This notice takes effect on April 14, 2003 and remains in effect until we replace it.


The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. This information is referred to as “protected health information” (PHI) and by definition is identifiable as “your information” with either a name, a social security number, or some other identifying information that would be connected to you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.



Law Requires Us to:
  1. Keep your medical information private.
  2. Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
  3. Follow the terms of the notice that is now in effect.
We Have the Right to:
  1. Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.
  2. Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
Notice of Change to Privacy Practices:
  1. Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.



The following section describes different 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 or disclose 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.
FOR TREATMENT: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treating you.
FOR PAYMENT: We may use and disclose your medical information for payment purposes.
FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.
ADDITIONAL USES AND DISCLOSURES: In addition to using and disclosing your medical information for treatment, payment, and health care operations, we may use and disclose medical information for the following purposes.
Notification: Medical information to notify or help notify: a family member, your personal representative or another person responsible for your care. We will share information about your locations, general condition, or death. 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 decision in your best interest about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you.
Disaster Relief: Medical information with a public or private organization or person who can legally assist in disaster relief efforts.
Funeral Director, Coroner, Medical Examiner: To help them carry out their duties, we may share the medical information of a person who has died with a coroner, medical examiner, funeral director, or an organ procurement organization.
Specialized Government Functions: Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.
Court Orders and Judicial and Administrative Proceedings: 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. If a subpoena for your protected health information is received, we will make every effort to notify you and provide opportunity (if requested) to “quash” the subpoena. This action requires your attorney to file a motion with the court and your sealed medical record would be sent to the court with only the judge empowered to review it as necessary to reach a determination on the motion to quash. If granted your records would then be returned without review, but if denied your protected health care information would be available to the attorneys and other court personnel for their review.
Public Health Activities: 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 we are 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.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health or safety of others. We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.
Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.
Health Oversight Activities: We may disclose medical information to an agency providing health oversight for oversight activities authorized by law, including audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure or disciplinary actions, or other authorized activities.
Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
Above and beyond what the law permits us to disclose, we will always attempt to inform you of any disclosure of PHI and, where prudent, obtain a written authorization for release of information, even if the law permits us to do so without such a release. We are committed to insuring that, wherever possible, no one will have access or knowledge of your PHI, except as you allow or request such disclosure. We feel this is the only way to provide a safe, secure, and trusting therapeutic milieu where you can safely undertake important personal growth and recovery from psychological difficulties. We will always attempt to error on the side of keeping your PHI private rather than subject you to potentially difficult exposure.



1. Look at or get copies of your medical information. We will, however, in some circumstances, recommend that you should not have copies of PHI. This would include circumstances where the information contained in your PHI would create potential problems for you. In some circumstances children’s disclosures and PHI will need protection from disclosure to parents or guardians when a clinician determines that information could be damaging to the child. This requires a “judgement” assessment on the part of the clinician involved and every effort would be made to explain this to you. You may be asked to review the information in the presence of your clinician so as to provide clarification where necessary of information that may be difficult to understand and/or accept. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You may get the form to request access by sending a letter to the contact person listed at the end of this notice. If you request copies, we will charge you a fee for the record’s search, for each page, and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.

2. Receive a list of all the times we or shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.

3. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).

4. Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing to the contact person listed at the end of this notice.

5. Request that we change your medical information. We may deny your request if we did not create the information you wanted changed or for certain other reasons. If we deny your request, we will provide you 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 reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

6. 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 in writing to the Privacy Officer at your office.



If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact Teresa Harris, Village Family Psychiatry, PLLC privacy officer at (804)285-8500 or provide a written summary of your complaint and send it to Teresa Harris at 6714 Patterson Avenue, Suite 103, Richmond, Virginia 23226.
You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.