Notice of Privacy Practices
As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act (HIPAA), this notice describes how health information about you may be used and disclosed and how you can get access to your individually identifiable health information. Please review this notice carefully.
A. Commitment to your privacy:
My practice is dedicated to maintaining the privacy of your individually identifiable health information, also called Protected Health Information (“PHI”). I am legally required to keep records regarding you and the treatment and services I provide. I am required by law to maintain the confidentiality of health information that identifies you. I am also required by law to provide you with this notice of my legal duties and the privacy practices I maintain in my practice concerning your PHI. By federal and state law, I must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
This notice is to provide you with the following important information:
How I may use and disclose your PHI,
Your privacy rights for your PHI,
My obligations concerning the use and disclosure of your PHI.
The terms of this notice apply to all records containing your PHI that are created or retained by my practice. Please note that I reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that my practice has created or maintained in the past and for any of your records that I may create or maintain in the future. In the case that changes are made to my policies, I will immediately notify you and you may request a copy of this Notice.
B. If you have questions about this Notice, please contact Nassau Wellness Marriage and Family Therapy PLLC at (516) 387-5143.
C. Your PHI may be used and disclosed in the following ways:
For treatment. I may disclose your PHI to other licensed health care providers who are involved with your care to coordinate treatment. For example, if you are seeing a psychiatrist, I may disclose your PHI to him or her in order to coordinate your care.
For payment. I may use and disclose your PHI in order to bill and collect payment for the services that you receive. For example, I may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and I may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. I also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. I may use your PHI to bill you directly for services and items.
For health care operations. I may use and disclose your PHI to facilitate the efficient and correct operation of my practice. For example, I might use your PHI in the evaluation of the quality of health care services that you have received for quality assurance. I may also provide PHI to my attorneys, accountants, consultants, and others to ensure that I am in compliance with applicable laws.
For disclosures required by law. I will use and disclose your PHI when I am required to do so by federal, state, or local law.
Other disclosures. For example, if you need emergency treatment, your consent is not required, but I must attempt to obtain your consent after treatment is rendered. Should you be unable to communicate with me while I am trying to obtain your consent (for example, if you are unconscious or in severe pain), I may disclose your PHI if I think you would consent to such treatment.
D. Your PHI may be used and disclosed in the following special circumstances:
The following categories describe unique scenarios in which I may be compelled to use or disclose your identifiable health information without your consent or authorization.
I may provide PHI to law enforcement staff able to prevent or mitigate a serious threat to the safety of a person or the public. Disclosure is permitted or mandated if you are in such a mental/emotional condition to be considered dangerous to yourself or others, and I determine that disclosure is necessary to prevent the threatened danger. Additionally, disclosure is mandated by child abuse and neglect reporting laws in New York State if I have reasonable suspicion of child abuse or neglect. Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful. Likewise, disclosure is mandated by elder or dependent adult abuse reporting laws in New York State if I have reasonable suspicion of elder or dependent adult abuse. If you tell me of a serious and/or imminent threat of physical violence by you against a reasonably identifiable victim(s), disclosure is also permitted.
Professional misconduct by a health care professional must be reported by other health care professionals.
When disclosure is required by federal, state, or local law; judicial, board, or administrative proceedings; or law enforcement.
If disclosure is compelled by a party to a proceeding before a court of an administrative agency pursuant to its lawful authority or by a court order.
If disclosure is compelled by the patient or the patient’s representative pursuant to the New York Health and Safety Codes or to corresponding federal statutes or regulations.
If disclosure is required by a search warrant lawfully issued to a government law enforcement agency.
For public health activities. For example, in the event of your death, if disclosure is permitted or compelled, I may need to give the county coroner information about you.
In the event of a client’s death, the spouse or parents of a deceased client have a right to access their child or spouse’s records.
For specific government functions. For example, I may disclose PHI of military personnel and/or veterans under certain circumstances.
For health oversight activities. For example, I may be required to provide information to assist the government in the course of an investigation or inspection of a health care organization or provider.
For Worker’s Compensation purposes. I may provide PHI in order to comply with Worker’s Compensation laws.
If disclosure is required or permitted to a health oversight agency for oversight activities authorized by law. For example, when compelled by the U.S. Secretary of Health and Human Services to investigate or assess my compliance with HIPAA regulations.
If disclosure is otherwise specifically required by law.
E. Your rights regarding your PHI
Confidential communications. You have the right to request that I communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that I contact you at home, rather than work. In order to request a type of confidential communication, please let me know and I will accommodate reasonable requests. You do not need to give a reason for your request.
Requesting restrictions. You have the right to request a restriction in my use or disclosure of your PHI for treatment, payment, or health care operations. Additionally, you have the right to request that I restrict my disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and/or friends. If such a request is agreed upon, we are bound by our agreement except when otherwise required by law, such as in emergencies or when the information is necessary to treat you.
Inspection and copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to me in order to inspect and/or obtain a copy of your PHI. You will receive a response from me within 30 days of my receiving your written request. Under certain circumstances, I may feel I must deny your request, but if I do I will give you in writing the reasons for my denial. I will also explain your right to have my denial reviewed. If you ask for copies of your PHI, I will not charge you more than $0.25 per page. I may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it and its cost in advance.
Amendment. You may ask me to amend your health information if you believe it is incorrect or incomplete and you may request an amendment for as long as the information is kept by me or my practice. To request an amendment, your request must be made in writing and submitted to me. You must provide me with a reason that supports your request for amendment. I will deny your request if you fail to submit your request and the reason supporting your request in writing. Also, I may deny your request if you ask me to amend information and is, in my opinion: (a) accurate and complete, (b) not part of the PHI kept by or for the practice, (c) not part of the PHI which you would be permitted to inspect and copy, or (d) not created by my practice, unless the individual or entity that created the information is not available to amend the information.
Accounting of disclosures. All of my patients have the right to request an “accounting of disclosures.” An accounting of disclosures is a list of certain non-routine disclosures I have made of your PHI for purposes not related to treatment, payment, or operations. Use of your PHI as part of the routine patient care in our practice is not required to be documented. For example, a doctor sharing information with the nurse or the billing department using your information to file an insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to me. All requests must state a time period, which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but I may charge you for additional lists within the same 12-month period. I will notify you of the costs involved with additional requests and you may withdraw your request before you incur any costs.
Minors/Guardianship. Parents/legal guardians of non-emancipated minor clients have the right to access their records. However, a minor over twelve may request that their PHI be kept from their parents or guardians, and I may honor that request.
Right to a paper copy of this notice. You are entitled to receive a paper copy of my Notice of Privacy Practices. You may ask me to give you a copy of this Notice at any time.
Right to file a complaint. If, in your opinion, I may have violated your privacy rights, or if you object to a decision I made about access to your PHI, you are entitled to file a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Washington, D.C., 20201. If you file a complaint about my privacy practices, I will take no retaliatory action against you.
If you have any questions regarding the Notice of Privacy Practices, please contact Nassau Wellness Marriage and Family Therapy PLLC at (516) 387-5143.
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