This notice describes how health information may be used and disclosed and how you can access that information. Please review it carefully.
Prepared for practice review. The practice must confirm the effective date, privacy contact, applicable legal requirements and final operational details before this notice is used for patient intake.
Your information and the clinical record
Bahali Psychology keeps clinical documentation separate from website scheduling. Public inquiry forms are not the place to submit diagnoses, detailed histories, psychotherapy notes or assessment results.
Uses and disclosures
Subject to applicable law, health information may be used or shared to provide and coordinate care, arrange payment and operate the practice. For example, a clinician may coordinate your care with another treating professional when permitted. The practice is self-pay and does not directly bill insurance. A superbill supplied at your request may contain clinical and billing information; consider what you share with your insurer.
Other disclosures may be permitted or required by law, including certain public-health reporting, abuse or neglect reporting, prevention of a serious threat, health oversight, workers’ compensation, lawful legal proceedings and disclosures to authorized officials after death. These are subject to legal conditions and do not create unrestricted access to records. Where New York law provides greater protection, that protection applies.
Uses outside applicable legal permissions require your written authorization. This generally includes marketing, sale of health information and most uses or disclosures of separately maintained psychotherapy notes. You may revoke an authorization in writing, except to the extent the practice has already relied on it or another legal exception applies.
Your choices
You may ask the practice to communicate with you in a particular way or at a particular location, and reasonable requests will be accommodated as required by law. You may request limits on uses or disclosures, although not every restriction must be accepted. When you pay in full out of pocket and request that the related information not be shared with a health plan for payment or operations, the practice must honor the restriction where legally required.
You may identify people involved in your care with whom you permit information to be shared. Your preferences are respected subject to applicable law and circumstances such as emergencies.
Your rights
- Request access to and a copy of your health records, with exceptions allowed by law; access rights do not generally include separately maintained psychotherapy notes.
- Request a correction if information is inaccurate or incomplete. If a request is denied, you will be told how to submit a statement of disagreement where applicable.
- Request an accounting of certain disclosures, subject to legal exceptions and time limits.
- Receive a paper copy of this notice, even if you previously agreed to receive it electronically.
- Have an authorized personal representative exercise rights on your behalf where applicable.
- Receive notice of a breach affecting your unsecured protected health information when required by law.
Verification of identity may be necessary. The practice will explain applicable response periods, permitted fees and review rights for your request.
Practice responsibilities
The practice must protect the privacy and security of health information under applicable law, provide this notice where required and follow the notice in effect. Changes to the notice may apply to information already held; an updated notice will be available through the practice and its website when applicable.
Questions and complaints
Contact Bahali Psychology through the contact page and request the privacy contact. Do not send clinical details through the public form. You can also complain to the U.S. Department of Health and Human Services Office for Civil Rights when within its jurisdiction. The practice will not retaliate against you for filing a complaint.
Background: HHS model notices and privacy guidance.