confidentiality. During a consultation, we make every effort to avoid revealing the identity of a patient. If you don’t object, we will not tell you about these consultations unless we feel that it is important in our work together.
- If a client threatens to harm himself/herself, we are obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection.
- If you are involved in a court proceeding and a request is made for information concerning our professional services, such information is protected by the psychologist-patient privilege law. We cannot provide any information without your (or your legal representative’s) written authorization, or a court order, or a subpoena. If you are involved in or contemplating litigation, you should consult with your provider to determine whether a court would be likely to order us to disclose information.
- If a parent or client files a complaint or lawsuit against us, we may disclose relevant information regarding that client in order to defend ourselves.
- If we have reason to know or suspect that a child has been abused or neglected, or has been a victim of sexual abuse by another child, the law requires that we file a report with the Department for Children, Youth and Families and other statutorily prescribed parties. Once such a report is filed, we may be required to provide additional information.
- If we believe that a client presents a life risk to another person, we are required to take protective actions including warning the potential victim(s), contacting the police, or seeking hospitalization of the client.
If such a situation arises, we will make every effort to fully discuss it with you before taking any action and we will limit our disclosure to what is necessary.
You should be aware that, pursuant to HIPAA, we keep Protected Health Information about you in two sets of professional records. One set constitutes your Clinical Record. It includes information about your child’s reasons for seeking therapy, a description of the ways in which the problem impacts his/her life, any diagnoses, the goals that we set for treatment, progress towards those goals, medical and social history, treatment history, any past treatment records that we receive from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier. In addition, we also keep a set of psychotherapy notes. While the contents of psychotherapy notes vary from client to client, they can include the contents of our conversations, an analysis of those conversations, and how they impact on your child’s therapy.
HIPAA provides you with several new or expanded rights with regard to your Clinical Record and disclosures of protected health information. These rights include requesting that we amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of protected health information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about our policies and procedures recorded in your records; and the right to a paper copy of this Agreement, the attached Notice form, and the privacy policies and procedures. We are happy to discuss any of these rights with you.
Minors & Parents
Patients under 18 years of age who are not emancipated from their parents should be aware that the law allows parents to examine their child’s treatment records. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is our policy to request an agreement from parents that they consent to give up their access to their child’s records. If they agree, during treatment, we will provide them only with general information about the progress of the child’s treatment, and his/her attendance at scheduled sessions. We will also provide parents with a summary of their child’s treatment when it is complete. Any other communication will require the child’s authorization, unless we feel that the child is in danger or is a danger to someone else, in which case, we will notify the parents of our concerns.
For any questions about our HIPAA compliance, please contact:
Dr. Dan Villiers
75 Holly Hill Lane, Suite 300
Greenwich, CT 06830
Phone: (203) 489-0888