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.
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
We will let you promptly know if a breach occurs that may have compromised the privacy or security of your information.
How we may use and disclose your information
Treatment: to provide, coordinate, or manage your care, including with other providers involved in your care.
Payment: to bill and receive payment from you, your health plan, or other payers.
Health care operations: to run our practice, improve care, and contact you when necessary, including appointment reminders.
Other uses and disclosures
We may share your information when required or permitted by law, including: for public health and safety, to prevent a serious threat to health or safety, for health oversight activities, in response to lawsuits and legal actions, for law enforcement purposes, for workers’ compensation, and as required by state or federal law.
Psychotherapy notes and sensitive information
Psychotherapy notes, if any, receive additional protection and will not be disclosed without your written authorization except as permitted by law. Certain information, such as substance use disorder treatment records, may also have additional protections under federal and state law.
Uses that require your written authorization
We will not use or share your information for marketing purposes, sell your information, or make most other uses not described in this notice without your written permission. You may revoke an authorization in writing at any time.
Your rights
Get a copy of your health and claims records, electronic or paper.
Ask us to correct health information you think is incorrect or incomplete.
Request confidential communications, for example contacting you at a different phone number or address.
Ask us to limit what we use or share. If you pay for a service in full out-of-pocket, you can ask us not to share that information with your health insurer.
Get a list of those with whom we’ve shared your information.
Get a paper copy of this notice at any time.
Choose someone to act for you, such as a legal guardian or someone with medical power of attorney.
File a complaint
If you feel your rights have been violated, you can contact us using the details below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Changes to this notice
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 website.
Privacy officer
George Kieh · Psychnic · 2564 US Highway 1, Lawrence New Jersey, 08648 · 609-532-9965 · george_kieh@psychnic.com
