Notice of Privacy Practices
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.
Plain-language draft based on the federal model notice. Before it goes live, the practice and its counsel need to confirm the New York specifics, the privacy contact, and whether 42 CFR Part 2 applies to any substance use services.
Your rights
When it comes to your health information, you have certain rights. You can:
- Get a copy of your records. Ask us for a paper or electronic copy of your health and billing records. We usually provide it within 30 days and may charge a reasonable, cost-based fee.
- Ask us to correct your records if you think something is wrong or missing. We may say no, but we'll tell you why in writing within 60 days.
- Ask us to contact you in a certain way, for example only on your cell phone or at a different address. We'll say yes to every reasonable request.
- Ask us to limit what we use or share for treatment, payment or running the practice. We don't have to agree if it would affect your care. If you pay for a service in full yourself, you can ask us not to share it with your health plan, and we'll say yes unless the law requires us to share it.
- Get a list of the times we've shared your information in the six years before you ask, who we shared it with and why. It leaves out sharing for treatment, payment and operations, and sharing you asked for. One list a year is free.
- Get a paper copy of this notice at any time, even if you agreed to get it electronically.
- Choose someone to act for you, such as a person with your medical power of attorney or a legal guardian. We'll check that they have that authority before we act.
- File a complaint if you feel your rights have been violated. The last section of this notice explains how.
Your choices
For some information, you can tell us whether to share it:
- With family, close friends or others involved in your care
- In a disaster relief situation
If you can't tell us your preference, for example if you're unconscious, we may share information if we believe it's in your best interest. We may also share it when needed to lessen a serious and imminent threat to health or safety.
We never sell your information or share it for marketing without your written permission. Most sharing of psychotherapy notes also needs your written permission.
How we use and share your information
We usually use or share your information to:
- Treat you. For example, your therapist may consult another professional about your care.
- Run the practice. For example, we use information to manage your care and improve our services.
- Bill for your services. For example, we give information to your health plan so it will pay for your sessions.
The law also allows or requires us to share information in other ways, usually for the public good, and only when its conditions are met:
- Public health and safety, such as reporting suspected abuse or neglect, or preventing a serious threat to someone's health or safety
- Research, under specific legal protections
- When state or federal law requires it, including to the Department of Health and Human Services
- Organ and tissue donation requests
- Working with a medical examiner or funeral director
- Workers' compensation claims, law enforcement, health oversight agencies and special government functions such as military or national security
- Lawsuits and legal actions, in response to a court or administrative order or a subpoena
New York law sometimes protects mental health information more than federal law does. When it does, we follow the stricter rule.
Our responsibilities
- The law requires us to keep your protected health information private and secure.
- We'll tell you promptly if a breach happens that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices in this notice and give you a copy of it.
- We won't use or share your information in ways not described here unless you tell us in writing that we can. You can change your mind at any time by letting us know in writing.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available on request, in our office and on this website.
Questions and complaints
For questions, to use any of these rights, or to file a complaint with us, contact Abby Venzor-Ramos, LCSW-R, (914) 734-5248, info@risinglotusgroup.com, 100 Stony Brook Ct, Newburgh, NY 12550.
You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6775, or www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.