Our Privacy Policy

Effective 1/1/2024

Notice of Privacy Practices (NOPP) effective 1/1/2024

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 and ask any questions before your appointment.

At Psychological Associates and Consultation Associates LLC (PACA) we are committed to protecting client privacy. As part of this commitment, we follow federal and state law requiring us to maintain the privacy of your health information and to provide you with this notice of our privacy practices. When we use or disclose your health information, we are required to follow the privacy practices described in this NOPP.

We must follow either federal or state law, whichever is more protective of your privacy rights. We reserve the right to change the privacy practices described in this NOPP at any time, and the changes will apply to all information we have about you. The NOPP will be available upon request, in our office, and on our website. You may request a copy of our current NOPP at any time. We will post a summary of the current notice in the facility; the notice will contain the effective date on the first page.

What is Protected Health Information (PHI)?

PHI is information about a person’s health that can be related to that person concerning: 

  • The individual’s past, present or future physical or mental health or condition.
  • The provision of healthcare to the individual.
  • The past, present, or future payment for the provision of healthcare to the individual.


It is our responsibility to:

  • Maintain the privacy and security of your PHI.
  • Follow the duties and privacy practices described in this NOPP.
  • Give you a copy of this NOPP and be available to you if you have any questions or concerns.
  • Use or share your information only as described here unless you tell us we can use or share it differently. If you tell us we can use or share it differently, you may change your mind at any time. Let us know in writing if you change your mind.
  • Notify you promptly if your information is compromised.

Your Health Information Rights

Access to Records 

  • You can ask to receive an electronic or paper copy of your medical record and other health information. 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.
  • In rare circumstances, we may deny your request. If we deny your request, we will tell you why, in writing.

Amend Your Medical Records

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but if we do, we will tell you why in writing within 60 days.

Request Restrictions

  •  You can ask PACA not to share your health information for treatment, payment, or health care operations.
  • You can also request a restriction of release to people involved in your care. For instance, you can request that we not share information about a procedure or treatment.
  • We are not always 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.

Requests of Confidential Communications

We may communicate with you through email, text messages, or phone calls. Emails that did not originate from us, text messages, or electronic communications may not be encrypted or secure and could be intercepted by another person or organization. We will assume you understand these risks if you provide us with a mobile phone number or email address to communicate with you. You can always ask us to contact you about health matters in the way that makes you comfortable. For example, you can ask that we only contact you at work or by mail. We will say “yes” to all reasonable requests.

Accounting of Disclosures

You can ask for a list (accounting) of the times we shared your health information for six years prior to the date you ask, whom 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 will provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Personal Representatives

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.

Using and Sharing Your PHI

We will NOT share your PHI for the following purposes without your written authorization: 

  • Psychotherapy Notes: A signed authorization or court order is required for any use or disclosure of psychotherapy notes except to carry out certain treatment, payment or healthcare operations, or for use by PACA for treatment, for training programs or for defense in a legal action.
  • Publicity: We may ask you to let us use your client story to tell others about PACA. If we do ask you to share your client story, we will ask you to sign a written authorization.

We are allowed to use your PHI and share it with others without your authorization for several reasons. Those reasons are:

  • Treatment: In order to provide the most appropriate medical care, we will use your PHI at PACA to treat you. Each person involved in your treatment such as psychologists and practicum students will write in your medical record to explain what care is being provided. This way, each person taking care of you will know what the others are doing during your course of treatment. We may also share your PHI with other doctors or specialists outside of PACA who care for you, so proper medical treatment is rendered. You must advise us if you do not wish to have your PHI released to any medical professionals who care for you outside of PACA.
  • Payment: PACA does not directly bill anyone but you for services. However, your client and billing information may be shared with other institutions (e.g., our banking or credit card service providers) in order to collect payment.
  • Operations: We may use your PHI for healthcare operations. Healthcare operations means all of the things the PACA location does to improve the quality of care for all patients. For example, in making sure our employees do their jobs correctly, managers may need to look at PHI to make sure that your treatment was provided correctly.
  •  Business Associates: Business associates are people or companies who provide some of the services needed for your care. For instance, client files are stored electronically using an online platform. When they perform the services we request, the business associates need to see some of your PHI. However, both federal law and PACA require business associates to protect the privacy of your PHI.
  • Communication with Family: We will tell your parents or guardian information that would help them to take part in your care. If you want, we may also share this information with other friends or family members.
  • Subpoena: We may have to share your PHI with a court or attorney if we receive a subpoena or court order. We will try to let you or your attorney know about the subpoena before we send the information. 
  •  Training: Many colleges and other schools send students to PACA as part of their training. These students and their teachers may be able to see your PHI as they learn how to take care of patients.
  • Medical Care: We may use some of your PHI, including your name and address, to remind you about appointments. 
  • Work and Safety Laws: We may need to give PHI to state and federal health and safety agencies such as workers compensation commissions. 
  • Public Health and Record-Keeping Agencies: We may have to share PHI with public agencies that work to prevent or control disease, injury, or disability or keep track of certain statistics. For example: If a child develops measles or mumps while in our care, we may be required to report that information to the state or local health department. 
  • Medical Examiners or Funeral Directors: We can share health information with a coroner, medical examiner, or funeral director when an individual dies. 
  • Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. We may also be required, by law, to make PHI available to offices that investigate abuse or neglect, or involve threats to health or safety.
  • Whistleblowers: If a person who works for us thinks we are breaking the privacy laws, they might tell an attorney or a government agency about their concern. We would need to cooperate in any follow-up inquiry, which may require disclosure of PHI.

What about other uses of my health information?

Uses and disclosures of your health information not covered by this NOPP or federal or state laws will be made only with your written authorization.

Can I revoke my authorization to disclose information?

If you authorize us to use or disclose your health information, but then change your mind, you can revoke your authorization at any time by submitting your request to the PACA Privacy Office using the contact information below. We will stop sharing your information upon processing your request. However, we will be unable to recall or redact any information we have already shared.

What if my information is lost or stolen from PACA?

PACA will contact you, informing you what information was lost and how best to protect yourself.

How do I contact the PACA’s Privacy Office?

If you have questions, you may contact the PACA Privacy Office at 617-322-5162 or via email at shorner@psych-assess.com, and ask for Dr. Horner. You can also 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/.

Get In Touch

Questions? Contact us by email, US mail or submit an online form request.*

By Phone
617-322-5162

By Email
shorner@psych-assess.com

Our Office Location
64 Schoosett St., Pembroke MA 02359 (inside South Shore Therapies)

By US Mail
3 Elliott Ave #1253
Pembroke, MA 02359 

*Information sent via this form is not encrypted.

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