Notice of Privacy Practices

Our Commitment to Your Privacy

Resilience Psychiatry, P.C. (“the Practice,” “we,” “us,” or “our”) is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to PHI, to notify you in the event of a breach of unsecured PHI, and to abide by the terms of the Notice currently in effect.

PHI is information that identifies you, including demographic information, that relates to your past, present, or future physical or mental health, the healthcare you receive, or the payment for that care. This Notice applies to all PHI we maintain about you in any form.

1. How We May Use and Disclose Your PHI Without Your Authorization

Treatment.

We may use and disclose PHI to provide, coordinate, or manage your psychiatric care and any related services. For example, your psychiatrist may share information with another provider involved in your care, such as your primary care physician, therapist, or a specialist to whom we refer you.

Payment.

We may use and disclose PHI so that we can bill and receive payment for the services we provide. For example, we may share information with your health plan to determine eligibility, obtain authorization for treatment, or submit a claim. Because we are an out-of-network practice, we typically provide you with a superbill (detailed invoice used by insurance companies) that you submit to your insurance directly; in that case, you control the disclosure to your plan.

Healthcare Operations.

We may use and disclose PHI for activities necessary to operate the Practice — for example, quality assessment, training of our staff, licensure and accreditation activities, business management, and customer service.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits.

We may contact you to remind you of an appointment, to tell you about a treatment alternative, or to provide information about health-related benefits and services that may be of interest to you. If you would prefer that we not contact you for these purposes, or that we use a particular method (such as text instead of voicemail), please tell us in writing.

2. Other Permitted and Required Uses and Disclosures Without Your Authorization

Federal and state law allow or require us to use and disclose PHI without your authorization in certain situations:

• Required by law. When the use or disclosure is required by federal, state, or local law.
• Public health activities. To public health authorities for the purpose of preventing or controlling disease, injury, or disability.
• Victims of abuse, neglect, or domestic violence. To appropriate authorities when we reasonably believe a patient is a victim of abuse, neglect, or domestic violence, in accordance with applicable law.
• Health oversight activities. To a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure actions.
• Judicial and administrative proceedings. In response to a court order, subpoena, discovery request, or other lawful process, when permitted by law and after giving you notice when required.
• Law enforcement. In limited circumstances permitted by law — for example, to identify or locate a suspect, fugitive, material witness, or missing person, or to report certain types of injury.
• Coroners, medical examiners, and funeral directors. To identify a deceased person, determine cause of death, or carry out their authorized duties.
• Organ and tissue donation. If applicable, to organizations that handle organ procurement or transplantation.
• Research. For research purposes when an Institutional Review Board (IRB) has approved a waiver of authorization or under other limited circumstances permitted by law.
• To avert a serious threat to health or safety. When we believe in good faith that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another person, consistent with applicable law and ethical standards.
• Specialized government functions. Including military and veterans’ activities, national security and intelligence activities, and protective services for the President and other officials, when permitted by law.
• Workers’ compensation. As authorized by and to the extent necessary to comply with workers’ compensation laws.
• Inmates. If you are an inmate of a correctional institution, to the institution as permitted by law.

3. Special Protections for Mental Health Information

Some categories of information receive heightened protection under federal and New York State law, including psychotherapy notes (notes that a mental health professional records during a private counseling session and that are kept separate from the rest of your medical record), HIV-related information, substance use disorder treatment records, and genetic information. We will not disclose these categories without your specific written authorization except in the limited circumstances permitted by law.

4. Uses and Disclosures Requiring Your Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization. In particular, the following always require your authorization:

• Most uses and disclosures of psychotherapy notes.
• Uses and disclosures for marketing purposes.
• Disclosures that constitute a sale of PHI.

You may revoke an authorization in writing at any time. If you revoke an authorization, we will no longer use or disclose PHI for the reasons covered by the authorization, except to the extent we have already relied on it.

5. Your Rights Regarding Your PHI

Right to inspect and copy.

You have the right to inspect and obtain a copy of the PHI we maintain about you, with limited exceptions (for example, psychotherapy notes). You may request your records in paper or electronic form. We may charge a reasonable, cost-based fee for copies, as permitted by law.

Right to request an amendment.

If you believe PHI we have about you is incorrect or incomplete, you may ask us to amend it. We may deny your request in certain circumstances; if we do, we will tell you why in writing and explain how to file a statement of disagreement.

Right to an accounting of disclosures.

You have the right to request a list of certain disclosures of your PHI we have made in the six years prior to your request, other than disclosures for treatment, payment, healthcare operations, those made with your authorization, and certain other limited categories.

Right to request restrictions.

You have the right to ask us to restrict how we use or disclose your PHI for treatment, payment, or healthcare operations, or to family members involved in your care. We are not required to agree to a requested restriction except in one situation: if you pay for a service or item out of pocket in full, you may request that we not disclose information about that service to your health plan, and we will agree.

Right to confidential communications.

You may ask us to communicate with you about medical matters in a particular way or at a particular location (for example, only by mail to a specified address, or only on your mobile phone). We will accommodate reasonable requests.

Right to a paper copy of this Notice.

You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Ask the front desk or contact us using the information at the end of this Notice.

Right to be notified of a breach.

You have the right to be notified following a breach of unsecured PHI, in the manner required by law.

6. Our Responsibilities

• We are required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices.
• We are required to abide by the terms of the Notice currently in effect.
• We will not use or disclose your PHI without your written authorization, except as described in this Notice.
• We will notify you if we are unable to agree to a requested restriction.
• We will accommodate reasonable requests for confidential communications.

7. Changes to This Notice

We reserve the right to change this Notice at any time and to make the revised Notice effective for all PHI we maintain. The current Notice will be posted in our office and on our website at resilience-psychiatry.com. The Effective Date at the top of this Notice indicates when it became effective.

8. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer using the information below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services:

We will not retaliate against you for filing a complaint.

9. For More Information or to Exercise Your Rights

To exercise any of the rights described in this Notice, please contact our Privacy Officer:

10. Acknowledgment

We will request a written acknowledgment that you have received this Notice when you become a patient of the Practice. If you decline to sign the acknowledgment, we will document the good-faith effort and continue to provide care.