CONFIDENTIALITY AGREEMENT

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law enacted mandate, to ensure privacy and security of a consumer’s Protected Health Information (PHI). PHI is defined as an individual’s identifiable health information that is transmitted or maintained in any form or medium (including electronic). You may be asked to sign a Release of Information so that Dr. Lewis may speak with other mental health professionals or to family members on your behalf. The following below describes instances where this may be applicable.

Issues discussed in therapy are important and are generally legally protected as both confidential and “privileged.” However, there are limits to the privilege of confidentiality. These situations include:

 

(1)  Suspected abuse or neglect of a child, elderly person or a disabled person

 

(2)  When Dr. Lewis believes you are in danger of harming yourself or another person or you are unable to care for yourself

 

(3)   If you report that you intend to physically injure someone, the law requires Dr. Lewis to Inform that person as well as the legal authorities

(4)   If Dr. Lewis is ordered by a court to release information as part of a legal involvement in company litigation, etc.

(5)   When your insurance company is involved (e.g., in filing a claim, insurance audits, case review or appeals, etc.)
 

(6)   In natural disasters whereby protected records may become exposed

(7)   When otherwise required by law.

OFFICE

600 Third Avenue, 2nd Floor,

New York, NY 10016

Tel: (646) 537-2545

Fax: (646) 537-2545

Email: j.lewis@drjenniferlewis.com

MAILING ADDRESS

J Lewis Professional Group, LLC

P.O. Box 2043

New York, NY 10010

  • Dr. Jennifer V. Lewis

Copyright © 2019 Dr. Jennifer V. Lewis. All rights reserved.

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