Kennedy-Arenivar Mental Health Counseling PLLC

NOTICE OF PRIVACY PRACTICES IN COMPLIANCE WITH: The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Effective Date: 01/27/2022

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. YOU MAY REQUEST A PRINTED COPY ANYTIME.

FOR MORE INFORMATION SEE: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Protecting Your Privacy

The Practice, a New York professional liability company, is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with notice of the legal duties and privacy practices with respect to such information. The law requires us to maintain the privacy and security of your protected health information. This includes maintaining reasonable and appropriate administrative, technical, and physical safeguards to protect against the unauthorized use or disclosure of your protected health information. We will alert you promptly if a breach occurs that may have compromised the privacy or security of your information. Additionally, we will mitigate, to the extent practicable, any harmful effect we learn was caused by a breach of privacy.

The law permits the use or disclose of your health information without your written consent or authorization for the following purposes:

 A. For Treatment, Payment, and Healthcare Operations

  • Treatment: The Practice may use or disclose your personal health information to provide treatment services. For example, the Practice may disclose your health information about you to other healthcare professionals involved in your care in order to coordinate services.

  • Health Care Operations: The Practice may use or disclose your personal health information for some other business-related matters that are called, in the law, Healthcare Operations. For example, to contact you, perform business audits, and to provide case management and care coordination.

  • Payment: The Practice may use or disclose your personal health information to receive payment for your healthcare services. For example, the Practice may use your information to send a bill for your healthcare services to you or to a collections agency.

B. As Required or Permitted By Law

  • Required by Law. The Practice may use and disclose your health information when law requires that use or disclosure.

  • Victims of Abuse, Neglect, or Violence. The Practice may disclose your information to a government authority authorized by law to receive reports of abuse, neglect, or violence. It is a policy of the Practice to notify patients prior to this disclosure if doing so is appropriate under the circumstances.

  • Workers Compensation. Both state and federal law allow healthcare information that is reasonably related to a worker’s compensation injury to be disclosed without your authorization. These programs may provide benefits for work related injuries or illness.

• Judicial and Administrative Proceedings. The Practice may disclose your health information in the course of an administrative or judicial proceeding as required by a court order or as permitted in response to a subpoena.

• Other circumstances include reporting any adverse medication reaction, assisting with public health and safety issues, preventing disease, assisting with product recalls, and supporting health oversight agencies' activities as authorized by law.

Uses and Disclosures That Require Your Authorization

·      You have some choices about how we use and disclose your information. If you have a clear preference for how we share your information in situations described below, please discuss that with so that we may respect this preference.

 A.        Except as described in this Notice or as permitted or required by law, the Practice will not use or disclose your Protected Health Information without written authorization from you.

 B.         If you do authorize use or disclosure of your health information, you may revoke your authorization in writing at any time. If you revoke your authorization, the Practice will no longer be able to use or disclose health information about you for the purpose covered by your written authorization. Your revocation will not apply to disclosures that the Practice has already made with your permission.

 C.         You have a right and choice to instruct us on how you'd like us to share information with your family or others involved in your care and how we respond to a disaster relief situation. However, if you cannot tell us your preference because, for example, if you are incapacitated, we may share your information if doing so is in your best interest. We may also share your information as necessary to lessen a serious and imminent threat to health or safety. You may designate someone to tell us your preference on your behalf.

We will never share your information unless you provide us with your written permission in the following situations:

1. When we seek to use your information for marketing purposes.

2. When we seek to sell your information.

3. When we seek to share any patient notes or HIV-related information from your record.

Your Health Information Rights

You have the following rights under federal and state law with respect to your Protected Health Information:

A.        Access. You have the right to inspect and obtain a copy of your Protected Health Information and billing records. You must submit a written request and a small fee of (.50/page) may be charged. You will receive a response from the Practice within 15 days upon receiving your written request. Under certain circumstances, the Practice may feel we must deny your request, but if we do the Practice will give you a written explanation of the denial, which you can review. Please note that you do not have the right to access information that does not directly relate to you.

B.         This may include, but is not limited to, business planning records, quality assessment records, or management records used for business decisions generally rather than to make decisions about you as an individual.

C.         Amendment. If you feel that there is an error or omission in your record, it is your right to request that it is corrected. The request must be made in writing and must include your reason to support the request. The Practice will respond no later than 60 days from the date that the request was received. The Practice may deny the request, in writing, if we find that the record is correct and complete, or if someone else provided the information.

D.        Accounting of Disclosures. You have the right to request a list of disclosures for your records. The Practice will provide a list of all disclosures except for those related to the following: coordination of treatment, billing, healthcare operations, or disclosures that you have requested. A small charge will incur if the request is more than a 12-month period.

E.         Restrictions on Certain Users and Disclosures. You have the right to request a restriction or limitation on your PHI. The Practice may not be legally bound to abide by all requests, but they will be reviewed. Agreed upon limits will be put in writing and respected. This does not include situations where disclosures are legally compelled. If you are paying out of pocket for your care, you have the right to not have any information released to insurance companies.

F.          The Right to Request Confidential Communications. You have the right to request communication about treatment matters in a certain way, such as sending correspondence to an alternative address. To request confidential communication, you must make your request in writing. The Practice will not ask you the reason for your request. The Practice will accommodate all reasonable requests.

Changes to This Notice

This Notice of Privacy Practices is effective as of January 27, 2022, and the Practice is required to abide by the Notice currently in effect. The Practice reserves the right to change the terms of the Notice of Privacy Practice and to make the new Notice provisions effective for all Protected Health Information the Practice obtains. This notice is located on the website for the Practice. You may also request a printed copy of a revised Notice of Privacy Practices.

Complaints

 You have the right to file a written complaint with the Practice, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this Notice or the policies and procedures of my office. Retaliation against those who file complaints is prohibited by law.

If you have any questions or want more information regarding this Notice, please contact: 

Kennedy-Arenivar Mental Health Counseling PLLC

Attn: Brian Kennedy-Arenivar, Chief Privacy Officer

125 E 23rd St Ste 402

New York, NY 10010-4547

(917) 590-1211 

For more information about your privacy rights or to file a complaint:

The U.S. Department of Health and Human Services Office of Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

(202) 619-0257 of Toll Free: 1-877-696-6775

TTD Number: 1-800-537-7697