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Notice of Privacy Practices

This notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Effective Date: April, 1, 2017

This notice is to inform you about the ways Dr. Christie Sosnowski, Psy.D. may collect, store, use and disclose your protected health information and your rights concerning your protected health information. “Protected Health Information” (PHI) is information about you that can be reasonably used to identify you and that relates to your past, present or future physical or mental health condition, the provision of health care provided to you and the payment for that care.

Federal and state law requires me to provide you with this Notice about your rights and my legal duties and privacy practices with respect to your PHI.

Uses and Disclosures of Your Protected Health Information

I may use and disclose your PHI for different purposes. Under certain circumstances, I am not required to obtain your authorization to disclose this information:

  1. Payment: I may use and disclose PHI in order to pay for your covered health expenses. For example, I may use your PHI to process claims or be reimbursed by an insurance company that may be responsible for payment.
  2. Treatment: I may use and disclose your PHI to assist your other health care providers in your diagnosis and treatment.
  3. Victims of Abuse, Neglect or Domestic Violence: I may disclose your PHI to government agencies about abuse, neglect or domestic violence.
  4. Judicial and Administrative Proceedings: I may disclose PHI in response to a court or administrative order. I may also disclose PHI about you in certain cases in response to a subpoena or other lawful processes.
  5. Law Enforcement: I may disclose PHI under limited circumstances to a law enforcement official in response to a warrant or similar process; to identify a suspect; or to provide information about the victim of a crime.
  6. To Avert a Serious Threat to Health or Safety: I may disclose PHI about you, with some limitations, when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  7. Workers’ Compensation: I may disclose PHI to the extent necessary to comply with state law for workers’ compensation programs.

Uses or Disclosures of PHI that Require your Authorization

Other uses or disclosures of your PHI will be made only with your written authorization, unless otherwise permitted by law. You may revoke an authorization you have made at any time, in writing, except to the extent that I have already taken action on the information disclosed (meaning I can’t take back information I released during the time you authorized it). 

Your Rights Regarding your Protected Health Information

You may have certain rights regarding PHI that Dr. Sosnowski maintains about you.

  • Right to Access Your Protected Health Information: You have the right to review or obtain copies of your PHI records, with some limited exceptions. Usually the records include billing, claims payment and case or medical management records. Your request to review and/or obtain a copy of your PHI must be made in writing. I may charge a fee for the costs of producing, copying and mailing your requested information, but I will tell you the cost in advance.
  • Right to Amend Your Protected Health Information: If you feel that your PHI maintained by Dr. Sosnowski is incorrect or incomplete, you may request that I amend the information. Your request must be made in writing and must include the reason you are seeking a change. I may deny your request, if for example, you ask me to amend information that was not created by myself, or you ask me to amend a record that is already accurate and complete. If I deny your request to amend, I will notify you in writing. You then have the right to submit to me a written statement of disagreement with my decision and I have the right to rebut that statement.
  • Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures I have made of your PHI, the list will not include my disclosures related to your treatment, my payment or health care operations, or disclosures made to you or with your authorization. The list may also exclude certain other disclosures, such as for national security purposes. Your request for an accounting of disclosures must be made in writing and must state a time period for which you want an accounting. This time period may not be longer than six years. Your request should indicate in what form you want the list (paper or electronic). For additional lists within the same time period, I may charge you for providing the accounting, but I will tell you the cost in advance.
  • Right to Request Restrictions on the Use and Disclosure of Your Protected Health Information: You have the right to request that I restrict or limit how I use or disclose your PHI for treatment, payment or health care operations. I may not agree to your request. If we do agree, I will comply with your request unless the information is needed for an emergency. Your request for a restriction must be made in writing. In your request, you must tell me (1) what information you want to limit; (2) whether you want to limit how I use or disclose your information, or both and (3) to whom you want the restriction to apply.
  • Right to Receive Confidential Communication: You have the right to request that I use a certain method to communicate with you or that I send information to a certain location if the communication with you could endanger you. This request must be made in writing and must clearly state that all or part of the communication from me could endanger you. 

I will accommodate all reasonable requests. Your requests must specify how or where you wish to be contacted.

Contact Information for Exercising Your Rights

You may exercise any of the rights described above by contacting:

Dr. Christie Sosnowski
60 Fairview Street Huntington, NY, 11743
718-215-0802
christie@dr-christie.com

Changes to This Notice

I reserve the right to change the terms of this Notice at any time, effective for protected health information that I already have about you, as well as any other information that I receive in the future. I will provide you with a copy of the new Notice whenever there is a change made to the privacy practices. Any time I make a material change, I will promptly revise and issue the new Notice with the new effective date.

Complaints

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may file a written complaint to the U.S. Department of Health and Human Services at www.hhs.gov.

I support your right to protect the privacy of your protected health information. I will not retaliate against you or penalize you for filing a complaint.

Legal Duty

It is my legal duty, as I am required by law to protect the privacy of your information, provide you with this notice about my information practices, and follow the information practices described in this notice.