Notice of Privacy Practices

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

We may say “no” to your request, but we’ll tell you why in writing within 60 days.

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

We will say “yes” to all reasonable requests.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request. We may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes”unless a law requires us to share that information.

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations,and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within twelve months.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.

You can complain if you feel we have violated your rights by contacting us using the information on the back page.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights

By Letter

200 Independence Avenue, S.W.
Washington, D.C.
20201

Email:[email protected]

Website:www.hhs.gov/ocr/privacy/hipaa/complaints/.

You may contact the Customer Response Center at 800-368-1019 or by calling 1-877-696-6775,

We will not retaliate against you for filing a complaint.

• Marketing purposes
• Sale of your Information
• Most sharing of psychotherapy notes

We may contact you for fundraising efforts, but you can tell us not to contact you again.

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We are part of a college and train healthcare students and trainees. We may share your health information with them for review and learning purposes.

Example: We can use your health information to remind you of upcoming appointments

Example: We use your health information to manage your treatment and services.

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

We can use or share your information for health research.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

We can share health information about you with organ procurement organizations.

We can share health information with a coroner, medical examiner or funeral director when an individual dies.

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• To provide you with health care, to protect health and safety of you, others and the correctional institution if you are an inmate or are detained by law enforcement
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

We can share health information about you in response to a court or administrative order or in response to a subpoena.

When we use or share health information about you for permitted purposes, there may be limited other use or sharing that we cannot reasonably prevent.

Under New York law, you will be asked to sign a general consent prior to receiving services from SUNY Plattsburgh allowing us to use and share your health information as described in this notice. If you revoke that consent, we will not be able to provide services or treatment to you and will not use or share your health information except to the extent we have already relied on your general consent.