Effective Date: May 30, 2022
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes how MCCD Psychiatry Services, PLLC and all members of its Affiliated Covered Entity (collectively, “MCCD Psychiatry Services,” “we” or “our”) may use and disclose your protected health information (“PHI”) to carry out treatment, payment, or business operations and for other purposes that are permitted or required by law. An Affiliated Covered Entity is a group of health care providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The members of the MCCD Psychiatry Services Affiliated Covered Entity will share protected health information with each other for treatment, payment, or health care operations related to the Affiliated Covered Entity and as permitted by HIPAA and this Notice of Privacy Practices. For a complete list of the members of the MCCD Psychiatry Services Affiliated Covered Entity, please contact:
MCCD Psychiatry Services
Attn: Privacy Officer
109 W 27TH Street #5S
New York, NY 10001
MCCD Psychiatry Services Responsibilities
Under HIPAA, MCCD Psychiatry Services must take steps to protect the privacy of your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical health or condition, treatment, or payment for health care services and includes information that we have created or received regarding your health or payment for your health. It also includes both your medical records and personal information such as your name, social security number, address, and phone number.
Under federal law, we are required to:
Protect the privacy of your PHI. All of our employees and physicians are required to maintain the confidentiality of PHI and receive appropriate privacy training
Provide you with this Notice of Privacy Practices explaining our duties and practices regarding your PHI
Follow the practices and procedures set forth in the Notice
Uses and Disclosures of Your Protected Health Information That Do Not Require Your Authorization
Your PHI may be used and disclosed by our health care providers, our staff, and others outside of our office that are involved in your care and treatment in a number of ways connected to your treatment, payment for your care, and our health care operations, and as otherwise authorized or required by law. Some examples of how we may use or disclose your PHI without your authorization are listed below.
TREATMENT
To our physicians, nurses, and others involved in your health care or preventive health care.
To our different departments to coordinate such activities as prescriptions and lab work.
To other health care providers treating you who are not on our staff such as emergency room staff and specialists. For example, if you are being treated at an emergency room for a serious accident we may share information between the hospital staff and your primary physician so they can provide proper care.
Treatment alternatives—To communicate with you about treatment services, options, or alternatives, as well as health-related benefits or services that may be of interest to you, or to describe our providers to you.
PAYMENT
To administer your health benefits policy or contract.
To bill you for health care we provide.
To pay others who provided care to you.
To other organizations and providers for payment activities unless disclosure is prohibited by law.
HEALTHCARE OPERATIONS
To administer and support our business activities or those of other health care organizations (as allowed by law) including providers and plans. For example, we may use your PHI to review and improve the care you receive and to provide training.
To other individuals (such as consultants and attorneys) and organizations that help us with our business activities. (Note: If we share your PHI with other organizations for this purpose, they must agree to protect your privacy.)
OTHER
We may also use or disclose your PHI without your authorization in the following circumstances:
Required by law – When we are required to do so by state and federal law, including workers’ compensation laws.
Public health and safety – To an authorized public health authority or individual to:
Protect public health and safety.
Prevent or control disease, injury, or disability.
Report vital statistics such as births or deaths.
Investigate or track problems with prescription drugs and medical devices (such as disclosures to the Food and Drug Administration).
Abuse or neglect – To government entities authorized to receive reports regarding abuse, neglect, or domestic violence.
Oversight agencies – To health oversight agencies for certain activities such as audits, examinations, investigations, inspections, and licensures.
Legal proceedings – In the course of any legal proceeding in response to an order of a court or administrative agency and, in certain cases, in response to a subpoena, discovery request, or other lawful process.
Law enforcement – To law enforcement officials in limited circumstances for law enforcement purposes. For example disclosures may be made to identify or locate a suspect, witness, or missing person; to report a crime; or to provide information concerning victims of crimes.
Military activity and national security – To the military and to authorized federal officials for national security and intelligence purposes or in connection with providing protective services to the President of the United States.
We may also use or disclose your PHI without your authorization in the following miscellaneous circumstances:
Family and friends—To a member of your family, a relative, a close friend—or any other person you identify who is directly involved in your health care—when you are either not present or unable to make a health care decision for yourself and we determine that disclosure is in your best interest. For example, we may disclose PHI to a friend who brings you into an emergency room.
De-identified information—If information is removed from your PHI so that you can’t be identified, as authorized by law.
Coroners, funeral directors, and organ donation—To coroners, funeral directors, and organ donation organizations as authorized by law.
Disaster relief—To an authorized public or private entity for disaster relief purposes. For example, we might disclose your PHI to help notify family members of your location or general condition.
Threat to health or safety—To avoid a serious threat to the health or safety of yourself and others.
Correctional facilities—If you are an inmate in a correctional facility we may disclose your PHI to the correctional facility for certain purposes, such as providing health care to you or protecting your health and safety or that of others.
Uses and Disclosures of Your Protected Health Information That Require Us to Obtain Your Authorization
Except in the situations listed in the sections above, we will use and disclose your PHI only with your written authorization. Without your authorization, we are expressly prohibited from using or disclosing your PHI for marketing purposes. We may not sell your PHI without your authorization. Your PHI will not be used for fundraising. We will not use or disclose your psychotherapy notes without your authorization, except as permitted by law.
In some situations, federal and state laws provide special protections for specific kinds of PHI and require authorization from you before we can disclose that specially protected PHI. In these situations, we will contact you for the necessary authorization. If you provide us with an authorization for certain uses and disclosure or your information, you may revoke your authorization, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization; instructions regarding how to do so are contained in the form authorization you obtain from us. If you have questions about these laws, please contact:
MCCD Psychiatry Services
Attn: Privacy Officer
109 W27th Street #5S
New York, NY 10001
Your Rights Regarding Your Protected Health Information
You have the right to:
Request restrictions by asking that we limit the way we use or disclose your PHI for treatment, payment, or health care operations. You may also ask that we limit the information we give to someone who is involved in your care, such as a family or friend. Please note that we are not required to agree to your request except when a restriction has been requested regarding a disclosure to a health plan in situations where the patient has paid for services in full and where the purpose of the disclosure is for payment or healthcare operations. If we do agree, we will honor your limits unless it is an emergency situation.
Ask that we communicate with you by another means. For example, if you want us to communicate with you at a different address we can usually accommodate that request. We may ask that you make your request to us in writing. We will agree to reasonable requests.
Request an electronic or paper copy of your PHI. We may ask you to make this request in writing and we may charge a reasonable fee for the cost of producing and mailing the copies, which you will receive usually in less than 30 days. In certain situations we may deny your request and will tell you why we are denying it. In some cases you may have the right to ask for a review of our denial.
Ask us to amend PHI about you that we use to make decisions about you. Your request for an amendment must be in writing and provide the reason for your request. In certain cases we may deny your request, in writing. You may respond by filing a written statement of disagreement with us and ask that the statement be included with your PHI.
Seek an accounting of certain disclosures by asking us for a list of the times we have disclosed your PHI. Your request must be in writing and give us the specific information we need in order to respond to your request. You may request disclosures made up to six years before your request. You may receive one list per year at no charge. If you request another list during the same year, we may charge you a reasonable fee. These lists will not include disclosures which were pursuant to an authorization, for purposes of treatment, payment, healthcare operations (unless the information is maintained in an electronic health record); or for certain other purposes.
Request a paper copy of this Notice.
Receive written notification of any breach of your unsecured PHI.
File a complaint if you believe your privacy rights have been violated. You can file a written complaint with us at the address below, or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Changes to Privacy Practices
We must follow the duties and privacy practices described in this Notice. MCCD Psychiatry Services may change the terms of this Notice at any time. The revised Notice would apply to all PHI that we maintain, including PHI we already have about you as well as any information we receive in the future. The current copy of this Notice will be available on our website. You are entitled to a copy of the Notice currently in effect.
Questions
If you have any questions about this Notice, please contact us at MCCD Psychiatry Services, PLLC, 109 W 27th Street, Suite 5S, New York, NY 10001, or call us at 917-634-5311 and ask to speak with our HIPAA Privacy Officer.
