Notice of Privacy Practices
This Notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully. This is a template based on the standard HIPAA Notice of Privacy Practices model — it should be replaced with a notice reviewed for this practice before use.
Our commitment to your privacy
This practice is required by law to maintain the privacy of your protected health information ("PHI"), to provide you with this Notice of our legal duties and privacy practices, and to notify affected individuals following a breach of unsecured PHI.
How we may use and disclose your health information
- Treatment — to provide, coordinate, or manage your psychiatric care, including sharing information with other providers involved in your care.
- Payment — to bill and collect payment for services, including from your health insurance plan.
- Healthcare operations — for quality assessment, licensing, and other activities needed to run this practice.
- As required by law — including for public health, safety, or legal proceedings where disclosure is required.
Other uses and disclosures not described in this notice will be made only with your written authorization, which you may revoke at any time.
Your rights
You have the right to:
- Request a copy of your medical record
- Request a correction to your medical record
- Request confidential communication
- Request restrictions on certain uses and disclosures
- Receive an accounting of certain disclosures
- Receive a paper copy of this notice, upon request
Our responsibilities
- We are required by law to maintain the privacy of your PHI
- We must provide you with this notice describing our legal duties and privacy practices
- We must follow the terms currently in effect
Changes to this notice
We reserve the right to change this notice and to make the revised notice effective for PHI already held, as well as PHI received in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with this practice or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Contact
Questions about this notice can be sent to hello@geepsychiatry.com.