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.
Wavelengths Psychology PC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
• You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.
• The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.
To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
• The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
• You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.
To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
Your therapist serves as a privacy officer who monitors that your privacy is protected and who attains the maximum standards of confidentiality. This practice relies on your input so that we may continually ensure that
we are protecting your privacy and effectively communicating your privacy rights. You may speak to your therapist directly or contact the owner, Sharon Grand, Ph.D., at 800-871-5491 x 700 to provide feedback or if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. The Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you.
• The Practice can use and share PHI with other professionals in the practice who are treating you.
• Your clinician can use and share PHI with clinical supervisors.
To run the health care operations.
• The Practice can use and share PHI to run the business, improve your care, and contact you.
• Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
• The Practice can use and share PHI to bill and get payment from health plans or other entities.
• Example: The Practice gives PHI, including progress notes as requested, to your health insurance plan so it will pay for your services.
To receive practice communications.
• The Practice may contact you by email with newsletters, office closings, practice updates, or information about our services. You may unsubscribe and ask not to be contacted again.
You may initiate restrictions on certain uses and disclosures of your protected health information. Your therapist will do everything possible to reach a reasonable consensus with you in regard to these restrictions. However, this practice may deny service if your therapist deems such restrictions would significantly preclude his/her ability to provide you with professional services.
2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:
To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: If in your therapist’s judgment you pose a serious and imminent risk to yourself or others, then we may have to break confidentiality in order to assure your safety or the safety of others.
• If, in your therapist's judgment you are likely to engage in conduct that would result in serious harm toyourself or others. then we are required by law to make a NY Safe Act report to determine your access tofirearms.
• If you reveal to your therapist information relating to the contemplation of a criminal act, your therapistmay need to break confidentiality to prevent any criminal act.
• To report abuse, neglect, or domestic violence. Your therapist is a mandated reporter of abuse and neglect and is required by law to contact child protective services for any allegations of child abuse, past or present. Under certain circumstances your therapist may be required to report elder abuse, abuse of compromised adults, or domestic violence..
To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law, including the NY SAFE Act..
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.
To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Business Associates: To provide information to organizations that perform functions, activities or services on our behalf.
Minors: Parents and guardians have legal access to information provided to us by minors (children under the age of 18). Parents are generally expected to be actively involved in the treatment of young children. For older children, trust and privacy are crucial to treatment success, however parents also may wish to know certain information about the treatment. For this reason, you and your child's therapist should discuss and come to an agreement about what information will be shared and what information will remain private. Our general philosophy is that parents should be informed about the goals of treatment, how the treatment is going and whether the child comes to his/her appointments. In addition, it is the policy of this practice to always inform parents if the therapist thinks that your child is in danger or at risk of endangering him/herself or others. One of the first tasks in treating children is to discuss and agree on a shared definition of dangerousness and expectations of confidentiality so all are clear about what will be disclosed.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Practice may disclose PHI to your family, friends, or others if PHI directly relates to that person's involvement in your care and if it is in your best interest because you are unable to state your preference. For example, your therapist may reach out to your emergency contact if you experience a medical emergency in the office.
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:
The Practice will not use or share PHI other than as described above in this Notice unless you give your permission in writing.
If you provide written authorization to use or share PHI, you may revoke your authorization, at any time, by contacting the Practice in writing at [email protected].
OUR RESPONSIBILITIES
• The Practice is required by law to maintain the privacy and security of PHI.
• The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
• The Practice reserves the right to amend this Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website wavelengthspsychology.com
• The Practice will inform you if PHI is compromised in a breach.
Complaints:
You may file a complaint with us by emailing our privacy offer, Dr. Sharon Grand, at sgrand@wavelengths,hush.com and with the Secretary of DHHS if you believe that your privacy rights have been violated. A complaint must name the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Notice of Privacy Practices. A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be retaliated against for filing any complaint. To file a complaint with the Secretary of DHHS, write or call:
The US Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
877-696-6775
This Notice is effective on 1/1/2024.
Wavelengths Psychology PC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain.
YOUR RIGHTS
Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
• You can ask for an electronic or paper copy of PHI. The Practice may charge you a reasonable fee.
• The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.
To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.
• The Practice may deny your request. The Practice will send a written explanation for the denial and allow you to submit a written statement of disagreement.
To request confidential communications.
• You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.
To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.
To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.
To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically.
To choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.
Your therapist serves as a privacy officer who monitors that your privacy is protected and who attains the maximum standards of confidentiality. This practice relies on your input so that we may continually ensure that
we are protecting your privacy and effectively communicating your privacy rights. You may speak to your therapist directly or contact the owner, Sharon Grand, Ph.D., at 800-871-5491 x 700 to provide feedback or if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. The Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business. The Practice typically uses or shares your health information in the following ways:
To treat you.
• The Practice can use and share PHI with other professionals in the practice who are treating you.
• Your clinician can use and share PHI with clinical supervisors.
To run the health care operations.
• The Practice can use and share PHI to run the business, improve your care, and contact you.
• Example: The Practice uses PHI to send you appointment reminders if you choose.
To bill for your services.
• The Practice can use and share PHI to bill and get payment from health plans or other entities.
• Example: The Practice gives PHI, including progress notes as requested, to your health insurance plan so it will pay for your services.
To receive practice communications.
• The Practice may contact you by email with newsletters, office closings, practice updates, or information about our services. You may unsubscribe and ask not to be contacted again.
You may initiate restrictions on certain uses and disclosures of your protected health information. Your therapist will do everything possible to reach a reasonable consensus with you in regard to these restrictions. However, this practice may deny service if your therapist deems such restrictions would significantly preclude his/her ability to provide you with professional services.
2. Uses and Disclosures of PHI That May Be Made Without Your Authorization or Opportunity to Object
The Practice may use or disclose PHI without your authorization or an opportunity for you to object, including:
To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
• Serious threat to health or safety: If in your therapist’s judgment you pose a serious and imminent risk to yourself or others, then we may have to break confidentiality in order to assure your safety or the safety of others.
• If, in your therapist's judgment you are likely to engage in conduct that would result in serious harm toyourself or others. then we are required by law to make a NY Safe Act report to determine your access tofirearms.
• If you reveal to your therapist information relating to the contemplation of a criminal act, your therapistmay need to break confidentiality to prevent any criminal act.
• To report abuse, neglect, or domestic violence. Your therapist is a mandated reporter of abuse and neglect and is required by law to contact child protective services for any allegations of child abuse, past or present. Under certain circumstances your therapist may be required to report elder abuse, abuse of compromised adults, or domestic violence..
To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law, including the NY SAFE Act..
• Judicial and administrative proceedings: To respond to a court order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose information about a victim of a crime.
• Specialized Government Functions: For military or national security concerns, including intelligence, protective services for heads of state, or your security clearance.
• National security and intelligence activities: For intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, for purpose of determining your own security clearance and other national security activities authorized by law.
• Workers' Compensation: To comply with workers' compensation laws or support claims.
To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized duties.
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional review board.
• Business Associates: To provide information to organizations that perform functions, activities or services on our behalf.
Minors: Parents and guardians have legal access to information provided to us by minors (children under the age of 18). Parents are generally expected to be actively involved in the treatment of young children. For older children, trust and privacy are crucial to treatment success, however parents also may wish to know certain information about the treatment. For this reason, you and your child's therapist should discuss and come to an agreement about what information will be shared and what information will remain private. Our general philosophy is that parents should be informed about the goals of treatment, how the treatment is going and whether the child comes to his/her appointments. In addition, it is the policy of this practice to always inform parents if the therapist thinks that your child is in danger or at risk of endangering him/herself or others. One of the first tasks in treating children is to discuss and agree on a shared definition of dangerousness and expectations of confidentiality so all are clear about what will be disclosed.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization or Opportunity to Object
Unless you object, the Practice may disclose PHI to your family, friends, or others if PHI directly relates to that person's involvement in your care and if it is in your best interest because you are unable to state your preference. For example, your therapist may reach out to your emergency contact if you experience a medical emergency in the office.
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or disclose PHI for the following purposes:
The Practice will not use or share PHI other than as described above in this Notice unless you give your permission in writing.
If you provide written authorization to use or share PHI, you may revoke your authorization, at any time, by contacting the Practice in writing at [email protected].
OUR RESPONSIBILITIES
• The Practice is required by law to maintain the privacy and security of PHI.
• The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.
• The Practice reserves the right to amend this Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website wavelengthspsychology.com
• The Practice will inform you if PHI is compromised in a breach.
Complaints:
You may file a complaint with us by emailing our privacy offer, Dr. Sharon Grand, at sgrand@wavelengths,hush.com and with the Secretary of DHHS if you believe that your privacy rights have been violated. A complaint must name the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Notice of Privacy Practices. A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be retaliated against for filing any complaint. To file a complaint with the Secretary of DHHS, write or call:
The US Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
877-696-6775
This Notice is effective on 1/1/2024.