Privacy Policy

Notice of Psychological HealthCare P.L.L.C.’s (PHC) Policies and Practices to Protect the Privacy of Your Health Information


I. Uses and Disclosures for Treatment, Payment, and Health Care Operation 
PHC may use. or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
“PHI” refers to information in your health record that could identify you.
“Treatment, Payment and Health Care Operations”
– Treatment is when your therapist provides, coordinates or manages your health care and other services related to your health care. An example of treatment would be when your therapist consults with another health care provider, such as your family physician or another therapist.
– Payment is when PHC obtains reimbursement for your healthcare. Examples of payment are when PHC discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
– Health Care Operations are activities that relate to the performance and operation of PHC’s practice. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
“Use” applies only to activities within PHC, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
“Disclosure” applies to activities outside of PHC, such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization 
Your therapist may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when your therapist is asked for information for purposes outside of treatment, payment and health care operations, she/he will obtain an authorization from you before releasing this information. Your therapist will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes your therapist may have made about your conversation during a private, group, joint, or family counseling session, which your therapist has kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI.
You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) your therapist has relied on and acted on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.
III. Uses and Disclosures with Neither Consent nor Authorization 
Your therapist may use or disclose PHI without your consent or authorization in the following circumstances:
Child Abuse: If, in your therapist’s professional capacity, a child comes before your therapist which she/he has reasonable cause to suspect is an abused or maltreated child, or she/he has reasonable cause to suspect a child is abused or maltreated where the parent, guardian, custodian or other person legally responsible for such child comes before your therapist in her/his professional or official capacity’ and states from personal knowledge facts, conditions or circumstances which, if correct, would render the child an abused or maltreated child, your therapist must report such abuse or maltreatment to the statewide central register of child abuse and maltreatment, or the local child protective services agency.
Health Oversight: If there, is an inquiry or complaint about your therapist’s professional conduct to the New York State Board for Psychology or Social Work, she/he must furnish to the New York Commissioner of Education, your confidential mental health records relevant to this inquiry.
Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that your therapist has provided you and/or the records thereof, such information is privileged under state law, and your therapist must not release this information without your written authorization, or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. Your therapist must inform you in advance if this is the case.
Serious Threat to Health or Safety: Your therapist may disclose your confidential information to protect you or others from a serious threat of harm by you.
Worker’s Compensation: If you file a worker’s compensation claim, and your therapist is treating you for the issues involved with that complaint, then she/he must furnish to the chairman of the Worker’s Compensation Board records which contain information regarding your psychological condition and treatment.

IV. Patient’s Rights and Psychologist’s and Social Worker’s Duties

Patient’s Rights:
Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, your therapist is not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing your therapist. Upon your request, PHC will send your bills to another address.)
Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in your therapist’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your therapist may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, your therapist will discuss with you the details of the request and denial process.
Right to Amend- You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Your therapist may deny your request. On your request, your therapist will discuss with you the details of the amendment process. Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, your therapist will discuss with you the details of the accounting process.
Right to a Paper Copy – You have the right to obtain a paper copy of the notice from your therapist upon request, even if you have agreed to receive the notice electronically.

Psychologist’s and Social Worker’s Duties: 
Your therapist is required by law, to maintain the privacy of PHI and to provide you with a notice of his/her legal duties and privacy practices with respect to PHI.
PHC reserves the right to change the privacy policies and practices described in this notice. Unless your therapist notifies you of such changes, however, she/he is required to abide by the terms currently in effect.
If PHC revises their policies and procedures, PHC will notify you by mail.

V. Complaints
If you are concerned that your therapist has violated your privacy rights, or you disagree with a decision she/he has made about access to your records, you may contact the Clinical Director of Psychological HealthCare, Ronald Fish, Ph.D. at (315) 422-0300 or the New York State Office of Professional Discipline at 800 442-8106.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.

A Message to Medicaid Beneficiaries, Advocates and Others:

Central New York Care Collaborative (CNYCC) is the lead organization of a Performing Provider System (PPS) under New York State’s Delivery System Reform Incentive Payment (DSRIP) program. DSRIP focuses on health care system transformation, where providers work to improve and coordinate community based, primary care, mental health and preventive care services. Psychological HealthCare participates in this program. If you have any questions, concerns or complaints about the DSRIP program, Psychological HealthCare, or the CNYCC PPS, please contact CNYCC’s compliance officer at 315-703-2985, or via email at

Or alternatively you may use an anonymous hotline. The system we are using for the Hotline, operated by EthicPoint (a NAVEX Global company) assures that reports can be made on a confidential basis. The hotline number is 1-855-343-5598.

Psychological HealthCare is committed to following up on all reports we receive. We are also fully committed to an environment that encourages reporting without any fear of intimidation or retaliation.

VI. Effective Date. Restrictions and Changes to Privacy Policy
This notice will go into effect on April 14, 2003.

PHC reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI that PHC maintains. PHC will provide you with a revised notice by mail.

April, 2003