This notice describes how medical information about you may be used and disclosed. It also describes how you can get access to this information. Please review it carefully.
In order to provide you care, Jonathan Keigher (your “Provider”) must collect, create and maintain health information about you, which includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. Your Provider is required by law to maintain the privacy of this information. This Notice of Privacy Practices (this “Notice”) describes how your health information may be used and disclosed, and explains certain rights you have regarding this information. Your Provider is required by law to provide you with this Notice, and will comply with the terms as stated.
How Provider Uses and Discloses Your Health Information
Your Provider protects your health information from inappropriate use and disclosure, and will use and disclose your health information for only the purposes listed below:
Uses and Disclosures for Treatment, Payment and Health Care Operations. Your Provider may use and disclose your protected health information in order to provide your care or treatment, obtain payment for services provided to you and in order to conduct our health care operations as detailed below.
Uses and Disclosures Without Your Consent or Authorization. We may use and disclose your health information without your specific written authorization for the following purposes:
Special Treatment of Certain Records. HIV related information, genetic information, alcohol and/or substance abuse records, mental health records related to services provided by a New York Article 31 mental health clinic and other specially protected health information may enjoy certain special confidentiality protections (that are more restrictive than those outlined above) under applicable state and federal law. Any disclosures of these types of records will be subject to these special protections.
Obtaining Your Authorization for Other Uses and Disclosures. Certain uses and disclosures of your health information will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of health information under the Privacy Rule. Your Provider will not use or disclose your health information for any purpose not specified in this Notice unless we obtain your express written authorization or the authorization of your legally appointed representative. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have relied on your authorization to provide your care.
Your Rights Regarding your Health Information
You have the following rights regarding your health information:
To make a request as described in any of the above, please contact your Provider.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with your Provider or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against by your Provider for filing a complaint.
Changes to this Notice. Your Provider may change the terms of this Notice of Privacy Practices at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by your Provider before or after the date on which the Notice is changed. Any updates to the Notice will be provided to you.
Effective Date: February 27, 2022
Last Revised: February 27, 2022