TERMS AND CONDITIONS

HIPPA 

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As part of the registration process, you will receive a Privacy Policy form to review and sign. The contents of this form is also included in the “Nondisclosure & Confidentiality” section of the site. The policy explains Health Insurance Portability and Accountability Act of 1996 (HIPAA) in depth and what we do to keep your information confidential. Our policy also explains the limits to confidentiality such as times your therapist is obligated to share information (e.g. mandated reporting) or, other potentials for confidentiality breaches (e.g. email is intercepted). For example, if you send protected health information (PHI) to your therapist via email it is not guaranteed to be secure (see Electronic Communication Disclosure section of this site for more information). 

Nondisclosure & Confidentiality
Protected health information (PHI) is individually identifiable health information expressed through oral, written or electronic communications. It includes demographic information (such as your age, address and e-mail address) and other information that relates to your past, present or future physical or mental health. PHI also includes related health care services or payment for those services. ABC respects the confidentiality of PHI and will protect it in a responsible manner and in accordance with all laws, rules and regulations. 
This Notice of Privacy Practices (notice) is provided to you in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The notice outlines how may use and disclose your PHI and the measures taken to protect it. The notice also describes your rights and ABC’s obligations regarding the use and disclosure of your PHI. 

Who will follow this notice: This notice describes the practices of and that of:

• Any other facility or program directly operated by ABC

• Any student or member of a volunteer group we allow to help you while you are in our care

• All employees, staff, and other personnel of ABC

Our Commitment to You:  ABC understands that the information collected about you and your health is personal. Keeping your health information confidential and secure is one of our most important responsibilities. We keep a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. We are committed to protecting your health information and to following all state and federal laws regarding the protection of your health information. 

We are required by law to:

• make sure that health information that identifies you is kept private 

• give you this notice of our legal duties and privacy practices with respect to health information about you 

• follow the terms of the notice 

• Notify you promptly of any breach that may have compromised the privacy or security of your PHI 

• Communicate any changes in this notice to you 

A.    Privacy Laws and Regulations: Several federal, State and City privacy laws have additional restrictions on the use and disclosure of health information. These laws affect substance abuse treatment, HIV/AIDS testing and treatment, sexually transmitted disease testing and treatment, and mental health treatment. ABC’s policies and this notice comply with these additional laws. 
If you have any questions about this notice, please contact ABC at 631-263-8307.

B.    Uses and Disclosures of PHI
By law, ABC must disclose your PHI to you unless a medical professional has determined that doing so would be harmful to your health. 
If requested, ABC must also disclose your PHI to the Secretary of the U.S. Department of Health and Human Services for investigations about our compliance with laws that protect your PHI. 

C.    Treatment. We will use and disclosure your PHI to provide, coordinate or manage your mental health treatment and any related services. This includes the coordination or management of your mental health care with a third party for treatment purposes. Individuals and programs within ABC may share health information about you to coordinate the services you may need, such as clinical examinations, therapy, nutritional services, medications, hospitalization, or transfers or referrals for follow-up care. We may use health information about you to provide you with treatment or services. In some cases, we may disclose your PHI to an outside treatment provider for purposes of the treatment activities of the other provider. 

D.    Payment.  ABC may release information about you to your health plan or health insurance carrier to obtain payment for our services. Your PHI will be used, as needed, to bill and collect payment for treatment and services provided to you. ABC may share information about treatment to your health plan (including Medicaid) or to a managed care organization to get approval for payment, inform you of benefits, to demonstrate medical necessity of the services, or as required by your insurance company for utilization review.

E.    Appointment Reminders.  ABC may use and disclose your PHI to send appointment reminders. These reminders will not identify the purpose of your visit. 

F.    Operations. We may use or disclosure your PHI as necessary for our own health care operations in order to facilitate the function of the provider and to provide quality care to all patients.

 

Health care operations include:

• Quality assessment and improvement activities

• Employee review activities

• Training programs, including those in which students, trainees or practitioners in health care learn under supervision

• Accreditation, certification, licensing or credentialing activities

• Review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs

• Business management and general administrative activities

G.    Uses and Disclosures Beyond Treatment, Payment and Health Care Operations Permitted Without Authorization or Opportunity to Object. 

 

• When Legally Required.  ABC will disclose health information about you when required by a federal, State or City law, rule or regulation

• To Report Abuse, Neglect or Domestic Violence. We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

• To Conduct Health Oversight Activities.  ABC may disclose your PHI to a health oversight agency for legal activities (such as audits, investigations, inspections and licensures) that monitor the health care system, government benefit programs, other government regulatory programs and civil rights laws. 

•  In Connection with Judicial and Administrative Proceedings. ABC may release your PHI in the course of any judicial or administrative proceedings in response to an order of court or administrative tribunal as expressly authorized by such order in response to a subpoena in some circumstances

• Research. Under certain circumstances, we may use and disclose your PHI for research purposes. The research must comply with applicable laws, rules and regulations, and the proposal and research protocols must be approved by Institutional Review Board to address the privacy of your PHI. 

• In the Event of a Serious Threat to Health or Safety. We may, consistent with applicable law and ethical standards or conduct, use or disclose your PHI if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

• For ABC’s Worker Compensation. ABC may release your PHI to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses. 

H.    Uses and Disclosures Which You Authorize:
Other than as stated above, we will not disclose your PHI other than with your written authorization. You may revoke your authorization in writing at any time, except to the extent that we have acted in reliance upon the authorization. 
 

I.    Your Rights

You have the following rights regarding health information we have about you:
1.    Right to Inspect and Copy. Your PHI is kept in a “designated record set” and may be used to make decisions about your care. The designated record set usually includes medical and billing records. You have the right to inspect and obtain this information for as long as ABC maintains your health records. This right does not apply to: 

 

o    Psychotherapy notes 

o    Information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding 

o    Protected health information that is subject to laws that prohibit access 

ABC may deny your request to inspect and copy records in very limited circumstances. If in our professional judgment, we determine that the access requested is likely to cause substantial harm to you or another person referenced within the information. You have a right to request a review of this decision. 

To inspect and copy your medical information you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us complying with your request. 

2.    Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care purposes. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. 
If you pay for a service or health care item out-of- pocket in full, you can ask us not to share your information with your health insurer for payment or health care purposes. We will agree unless we are required by law to share that information. 
 

3.    Right to Request Confidential Communications. You may request that we communicate with you using alternative means or at an alternative location to protect your confidentiality. For example, you may ask that we contact you at work or by mail. You may also ask that we mail information to you in a closed envelope rather than a postcard. 
To request confidential communications, send a written request to ABC. Your request must specify how or where you wish to be contacted. 
 

4.    Right to Request Amendment. If you believe your PHI is incorrect or incomplete, you may ask us to amend (change or add to) the information. You have the right to request an amendment, in writing, for as long as ABC maintains the information.  may deny your request if it is not in writing or does not include a reason to support the request. The written request must be directed to the Privacy Officer.
 

5.    Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosure of your PHI made by the provider. An “accounting of disclosures” is a list of PHI disclosures. This list does not include disclosures made for treatment, payment or health care purposes as described in this notice, or certain other disclosures (such as any you asked us to make). You have the right to an “accounting of disclosures” of health information from the six years prior to the date of your request. Accounting requests may not be made for periods of time in excess of 6 years. We are not required to account for disclosures that your requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting may be subjective to a reasonable cost-based fee. The request for an accounting must be made in writing to our Privacy Officer. 
 

6.    Right to Obtain a Copy of this Notice. You have the right to a paper copy of this notice at any time. Contact ABC at 631-263-8307.
 

J.    Complaints 
If you believe your privacy rights have been violated, you may file a complaint in writing to the Secretary of the U.S. Department of Health and Human Services or to the ABC Privacy Officer using the contact information listed below. No retaliation will occur against you for filing a complaint. 
 

K.    Contact Person
The providers contact person for all issue regarding patient privacy and your rights under the Federal Privacy Standards is the Privacy Officer. Information regarding matters covered by this notice can be requested by contacting the Privacy Officer. 

 

Karli Coverdale
Privacy Officer
1767 Veterans Hwy, Suite 24, Islandia, NY 11749
Phone: 631-263-8307
Office for Civil Rights
Phone: 866-OCR-PRIV (866-627-7748) or TDD 877-521-2172 886-788-4989 TTY.
Secretary of Health and Human Services 
200 Independence Avenue, SW, Federal Center for Deaf and Hearing Impaired: 1-800-877-8339 
Washington, D.C. 20201
Toll Free Phone: 877-696-6775