Notice of Privacy Practices

This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access to This Information.


Please review it carefully.


Commitment to Your Privacy


I am required by law to provide you with a notice that explains my privacy practices with regard to your medical information and how I may use and disclose your protected health information (PHI). In my psychotherapy practice, I will create records regarding you and our work together and services I provide to you. I am required by law to maintain the confidentiality of health information that identifies you. I am also required by law to provide you with this notice of my legal duties and the privacy practices that I maintain in my practice concerning your PHI. By federal and state law, I must follow the terms of the Notice of Privacy Practices that I have in effect at the time.

 

I realize that these laws are complicated, but I must provide you with the following important information:
 

  1. How I may use and disclose your PHI
  2. Your privacy rights in your PHI
  3. My obligations concerning the use and disclosure of your PHI

 

My Responsibilities

 

I am required by law to maintain the privacy and security of your protected health information.

I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

I must follow the duties and privacy practices described in this notice and give you a copy of it.

I will not use or share your information other than as described below unless you tell me in writing that I can. If you tell me I can, you may change your mind at any time. Let me know in writing if you change your mind.

 

The terms of this notice apply to all records containing your PHI that are created or retained by my practice. I reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that my practice has created or maintained in the past, and for any of your records that I may create or maintain in the future. You may request a copy of the most current Notice at any time.

 

If you have questions about this Notice, please contact:

 

Lourdes Dolores Follins, Ph.D.
3640 Johnson Avenue, Unit PR-1N
Bronx, NY 10463
info@drldfollins.com

 

Uses and Disclosures of PHI

 

The following categories describe the different ways in which I may use and disclose your PHI:

  1. Provision and Coordination of Services: I may use and disclose your PHI to provide, coordinate, or manage your mental health services. This may include disclosures to your psychiatrist or loved ones involved in your care.
  2. Payment: I may use and disclose your PHI to bill and collect payment for the services I provide you.
  3. Health Care Operations: I may use and disclose your PHI to support and operate my practice, such as evaluating performance and services.
  4. Appointment Reminders: I may use and disclose your PHI to remind you of scheduled appointments.
  5. Care Alternatives: I may use and disclose your PHI to inform you of alternative services or options that may interest you.
  6. Others Involved in Your Care: I may disclose your PHI to family members, close friends, or others involved in your care.
  7. As Required by Law: I may use and disclose your PHI when required by federal, state, or local law.

 

Use and Disclosure of PHI in Special Circumstances

 

Some special cases in which I may use or disclose your PHI include:

  1. Public Health Risk: Reporting abuse, neglect, or notifying authorities in cases of domestic violence.
  2. Health Oversight Activities: Disclosures for investigations, audits, or compliance with legal requirements.
  3. Lawsuits and Legal Proceedings: Disclosures in response to court orders or subpoenas.
  4. Workers’ Compensation: Disclosures related to workers’ compensation programs.

 

Your Rights Regarding Your PHI

 

You have several rights concerning your PHI, including:

  1. Confidential Communications: You may request communication through a specific method or location.
  2. Requesting Restrictions: You may request restrictions on certain uses or disclosures of your PHI.
  3. Inspection and Copies: You may inspect and obtain a copy of your PHI.
  4. Amendment: You may request amendments to your PHI if you believe it is incorrect.
  5. Accounting of Disclosures: You may request a list of non-routine disclosures of your PHI.
  6. Right to a Paper Copy: You are entitled to receive a paper copy of this notice.
  7. Right to File a Complaint: You may file a complaint if you believe your privacy rights have been violated.
  8. Right to Provide an Authorization: You may authorize additional disclosures not covered in this notice.

Privacy Officer Information

 

If you have any questions regarding my notice of privacy policies, complaints about my privacy practices, or need information on how to file a complaint, please contact:

 

Lourdes Dolores Follins, Ph.D.
3640 Johnson Avenue, Unit PR-1N
Bronx, NY 10463
info@drldfollins.com