HIPAA 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.
Our Commitment to Your Privacy Equilibrium Psychiatry PLLC is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice of our legal duties and privacy practices. We are required to abide by the terms of this notice currently in effect.
How We May Use and Disclose Your Health Information We may use and disclose your PHI for the following purposes without your formal authorization:
Treatment: To provide, coordinate, or manage your psychiatric care. For example, we may disclose information to a pharmacy to refill a prescription.
Payment: To obtain payment for services rendered. For example, providing necessary billing codes to your insurance company if you seek reimbursement.
Healthcare Operations: To support the business activities of the practice, such as quality assessment, auditing, or licensing.
As Required by Law: We will disclose PHI when required to do so by federal, state, or local law (e.g., reporting abuse or neglect, complying with a court order).
Safety and Public Health: We may disclose PHI to prevent a serious and imminent threat to your health and safety or the health and safety of another person.
Special Notes on Psychotherapy Notes Notes documenting the contents of our conversations during a private or joint counseling session are maintained with an extra layer of protection. Most uses and disclosures of psychotherapy notes require your explicit, written authorization.
Your Rights Regarding Your PHI You have the following rights under HIPAA regarding the health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your medical and billing records.
Right to Amend: If you feel the medical information we have is incorrect or incomplete, you may request an amendment in writing.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or operations.
Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose. While we will consider your request, we are not legally required to agree to it (unless you pay for a service entirely out-of-pocket and request we not share it with your insurance).
Right to Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location (e.g., home phone vs. cell phone).
Breach Notification You have the right to be notified following a breach of unencrypted protected health information.
Complaints If you believe your privacy rights have been violated, you may file a complaint with Equilibrium Psychiatry PLLC or with the Secretary of the Department of Health and Human Services (HHS). You will not be penalized or retaliated against for filing a complaint.
Contact Information To exercise any of your rights or ask questions about these practices, please contact: Privacy Officer: Lisa M. Quaranta, APRN Email/Phone: lisa@cteqpsych.com (860) 901-1867
Click Here to download our Notice of Privacy Practices