Notice of Privacy Practices
This document describes how I, and mental health professionals in general, typically use and release information as well as broad descriptions of situations where it may be permissible for a mental health professional to be required by law to release information. It also describes how you can get access to this information. In all circumstances I will consider the situation very carefully and where there is any doubt as to the appropriateness of releasing information, I will always favor avoiding the release of information, if at all possible, in accordance with the law and the with ethical standards of my profession.
In order to provide you with care, I, Dr. Michael Miello, Ph.D., doing business as Rivertown Psychological Services, PLLC must collect, create and maintain health information about you, which includes any individually identifiable information that I 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. I am 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. I am required by law to provide you with this Notice and will comply with the terms as stated.
It is my right to make changes in the manner in which I treat protected health information, provided that those changes do not violate State or Federal law. Such changes will be in effect for all health information maintained, created and/or received by me before the changes to my Notice of Privacy Practices were made. You may request a copy of my Privacy Notice at any time by contacting me using the contact information I have provided at the end of this form.
TYPICAL USES AND DISCLOSURES OF HEALTH INFORMATION
I shall protect your health information from inappropriate use and disclosure, and will use and disclose your health information for only the purposes listed below:
1. 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. This includes granting access to your information to employees who have signed an agreement of confidentiality.
2. Appointment Reminders: I may use or disclose your health information to provide you with appointment reminders, including but not limited to automated voicemail messages, e-mails, text messages, or letters.
3. Employees will only be granted that information necessary to complete tasks related to billing, scheduling, filing, record keeping, and general office procedures. Employees will not have access to clinical records such as the content of session notes. All employees will sign a confidentiality agreement.
4. Medical Record Software. I pay to use an electric medical record system (such as Therapy Notes) as required by current standards of care. This third party will securely store and maintain your health information in accordance with HIPAA guidelines and is committed to maintaining the privacy of my records.
5. Medical Communication Applications. I will release information as necessary in order to utilize a HIPAA compliant Messaging Applications (Such as Spruce) as required by current standards of care. This third party will securely store and maintain your health information and is committed to maintaining the privacy of my records.
6. Treatment and Care Management. I may use and disclose health information about you to facilitate treatment, and coordinate and manage your care with other health care providers.
7. Payment. I may use and disclose health information about you for our own payment purposes and to assist in the payment activities of other health care providers. Our payment activities include, without limitation, determining your eligibility for benefits and obtaining payment from insurers that may be responsible for providing coverage to you, including Federal and State entities.
8. Health Care Operations. I may use and disclose health information about you to support health care functions related to treatment and payment, which include, without limitation, care management, quality improvement activities, evaluating our own performance and resolving any complaints or grievances you may have. I may also use and disclose your health information to assist other health care providers in performing health care operations. I will disclose necessary information to your insurer for the purpose of billing and maintaining approval for care. I may communicate information about your care to Alma, a company through which I may bill your insurance.
9. Non-routine Uses and Disclosures Without Your Consent or Authorization. I may use and disclose your health information without your specific written authorization for the following purposes:
(a) As required by law. I may use and disclose your health information as required by state, federal and local law. This includes, but is not limited to court administrative orders, subpoenas, discovery requests, or other lawful processes. I will use and disclose your information when requested to by national security, intelligence agencies, and other State and Federal officials and/or if you are an inmate or otherwise under custody of law enforcement.
(b) Danger to Self or Other: I may disclose your health information to appropriate authorities if I reasonably believe that you pose a significant threat to either yourself or any other individual. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.
(c) Public health activities. I may disclose your health information to public authorities or other agencies and organizations conducting public health activities, such as preventing or controlling disease, injury or disability, reporting births, deaths, child abuse or neglect, domestic violence, potential problems with products regulated by the Food and Drug Administration or communicable diseases.
(d) Victims of abuse, neglect or domestic violence. I may disclose your health information to an appropriate government agency if I believe you are a victim of abuse, neglect, domestic violence and you agree to the disclosure or the disclosure is required or permitted by law. I will let you know if I disclose your health information for this purpose unless I believe that advising you or your caregiver would place you or another person at risk of serious harm.
(e) Health oversight activities. I may disclose your health information to federal or state health oversight agencies for activities authorized by law such as audits, investigations, inspections and licensing surveys.
(f) Judicial and administrative proceedings. I may disclose your health information in the course of any judicial or administrative proceeding in response to an appropriate order of a court or administrative body.
(g) Law enforcement purposes. I may disclose your health information to a law enforcement agency to respond to a court order, warrant, summons or similar process, to help identify or locate a suspect or missing person, to provide information about a victim of a crime, a death that may be the result of criminal activity, or criminal conduct on our premises, or, in emergency situations, to report a crime, the location of the crime or the victims, or the identity, location or description of the person who committed the crime.
(h) Deceased individuals. I may disclose your health information to a coroner, medical examiner or a funeral director as necessary and as authorized by law.
(i) Health or safety. I may use or disclose your health information to prevent or lessen a threat to the health or safety of you or the general public. I may also disclose your health information to public or private disaster relief organizations such as the Red Cross or other organizations participating in bio-terrorism countermeasures.
(j) Specialized government functions. I may use or disclose your health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, I may disclose your health information to appropriate military authority as is deemed necessary. I may also disclose your health information to federal officials for lawful intelligence or national security activities.
(k) Workers’ compensation. I may use or disclose your health information as permitted by the laws governing the workers’ compensation program or similar programs that provide benefits for work-related injuries or illnesses.
(l) Individuals involved in your care. I may disclose your health information to a family member, other relative or close personal friend assisting you in receiving health care services. If you are available, I will give you an opportunity to object to these disclosures, and I will not make these disclosures if you object. If you are not available, I will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon my professional judgment.
(m) Incidental Uses and Disclosures. Incidental uses and disclosures of your health information sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
(n) 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.
10. 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; (d) for attaining my own training and certification. I will not use or disclose your health information for any purpose not specified in this Notice unless I 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 I will no longer use or disclose your health information for the purpose you authorized, except to the extent I have relied on your authorization to provide your care.
Your Rights Regarding your Health Information
You have the following rights regarding your health information:
1. Right to Inspect or Get a Copy of Your Medical Record. You have the right to inspect or request a copy of health information about you that I maintain. Your request should describe the information you want to review and the format in which you wish to review it. I may refuse to allow you to inspect or obtain copies of this information in certain limited cases. I may charge you a fee of up to $.75 per page for copies or the rate established by the Department of Health. I may also deny a request for access to health information under certain circumstances if there is a potential for harm to yourself or others. If I deny a request for access for this purpose, you have the right to have our denial reviewed in accordance with the requirements of applicable law.
2. Right to Request Changes to Your Medical Record. You have the right to request changes to any health information I maintain about you if you state a reason why this information is incorrect or incomplete. I might not agree to make the changes you request. If I do not agree with the requested changes I will notify you in writing and inform you how to have your objection included in our records.
3. Right to an Accounting of Disclosures. You have the right to receive a list of all disclosures I have made of your health information. The list will not include disclosures made for certain purposes including, without limitation, disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period covered by your request, which cannot exceed six years. The first time you request a list of disclosures in any 12-month period, it will be provided at no cost. If you request additional lists within the 12-month period, I may charge you a nominal fee.
4. Right to Request Restrictions. You have the right to request restrictions on the ways which I use and disclose your health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. I are required to comply with your request if it relates to a disclosure to your health plan regarding health care items or services for which you have paid the bill in full, though in other instances, I may not agree to the restrictions you request.
5. Right to Request Confidential Communications. You have the right to ask me to send health information to a different location. I will offer you a secure means of communication such as the Spruce Messaging app.
6. Right to Receive Notification of Breach. You have the right to receive a notification, in the event that there is a breach of your unsecured health information, which requires notification under the Privacy Rule.
7. Right to Paper Copy of Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time.
To make a request as described in any of the above, please contact Dr. Michael Miello.
Right to File a Complaints. 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:1/1/2022
Last Revised: 4/10/2022
How to contact Dr. Michael Miello: Call (914) 996-7328
or
e-mail at info@DrMiello.sprucecare.com
To download a copy of this notice click here.