HIPAA Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THIS NOTICE IS ISSUED BY INSTRIDE HEALTH MA, P.C., DOING BUSINESS IN NEW YORK AS “IN STRIDE MEDICAL,” AND BY INSTRIDE HEALTH NJ, P.C.

I. OUR PLEDGE REGARDING HEALTH INFORMATION:

We understand that health information is personal, and we are committed to protecting your health information. We create a record of the care and services our team provides. We need this record to provide quality care and to comply with certain legal requirements. This notice applies to all of the records of care generated by InStride and  will tell you about the ways in which we may use and disclose health information. We also describe your rights to the health information we keep about you, and certain obligations we have regarding the use and disclosure of health information. We are required by law to:

• Make sure that your protected health information (“PHI”) is kept private and secure.
• Notify you if a breach occurs that might have compromised the privacy or security of your information.
• Give you this notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.

We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request.

II. HOW WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION:

Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient to use or disclose the patient’s personal health information without the patient’s (or parent’s for a minor) written authorization to carry out the health care provider’s own treatment, payment, and health care operations.

1. Provide Treatment: We may disclose your protected health information for the treatment activities of any health care provider. This can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
2. Bill for services: We can use and share your health information to bill and get payment from health plans or other entities.
3. Run our organization: We can use and share your health information to run our practice, improve your child’s care, and communicate with you regarding scheduling and appointments.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy and Psychopharmacology Notes. We do keep notes as defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
   a. For our use in treating you.
   b. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
   c. For our use in defending ourselves in legal proceedings instituted by you.
   d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
   e. Required by law and the use or disclosure is limited to the requirements of such law.
   f. Required by law for certain health oversight activities pertaining to the originator of the notes.
   g. Required by a coroner who is performing duties authorized by law.
   h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. We will not use or disclose your PHI for marketing purposes.
3. Sale of PHI. We will not sell your PHI in the regular course of our business.

IV. CERTAIN ADDITIONAL USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following additional reasons (for more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html):

1. When disclosure is required by state or federal law and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, reporting adverse reactions to medications, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
   
4. For judicial and administrative proceedings, including responding to a court or administrative order, or in response to a subpoena.
5. For law enforcement purposes.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, e.g., studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide PHI in order to comply with workers’ compensation laws.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.

Disclosures to family, friends, or others. We may provide PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for the health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way (for example, email, home phone, etc.) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. You can ask to see or get an electronic or paper copy of your medical record and other health information. Ask us how to do this. We will provide you with a copy of your record, or a summary if you agree to receive a summary, within 30 days of receiving your written request. We may charge a reasonable, cost based fee for doing so.
5. The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on October 1, 2021. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

File a complaint if you feel your rights are violated

• If you feel we have violated your rights you can complain by contacting the InStride Privacy Officer, Laurie Beth Pliakos at lauriebeth.pliakos@instride.health
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.