Notice of Privacy Practices-HIPAA
This notice describes how protected health information (PHI) about you may be used and
disclosed and how you can access this information.
If you have any questions about this notice, please contact 800-413-7959 x 700.
Our Pledge Regarding Your Protected Health Information
We understand that your PHI is personal. We are committed to protecting the privacy of this
information. Each time you visit my office, we create a record of
the care and services you receive. We need this record to provide you with quality care, and
comply with certain legal requirements. This notice applies to all records of your care generated by this office. This notice will tell you about ways in which we may
use and disclose PHI about you. We also describe your rights and certain obligations we have regarding the use and disclosure of PHI.
Our primary responsibility is to safeguard your PHI. We must also give you this notice of our
privacy practices and we must follow the terms of the notice that is currently in effect.
Changes to this Notice
We reserve the right to change this notice, and we reserve the right to make the revised or
changed notice effective for the PHI we have already collected as well as any information we receive in the future. We will post a copy of the current notice on premises.
Your PHI Rights
Although your health record is the physical property of the Offices of Michael DeMarco, PhD
the information belongs to you. You have the right to:
● File a complaint
If you believe your privacy rights have been violated, you may file a complaint in writing to: Michael DeMarco, PhD, 116 West 23rd St, Ste 500 NY NY 10011 There will be no retaliation for filing a complaint. You may also file a complaint with the Secretary of Health and Human Services, 200 Independence Avenue SW, Washington, D.C., 20201.
●Request a restriction
You may request a restriction on certain uses and disclosures of your information. We are not required by law to agree to your request. If we do agree, we will comply with your request unless your information is needed to provide you with emergency treatment.
●Copy this Notice of Privacy Practices upon request
You may request and inspect a copy of your PHI for a copying fee of $50. We may deny your request under limited circumstances. If you are denied access to health information, you may request that the denial be reviewed by another behavioral health professional chosen by someone on our behavioral health team. We will abide by the outcome of that review.
You may request an amendment to your health record in writing if you feel the
information is incorrect or incomplete. Your request must include a reason to support the request. Your request may be denied if the information was not created was not created by our behavioral health team, is not part of the information kept by our facility, is not part of the information we are not permitted to copy (such as information we receive from other facilities), or if that information is not accurate and complete. Please note that if we accept the request, we are not required to delete any information from our record.
You may obtain an accounting of disclosures of your health information. The accounting will only provide information about disclosures made for purposes other than treatment, payment, or health care operations.
You may revoke your authorization to use or to disclose your PHI except to the extent that action has already been taken.
How we may use and disclose information about you
The following categories describe different ways that we use your PHI. We have not listed every use or disclosure within the categories but all permitted uses and disclosures will fall within one of the following categories:
Treatment – We may use PHI about you to provide you with treatment and services. We may disclose PHI about you to doctors, nurses, technicians, medical students, interns, or other personnel who are involved in taking care of you during your visit with us.
Payment – We may use and disclose PHI about you so the treatment and services you receive may be billed and payment collected from you. This may also include the disclosure of PHI to obtain prior authorization for treatment and procedures from your insurance plan.
Health Care Operations – We may use and disclose PHI about you for health care operations including quality assurance activities, administrative activities, the Offices of Michael DeMarco, PhD, financial business planning development, customer service activities including investigation of complaints, and certain marketing and fundraising activities, etc. These uses and disclosure are necessary to operate our behavioral health practices and ensure all of our clients receive quality care.
Appointment Reminders – We may use and disclose PHI to contact you as a reminder that you have an appointment for treatment in our practice.
With Specific Written Authorization – Other uses and disclosures of PHI not covered by the notice or the laws that apply to use will be made only with your written authorization. If you authorize us to disclose PHI about you, you may revoke that authorization in writing at any time. If you revoke your authorization, will no longer use or disclose PHI about you for that reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have made with your permission, and that we are required by law to retain our records of the care provided to you.
Special Situations that do not require your consent or authorization
Military and Veterans
If you are a member of the Armed Forces, we may disclose PHI about you as required by military command authorities.
We may release PHI about you for worker’s compensation or similar programs if you have a work-related injury.
Averting Serious Threat
We may use and disclose information about you when necessary to prevent serious threat to your health or safety or the health and safety of another person or the public. These disclosures would be made only to someone able to help prevent the threat.
Public Health Activities
We may disclose PHI about you for public activities including the prevention or control of disease, injury or disability, to report births and deaths, to report child abuse or if we believe the client has been a victim of abuse (including elder abuse), neglect or domestic violence.
Health Oversight Activities
We may disclose PHI to a health oversight agency for activities authorized by law such as investigations, audits, inspections and licensure.
Lawsuits and Disputes
If you are involved in a legal dispute or lawsuit, we may disclose PHI about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute. We would only disclose this information if efforts have been made to tell you about the request to allow you to obtain an order protecting the information requested.
Law Enforcement, Coroners, Medical Examiners, National Security, Inmates
We may disclose PHI in emergency situations as required by law to law enforcement, coroners, medical examiners and/or to authorized federal officials for intelligence. If you are an inmate of a correctional institute we may disclose PHI about you so that you are provided with health care, to protect your health and safety, and the health and safety of others.
Acknowledgement of Receipt of Notice of Privacy Practices-HIPAA and Informed Consent
I hereby acknowledge that I have read the Notice of Privacy Practices-HIPAA and consent to treatment with the MyTherapist / Offices of Michael DeMarco, PhD under the policies discussed above at the time I schedule my session with this office. An electronic copy of this informed consent packet will be included in a confirmation email upon confirming your appointment request.