Notice of Privacy Practices

You have rights regarding your protected health information. Subject to applicable law, you may:

• get an electronic or paper copy of your medical record
• ask us to correct your medical record
• request confidential communications
• ask us to limit certain information we use or share
• get a list of certain disclosures of your information
• get a copy of this notice
• choose someone to act for you when legally authorized
• file a complaint if you believe your privacy rights have been violated

Get an electronic or paper copy of your medical record

You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. A copy or summary will usually be provided within 30 days of your request. A reasonable, cost-based fee may apply where permitted by law.

Ask us to correct your medical record

You may ask us to correct health information that you believe is incorrect or incomplete. In some cases, the request may be denied, but the reason will be provided in writing.

Request confidential communications

You may ask us to contact you in a specific way or at a specific address, phone number, email address, or patient portal account. Reasonable requests will be accommodated.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not always required to agree to your request, especially if agreeing could affect your care.

If you pay for a service in full out of pocket, you may ask us not to share information about that service with your health insurer for payment or health care operations purposes, unless disclosure is otherwise required by law.

Get a list of certain disclosures

You may ask for an accounting of certain disclosures made during the six years before your request. The accounting will not include all disclosures, such as disclosures for treatment, payment, health care operations, or disclosures you authorized. One accounting in a 12-month period is available without charge. Additional requests may involve a reasonable, cost-based fee.

Get a copy of this notice

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

Choose someone to act for you

If someone is your legal guardian, health care proxy, personal representative, or otherwise has lawful authority to act for you, that person may exercise your rights and make choices about your health information, consistent with applicable law.

File a complaint

You may file a complaint with Sattva Psychiatry 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. You will not be retaliated against for filing a complaint.

In some situations, you may tell us your preferences about how we share your information. For example, you may tell us whether you want us to share information with family members, close friends, other clinicians, or others involved in your care.

If you are not able to tell us your preference, we may share your information if we believe it is in your best interest and the disclosure is permitted by law.

Uses and disclosures not described in this notice will generally be made only with your written authorization when authorization is required. You may revoke an authorization in writing at any time, except to the extent action has already been taken in reliance on it.

Sattva Psychiatry may use and disclose your protected health information as permitted or required by applicable law.

Treatment

Your information may be used or shared to provide, coordinate, or manage your care. For example, with your consent or as otherwise permitted by law, information may be shared with another health care professional involved in your treatment.

Payment

Your information may be used or shared to bill and receive payment for services provided. For example, information on a superbill may be used by you or your insurer for possible out-of-network reimbursement.

Health Care Operations

Your information may be used for practice operations such as quality review, compliance, auditing, credentialing, licensing, legal or accounting services, technology support, business management, and other health care operations permitted by law.

Business Associates

Sattva Psychiatry may share information with service providers who perform functions on behalf of the practice, such as electronic health record, billing, payment processing, secure communication, telehealth, legal, accounting, or technology services. When required, these service providers must agree to protect your information.

Other Uses and Disclosures Permitted or Required by Law

In some situations, your information may be used or disclosed without written authorization when permitted or required by law, including:

• to help with public health and safety issues
• to prevent or reduce a serious threat to health or safety
• when abuse, neglect, or domestic violence reporting is required or permitted by law
• for health oversight or regulatory activities
• in response to court orders, subpoenas, discovery requests, or other lawful legal process when applicable requirements are met
• for law enforcement or certain government functions when permitted by law
• for workers’ compensation or similar legal programs
• for medical examiners, coroners, funeral directors, or organ procurement organizations when permitted by law
• for research when permitted by law
• as otherwise required by federal, state, or local law

Psychotherapy Notes

If psychotherapy notes are created and maintained separately from the medical record, they receive special protection under HIPAA. Most uses and disclosures of psychotherapy notes require your written authorization, except in limited circumstances permitted by law. Sattva Psychiatry primarily provides psychiatric evaluation, medication management, and consultation rather than primary psychotherapy.

Sattva Psychiatry is required by law to maintain the privacy and security of your protected health information, provide you with this notice of privacy practices, and follow the terms of the notice currently in effect.

Sattva Psychiatry is also required to notify affected individuals following a breach of unsecured protected health information when required by law.

This notice may be changed from time to time. If it is revised, the updated notice will be posted on this page and made available upon request. The revised notice may apply to information already maintained by the practice, as well as information created or received after the change.

Telepsychiatry services are provided using secure technology. Patients must be physically located in New York, Washington, DC, or Virginia at the time of service.

The patient portal may be used for forms, appointment information, billing information, and secure practice communication where available.

Email may be used for administrative matters and limited practice communication. Email is not a substitute for urgent or emergency clinical care. Sensitive clinical matters may be redirected to secure systems or handled during appointments, as appropriate.

Text messaging, email, and other electronic communications may carry privacy risks. By using these methods to contact the practice, you acknowledge that these communications may not be appropriate for urgent, emergency, or sensitive clinical matters.

To the extent Sattva Psychiatry maintains substance use disorder records subject to 42 CFR Part 2, those records will be handled according to applicable Part 2 protections.

Such records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide written consent or the disclosure is otherwise permitted or required by law.

This section applies only to records subject to 42 CFR Part 2. Not all mental health or psychiatric records are Part 2 records.

If you have questions about this notice, want to exercise your privacy rights, or want to file a complaint with the practice, contact:

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Filing a complaint will not affect your care and will not result in retaliation.

A paper copy of this notice is available upon request.