Notice of Privacy Practices

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your health and claims records

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your record

You can ask us to correct health information that you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way, for example by cell phone instead of home phone, or to send mail to a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree if it would affect your care. If you pay for a service out of pocket in full, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.

Get a list of those with whom we have shared information

You can ask for a list of the times we have shared your health information for six years before the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment and health care operations, and certain others such as any you asked us to make. We provide one list a year for free.

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.

Choose someone to act for you

If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.

File a complaint if you feel your rights are violated

You can complain by contacting our Privacy Officer at (848) 801-9248 or by mail at 640 Eagle Rock Avenue, Suite 6, West Orange, NJ 07052. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. In these cases, you have both the right and the choice to tell us to share information with your family, close friends or others involved in your care, and to share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes or sell your information unless you give us written permission. Most uses and disclosures of psychotherapy notes require your written authorization.

Our uses and disclosures

Treat you

We can use your health information and share it with other professionals who are treating you, for example a primary care provider or a pharmacy filling a prescription.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary, for example to send appointment reminders or payment requests.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Other ways we may share your information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes:

• Preventing disease, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone's health or safety
• Health research, under strict conditions
• Complying with state or federal law, including when the Department of Health and Human Services asks
• Responding to organ and tissue donation requests, and working with a medical examiner or funeral director
• Workers' compensation claims, law enforcement purposes, health oversight agencies, and special government functions
• Responding to a court or administrative order, or a subpoena

Extra protections for certain information

Substance use disorder treatment records

Records of substance use disorder treatment that we receive or keep may be protected by federal regulations at 42 CFR Part 2, in addition to HIPAA. In general, we will not use or share these records, or testimony about them, in any civil, criminal, administrative or legislative proceeding against you unless you give specific written consent or a court issues an order that meets Part 2's requirements and is accompanied by a subpoena. You may give a single consent for us to use and share these records for treatment, payment and health care operations, and you may revoke that consent in writing. Violations can be reported to the U.S. Department of Health and Human Services.

New Jersey law

New Jersey law gives extra protection to some information, including certain mental health, HIV and genetic information. Where state law is more protective than HIPAA, we follow state law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by letting us know in writing.

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 new notice will be available on request, in our office, and on this website.

Contact

Privacy Officer, Krystite Care LLC, 640 Eagle Rock Avenue, Suite 6, West Orange, NJ 07052. Phone (848) 801-9248.

Effective date: to be set by the practice before launch.