• Have you ever had a panic attack (suddenly felt frightened or anxious for no reason)?
• Have you ever felt frightened while in a crowded public space?
• Do you ever worry that there might be something terribly wrong with you, like you are having a heart attack or going crazy?
• Do you often avoid going places for fear that something bad might happen if you did?
• Do you ever feel uncomfortable when you are away from home?
• Do you ever feel uncomfortable when you are on a bridge?
• Do you often experience physical symptoms that include: tightness in your chest, shortness of breath, increased heart rate, sweaty palms or all over increased sweating?
• Have you ever been bothered by thoughts that did not make any sense to you and kept coming back even if you tried not to have them?
• Have you ever thought that you might be contaminated by germs or dirt?
• Was there ever anything that you had to do over and over again and could not stop doing it, like washing your hands, counting up to a certain number, or checking something several times to make sure you had done it right?
• Do you have a fear of public speaking?
• Do you ever relive a traumatic experience like it was happening at that moment?  This could be having bad dreams or seeing it in a daydream?

All of the above may be symptoms of anxiety.  The only way to really know if you suffer from an anxiety disorder is to meet with a mental health provider.  In your initial meeting, your provider will ask questions to help determine if you do suffer from anxiety or depression and then work with you to formulate a plan to help make your life better by reducing your symptoms if needed.

• Has there been a period of time when you were feeling sad or down most ofthe day, nearly every day?
• Have you lost interest or pleasure in activities that you used to enjoy doing?
• Have you noticed your sleeping patterns have changed?
• Have you noticed that you get tired more easily than you used to?
• Do you often feel guilty about things?
• Do you have problems concentrating?
• Do you ever think about harming yourself or others?

All of the above may be symptoms of depression.  Again, the only way to really know if you suffer from depression is to meet with a mental health provider.  Questions asked in the initial meeting will help your provider to determine whether you do have depression and then you can work together to formulate a plan to help with those feelings or symptoms.

No, unless you explicitly give your written consent to have us provide them with your information.  What is discussed in therapy is confidential and private.

By law it is illegal for your provider or anyone else at PAC to disclose any information about you without your written consent except under a few, very specific circumstances (for ex: in cases of imminent risk of suicide).

This includes not disclosing information to partners, spouses, or parents (for individuals over 15 years of age) no matter who is paying for treatment.

Confidentiality and the limits to confidentiality will be explained to you in detail before you begin treatment so you can feel confident the information you discuss will be private.

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

When it comes to your health information, you have certain rights.

This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved inyour care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We may use and share your information as we:

• Treat you
• Bill for your services
• Comply with the law
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security,and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We will never market or share your personal information.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. This notice is effective 11/28/2015.