This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact Shana V. Hamilton-Lockwood, Ph.D. at 865-525-1099 ext. 23

This notice describes the privacy practices at our office.
We are required by law to:
- Maintain the privacy of protected health information
- Give you this notice of our legal duties and privacy practices regarding your health information
- Follow the terms of the notice currently in effect

How we may use and disclose your health information
The following section describes ways that we use and disclose medical information. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. We will not use your medical information for any purpose not listed below without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us at the address provided at the end of this notice.

Treatment. We may use and disclose your health information for your treatment and to provide you with treatment related health care services. For example, we may disclose your health information to doctors, nurses, technicians, or other personnel, including people outside of our office who are involved in your medical care and need the information to provide you with medical care.

Payment. We may use and disclose your health information so that others, or we, may bill and receive payment from you, or an insurance company, or a third party for the treatment and services you received. For example, we may give information to your health plan so that they will pay for your treatment.

Health Care Operations. We may use and disclose your health information to evaluate and improve our medical care and to operate and manage our office. For example, we may use and disclose information to a peer review organization or a health plan that is evaluating our care. We may also share information with others that have a relationship with you for their health care operations activities.

Appointment reminders, treatment alternatives, and health related benefits and services. We may use and disclose your health information to contact you and remind you of your appointment, to tell you about treatment alternatives or health related benefits and services that you could use.

Individuals involved in your care or payment for your care. When appropriate we may share your health information with a person involved in, or paying for, your care (such as your family or a close friend). We may notify your family about your location or general condition or death or disclose such information to an entity assisting in disaster relief. If you are present we will get your permission if possible before we share or give you the opportunity to refuse permission. In case of emergency and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, or medical information about you.

Research. We may use and disclose your health information for research. For example a research project may involve comparing the health of patients who received one treatment to those who received another for the same condition. Before we do so, the project needs to go through a special approval process with a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information. Even without special approval, we may permit researchers to look at records to help identify patients who may be included in their research, as long as they do not remove or copy any of your health information.

As required by law. We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

To avert a serious threat to health or safety. As required by law we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the food and drug administration for purposes of reporting adverse events associated with product defects or problems to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the food and drug administration. We may also, when authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

Business Associates. We may also disclose health information to our business associates that perform functions on our behalf or provide us with services if necessary. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose the information for any other purpose than appears in their contract with us.

Military and veterans. If you are a member of the armed forces, we may release your health information as required by military command authorities. If you are a member of a foreign military we may release your health information to the foreign military command authority.

Workers compensation. We may release your health information for workers compensation or similar programs that provide benefits for work related injuries or illness.

Public Health Risk. We may disclose your health information for public health activities to prevent or control disease, injury, or disability. We may use your health information in reporting births or deaths, suspected child abuse or neglect, medication reactions or product malfunctions or injuries, and product recall notifications. We may use your health information to notify someone who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. If we are concerned that a patient may have been a victim of abuse, neglect, or domestic violence, we may ask your permission to make a disclosure to an appropriate government authority. We will make that disclosure only when you agree or when required or authorized to do so by law.

Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. These may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor health care systems, government programs, and compliance with civil rights.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose your health information in response to a court administrative order. We may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release your health information request by law official if 1) there is a court order, subpoena, warrant, summons, or similar process; 2) if the request is limited to information needed to identify or locate a suspect, fugitive, material witness, or missing person; 3) the information is about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain your agreement; 4) the information is about a death that may be the result of criminal conduct; 5) the information is relevant to criminal conduct on our premises; and 6)it is needed in an emergency to report a crime, the location of a crime or victims, or the identity, description, or location of the person who may have committed the crime.

Coroners, Medical Examiner, and Funeral Directors. We may release your health information to a coroner, medical examiner, or funeral director to identify a deceased person or cause of death, or other similar circumstance.

National security and intelligence activities. We may disclose your health information to authorized federal officials for intelligence and other national security activities authorized by law.

Inmates of Individuals in Custody. If you are an inmate of a correctional institution or in custody we may disclose your information 1) for the institution to provide you with health care; 2) to protect your health and safety or that of others, and 3) for the safety and security of the institution.

When HIPAA and State Laws Differ. When there is a discrepancy between HIPAA mandates and mandates of Tennessee laws governing the practice of psychology or my ethical code of conduct, I will do my best to uphold the strictest form of confidentiality and provide you with the maximum amount of protection for your private health information.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and copy. You have the right to inspect and copy your medical billing records by written request to Shana V. Hamilton-Lockwood, Ph.D. If you request copies we will charge you $0.25 for each page and postage if you want the copies mailed to you.

Right to amend. You have the right to request an amendment to your records by written request to Shana V. Hamilton-Lockwood, Ph.D. We may deny your request if we did not create the information you want changed or for certain reasons. If we deny your request we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information we will make all reasonable efforts to tell others, including people you name of the change, and to include the changes in any future sharing of that information.

Right to an Accounting of Disclosures. You have a right to an accounting of certain disclosers by written request to Shana V. Hamilton-Lockwood, Ph.D.

Right to request restrictions. You have the right to request restriction or limitation on your health information used for treatment, payment or health care operations. You may request us to limit disclose to someone involved in your care or in payment for your care (such as a spouse) by written request to Shana V. Hamilton-Lockwood, Ph.D. We are not required to agree with your request, but will try to comply.

Right to request confidential communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that we contact you only by mail or at work. Your written request must specify how or where you wish to be contacted and be addressed to Shana V. Hamilton-Lockwood, Ph.D. We will accommodate reasonable requests.

If you have received this notice electronically and wish to receive a paper copy, you have the right to obtain a paper copy by making a request to the contact person listed at the end of this notice.

CHANGES TO THIS NOTICE
We may change this notice and make it effective for medical information we already have about you as well as new information. The current notice will be available at all times. You have the right to request a paper copy of the current notice at any visit or by written request to Shana V. Hamilton-Lockwood, Ph.D.

Shana V. Hamilton-Lockwood, Ph.D., Licensed Psychologist, HSP
Shana V. Hamilton-Lockwood, Ph.D., P.L.L.C
108 W. Summit Hill Dr., Knoxville, TN 37902
865 525-1099 ext. 23