Privacy Practices
Introduction & Purpose
This Notice describes how your Protected Health Information (PHI) may be used and disclosed and how you can access this information. Please review it carefully.
At Greenwich Child & Adolescent Psychiatry, we respect the privacy of your health information and are committed to
protecting it. We create a record of the care and services you receive to provide quality care and comply with legal
requirements.
We are required by law to:
• Maintain the privacy of your PHI.
• Provide this Notice describing our legal duties and privacy practices.
• Abide by the terms of the current Notice.
• Notify you if a breach of your unsecured PHI occurs.
We may change the terms of this Notice at any time. Any changes will apply to all PHI we maintain. The current Notice
will always be available upon request and posted in our office and on our website.
How We May Use & Disclose Your PHI
We typically use or disclose your PHI in the following ways:
1. For Treatment, Payment & Health Care Operations
• Treatment: We may use or share your PHI with other health care providers to coordinate care (e.g., consultations,
referrals, or interdisciplinary treatment planning).
• Payment: We may use your PHI to bill and collect payment for services rendered.
• Health Care Operations: We may use PHI for internal administrative purposes, quality improvement, and staff
training.
> Note: Federal law allows full access to PHI for treatment purposes, as complete information is essential for safe, quality care.
2. Other Permitted Uses & Disclosures Without Authorization
We may use or disclose your PHI without your written authorization when required or permitted by law, including:
• Public Health Activities: Reporting suspected abuse, neglect, or threats to health or safety.
• Health Oversight: Audits, inspections, or investigations by health agencies.
• Judicial & Administrative Proceedings: In response to court orders or lawful subpoenas.
• Law Enforcement: To comply with legal requirements or locate missing persons.
• Coroners, Medical Examiners, Funeral Directors: To carry out lawful duties.
• Research: Under strict regulatory approval and de-identification standards.
• Specialized Government Functions: Military, national security, or protective services.
• Workers’ Compensation: To comply with workers’ compensation laws.
• Appointment Reminders & Health-Related Services: Informing you about treatment options or benefits.
3. Uses & Disclosures Requiring Authorization
Certain uses of PHI require your explicit, written consent:
• Psychotherapy Notes: Except for limited exceptions (e.g., emergencies, compliance audits, or legal defense),
psychotherapy notes require your written authorization for release.
• Marketing or Sale of PHI: We do not sell or use your PHI for marketing without your written authorization.
• Other Disclosures: Any use not described in this Notice requires your authorization, which you may revoke at any
time in writing.
4. Uses & Disclosures Allowing Opportunity to Object
We may share PHI with family members or others involved in your care unless you object. In emergencies, we may act
without prior consent but will offer the opportunity to object afterward.
Your Rights Regarding PHI
You have the following rights under federal law:
1. Right to Access & Copies
You may request an electronic or paper copy of your health record (excluding psychotherapy notes). We will
respond within 30 days of receiving your written request and may charge a reasonable fee for copying or mailing.
2. Right to Request Restrictions
You may ask us to limit how your PHI is used or disclosed for treatment, payment, or operations. We are not
required to agree unless it involves restricting disclosure to a health plan when you paid out-of-pocket in full.
3. Right to Confidential Communications
You may request that we contact you in specific ways (e.g., at a different address or phone number). We will
accommodate all reasonable requests.
4. Right to Amend
If you believe your PHI is incorrect or incomplete, you may request an amendment. We may deny your request if
the information is accurate, but we will explain our decision in writing within 60 days.
5. Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI for purposes other than treatment, payment, or operations
within the last six years. The first request in a 12-month period is free; subsequent requests may incur a fee.
6. Right to a Copy of This Notice
You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it
electronically.
7. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
• Our Privacy Officer at the contact information above.
• The U.S. Department of Health & Human Services – Office for Civil Rights.
You will not face retaliation for filing a complaint.
Acknowledgment of Receipt
By signing below, you acknowledge that you have received and reviewed this Notice of Privacy Practices.