Notice of Privacy Practices and Policies

The Health Insurance Portability and Accountability Act (HIPAA) requires that I provide you with this notice of my privacy policies and practices, and that I obtain your signature acknowledging that you have received this notice if you move forward with becoming a client. If you do not understand any part of this notice, please ask for further explanation. Protected health information (PHI) is information in our records that could identify you. This notice describes how information about you may be used and disclosed.

Laws and Professional Ethics that Govern Counselors

The services provided by Leilani Maxera, LCSW are governed by various federal and state laws and regulations, licensing boards, and codes of professional ethics. The laws, professional standards, and code of professional ethics are sometimes in direct conflict, and these conflicts sometimes pose moral, professional, and legal dilemmas for counselors – and sometimes for clients. Several areas of potential conflict are noted below:

Privacy, Confidentiality, and Privileged Communication

• Privacy is your right to choose to whom, when, and under what circumstances your personal information may be revealed.
• Confidentiality refers to a counselor’s legal obligation to protect your private information from disclosure to any source without your prior written consent. However, there are legal limits to privacy and confidentiality. These are fully discussed below.

Federal and state laws, and professional codes of ethics safeguard every client’s right to privacy and confidentiality. However, the level of privacy and confidentiality the law grants to a client depends on the nature of a person’s problem, the credential of a therapist, and the context in which he or she practices.

There are exceptions to protecting your privacy and confidentiality, broken into two categories: 1) duty to protect or warn, and 2) delivery of care. Within these two categories a therapist does not need your permission to release your private and confidential information:

Duty to Warn and to Protect
Law permits a counselor to:

• Report maltreatment, abuse, or neglect of a child (state mandated reporting).
• Report maltreatment, abuse, or neglect of a vulnerable adult.
• Request help from emergency medical personnel in a bona fide medical emergency.
• Request help for harm threatened or committed against another person or oneself – if a counselor suspects a client may do harm to him or herself or to someone else, a therapist is required by state law to attempt to prevent the potential tragedy by breaking confidentiality and warning the appropriate parties and people who may be near them. If the patient threatens to harm themself, I may be obligated to seek hospitalization for them or to contact family members or others who can help provide protection.

Delivery of Care
Law permits a counselor to:

• Use or disclose protected health information for routine treatment, payment, and health care operation purposes. Please note that this can include billing services and collection agencies. For these purposes, you will have given consent.
• Share protected health information with coworkers within the treatment setting regarding a client, other professionals within the context of professional supervision, audit, or evaluation, and qualified service organizations (i.e. a Mental Health Ombudsman).
• Disclose to a court with appropriate jurisdiction and authority to comply with a valid court order – if you are involved in court proceedings and a request is made for information about the psychological services provided to you and/or the records thereof, such information is privileged under Hawaiʻi law. We shall release such information only with written authorization by you or your legally appointment representative or at the direction of a court order.
• Share information regarding Workers’ Compensation and Personal Injury Claims – if you have filed a Worker’s Compensation, No Fault, or other personal injury claim, we may be required to disclose PHI about any services we have provided to you that are relevant to the claimed injury.
• Disclose relevant information regarding a client if they file a complaint or lawsuit against me.
• While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.

Patient’s Rights

Right to Request Restrictions – You have the right to request restrictions on uses and disclosures of PHI. We will attempt to accommodate reasonable requests, but we are not required to agree to a restriction.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications by alternative means and locations (for example, you may request that bills or other correspondence be sent to another address).
Right to Inspect and Copy – You have the right to inspect and obtain a copy of PHI in our clinical and billing records for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request we will discuss with you the details of the request and denial process. A fee may be charged for copies.
Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process. 
Right to Accounting – You have the right to receive an accounting of disclosures of PHI. On your request, we will discuss with you the details of the accounting process.
Right to Paper Copy – You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically.

Client Disclosures in Groups
Within the context of group counseling, a therapist is not permitted to acknowledge whether they have privately conferred with an individual client. A client’s confidences, which are shared privately with their therapist, may not be shared with peers in the client’s therapeutic community without the client’s prior written approval. Once a client has publicly disclosed information to their therapeutic community, a therapist may repeat the disclosure to group members.

Terminating Therapy
Your participation in therapy is voluntary and you have the right to end therapy whenever you want. However, if you do decide to exercise this option, I encourage you to talk with me about the reason for your decision in a therapy session together. I ask that you allow for us to have an ending session together, to review what we’ve done and to offer feedback to each other. Likewise, at my discretion, I reserve the right to end our therapy work together and provide you with some appropriate referrals. This may be for reasons including, but not limited to: failure to participate in therapy, conflicts of interest, untimely payment of fees, or my belief that I may not be the best person for your needs (due to expertise). Any reason will be discussed prior to termination.

Complaints
If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may contact me, the State of HI Department of Health, or the Secretary of the U.S. Department of Health and Human Services.
If you have any questions, complaints, or concerns about this notice or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact me at:

Leilani Maxera, MPH, LCSW

PO Box 61211

Honolulu, HI 96839

+1 (808) 353-8554

leilani.maxera.therapy@gmail.com

Effective Date and Changes to Policies
This notice will go into effect on March 23, 2023. I reserve the right to revise the policies and practices described in this notice, in which case you will be notified.