Notice of Privacy Practices

This Notice describes the privacy practices of Karen Sussan, LCSW, LMHC, regarding protected health information (PHI) as required by the Health Insurance Portability and Accountability Act (HIPAA) and applicable New York and Florida law.

My Obligations

• I am required by law to maintain the privacy of your protected health information.
• I am required to provide you with this Notice of my legal duties and privacy practices.
• I am required to notify you following a breach of unsecured protected health information.
• I must follow the terms of the Notice currently in effect.

Uses and Disclosures That Do Not Require Your Authorization

Treatment. I may use your information to provide, coordinate, or manage your care, including consultation with other providers involved in your treatment where permitted.

Payment. I may use and disclose information to obtain payment for services, including submitting claims or providing documentation to an insurer where you have authorized use of benefits.

Health Care Operations. I may use information for quality assessment, professional consultation, supervision, training, and business functions of the practice.

Required by Law. I may disclose information when required by federal, state, or local law.

Situations Requiring Disclosure Without Your Consent

There are limits to confidentiality. I am legally and ethically obligated to disclose information without your authorization in the following circumstances:

• Suspected abuse or neglect of a child. As a mandated reporter in New York and Florida, I am required to report reasonable suspicion of child abuse, neglect, or maltreatment to the appropriate state authority.
• Suspected abuse, neglect, or exploitation of a vulnerable or elderly adult. Reporting is required under both New York and Florida law.
• Serious and imminent threat of harm to another person. Where a client communicates a serious threat of physical violence against a reasonably identifiable victim, I may be required to take protective action, which can include notifying the potential victim, contacting law enforcement, or seeking hospitalization.
• Serious and imminent risk of harm to yourself. I may take steps necessary to protect your safety, which can include contacting emergency services or a designated emergency contact.
• Court order or valid legal process. I may be compelled to release records by court order, subpoena accompanied by proper legal authority, or other lawful process.
• Health oversight and licensing. Information may be disclosed to a licensing board or health oversight agency conducting an authorized investigation.
• Coroners, medical examiners, and serious public health threats, as permitted by law.

Psychotherapy Notes

Psychotherapy notes are process notes kept separately from the rest of your record. Under HIPAA, most uses and disclosures of psychotherapy notes require your specific written authorization. Limited exceptions exist, including use by me for your treatment, required health oversight of my practice, defense in a legal action you bring, and situations where disclosure is required by law.

Uses and Disclosures Requiring Your Written Authorization

Other uses and disclosures require your written authorization, including marketing, the sale of protected health information, and most disclosures of psychotherapy notes. You may revoke an authorization in writing at any time, except to the extent action has already been taken in reliance on it.

Your Rights Regarding Your Health Information

• Right to inspect and copy. You may request access to your records, with limited exceptions. Psychotherapy notes may be excluded.
• Right to request amendment. You may request that I amend information you believe is inaccurate or incomplete.
• Right to an accounting of disclosures. You may request a list of certain disclosures made in the six years prior to your request.
• Right to request restrictions. You may request limits on how information is used or disclosed. I am not required to agree except where a disclosure to a health plan concerns a service you paid for in full out of pocket.
• Right to confidential communications. You may request that I contact you at a specific phone number or address.
• Right to a paper copy of this Notice upon request.
• Right to be notified of a breach of unsecured protected health information.

Complaints

If you believe your privacy rights have been violated, you may contact me directly. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr. You will not be retaliated against for filing a complaint.

Changes to This Notice

I reserve the right to change this Notice and to make the revised Notice effective for information I already hold as well as information I receive in the future. The current Notice will be posted on this website and available in my office.

Contact

Karen Sussan, LCSW, LMHC
Privacy Officer
29 N Airmont Road, Suite 3, Suffern, NY 10901
845-202-9774
[email protected]