AY Neuropsych, PLLC
185 Madison Avenue, New York, NY 10016
Email: [email protected] | Phone: (646) 400-0986
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Summary
Your Rights
You have the right to:
Get a copy of your paper or electronic medical record
Correct your paper or electronic medical record
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
Tell family and friends about your condition
Provide disaster relief
Provide mental health care
Market our services and sell your information
Raise funds
Our Uses and Disclosures
We may use and share your information as we:
Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
Your Rights
Get an electronic or paper copy of your medical record
You can ask to see or receive an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary within 30 days of your request and may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information you believe is incorrect or incomplete. We may deny your request, but we’ll explain why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way or send mail to a different address. We will accommodate all reasonable requests.
Ask us to limit what we use or share
You may ask us not to use or share certain health information for treatment, payment, or operations. While we are not always required to agree, we will honor requests when legally required, including certain self-pay situations.
Get a list of disclosures:
You can request a list of the times we’ve shared your health information over the past six years, excluding certain routine disclosures. One request per year is free.
Get a copy of this privacy notice:
You may request a paper copy of this notice at any time.
Choose someone to act for you:
If you have granted medical power of attorney or legal guardianship to someone, that person may exercise your rights on your behalf.
File a complaint:
If you believe your privacy rights have been violated, you may contact us directly or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will never retaliate against you for filing a complaint.
Your Choices:
For certain health information, you may tell us your preferences regarding what we share. This includes sharing information with family members, close friends, or others involved in your care.
We will never share your information for marketing purposes, sell your information, or share psychotherapy notes without your written permission.
Our Uses and Disclosures
Treat You
We may use and share your health information with professionals involved in your care.
Run Our Practice
We may use your information to improve care, manage services, and contact you when necessary.
Bill for Services
We may use and share your information to bill and receive payment from health plans or other entities.
Additional Situations
We may also share information when required by law, for public health and safety purposes, research, workers’ compensation claims, law enforcement requests, lawsuits, or government oversight activities.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information. We will notify you promptly if a breach occurs that may compromise your information. We must follow the privacy practices described in this notice and will not use or share your information beyond what is described here unless you give us written permission.
For more information, visit the U.S. Department of Health & Human Services HIPAA resource center:
HHS HIPAA Information
Changes to This Notice
We may update the terms of this notice at any time. Updated versions will apply to all information we maintain and will be available upon request, in our office, and on our website.
Effective Date: 08/06/2022
