Notice of Privacy Practices

1. Our duties

We are required by law to:

• Keep your health information private and secure
• Give you this notice of our legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Tell you promptly if a breach occurs that may have compromised the privacy or security of your information

We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you can change your mind at any time by letting us know in writing.

2. How we use and share information for your care

2.1 Treatment

We use your information to provide your therapy and may share it with other professionals involved in your care. For example, if you take part in ketamine-assisted psychotherapy, we coordinate with the independent medical provider who prescribes and oversees the medicine. We ask for your written consent before sharing for KAP coordination.

2.2 Payment

We use your information to bill you and to prepare superbills. We are an out-of-network practice and don't bill insurers directly. If you submit a superbill to your insurer, yourself or through a service like Reimbursify, it includes your diagnosis and the dates and types of service.

2.3 Health care operations

We use your information to run the practice and improve care, for example for clinical supervision of clinicians with limited permits and interns, quality reviews, training, licensing, and legal and accounting services.

2.4 Appointment reminders and practice communications

We may contact you by phone, text, email, or our client portal about appointments, billing, and other parts of your care. Tell us if you'd like us to contact you a certain way or at a certain number or address (see your rights).

2.5 People involved in your care

If you agree, or don't object when given the chance, we may share information with a family member, partner, or friend involved in your care or in paying for it. In an emergency or if you can't agree, we may share what we believe is in your best interest.

2.6 Our business associates

Some services are provided for us by companies such as our electronic health record, telehealth, and email providers. They may need your information to do that work, and they are required by contract to protect it.

3. When we need your written permission

• Psychotherapy notes: a clinician's separate personal notes about the content of sessions get extra protection. We share them only with your specific written authorization, except in the limited situations the law allows.
• Marketing: we will not use your information for marketing without your written authorization.
• Sale of information: we will never sell your health information.
• Everything else: any use or sharing not described in this notice requires your written authorization.

You can revoke an authorization in writing at any time. Revoking it stops future sharing but can't undo sharing that already happened.

4. When the law allows or requires sharing

Therapy is confidential. In limited situations, the law allows or requires us to share information without your permission. We share only the minimum necessary.

• Safety: to prevent or lessen a serious and imminent threat to your health or safety or someone else's
• Abuse or neglect: to report suspected abuse or neglect of a child, and in other situations where New York law requires a report
• Legal proceedings: in response to a court order, and in other legal processes only as the law allows
• Required by law: when a federal or New York law requires it, including to show the U.S. Department of Health and Human Services that we comply with privacy law
• Health oversight: to agencies that license and oversee health care providers, for audits, investigations, and inspections
• Public health: for public health activities the law requires, such as preventing disease
• Law enforcement: in limited circumstances, such as in response to a valid legal order
• Coroners and medical examiners: when the law requires it
• Workers' compensation: as workers' compensation laws allow
• Specialized government functions: such as military or national security purposes, as the law allows

5. Extra protections under New York law

New York law gives some health information more protection than HIPAA does, such as HIV-related information and certain mental health information. When New York law is stricter than HIPAA, we follow New York law. For example, we share HIV-related information only with your specific written authorization or as New York law permits.

6. Your rights

To use any of these rights, contact our privacy officer in writing at the address or email at the end of this notice.

6.1 See and get a copy of your records

You can ask to see or get a paper or electronic copy of your health information. We'll respond within 30 days. We may charge a reasonable, cost-based fee for copies. In rare cases we may deny access to part of a record, and we'll tell you why in writing and how to ask for a review.

6.2 Ask us to correct your records

If you believe information in your record is wrong or incomplete, you can ask us in writing to correct it. We'll respond within 60 days. If we say no, we'll explain why, and you can add a statement of disagreement to your record.

6.3 Get a list of those we've shared information with

You can ask for a list of the times we've shared your information in the six years before your request, who we shared it with, and why. The list won't include sharing for treatment, payment, or operations, sharing you authorized, and certain other disclosures. We'll provide one list a year for free and may charge a reasonable fee for more.

6.4 Ask us to limit what we use or share

You can ask us not to use or share certain information. We don't have to agree, and may say no if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share information about it with your health plan, and we will agree unless the law requires us to share it.

6.5 Ask us to contact you confidentially

You can ask us to contact you in a specific way, such as by a certain phone number or email, or at a different address. We'll say yes to all reasonable requests, and we won't ask why.

6.6 Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.

6.7 Choose someone to act for you

If you have given someone medical power of attorney, or someone is your legal guardian, that person can use your rights and make choices about your health information. We'll confirm they have this authority first.

6.8 Be notified of a breach

If a breach affects your unsecured health information, we will notify you as the law requires.

7. Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The current notice is always available on this page, in our offices, and on request.

8. Questions and complaints

If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. We will never retaliate against you for filing a complaint.

U.S. Department of Health and Human Services, Office for Civil Rights: file online at hhs.gov/ocr/complaints or call 1-800-368-1019.

For how we handle information on our website, see our Legal & Privacy page.