Notice of Privacy Practices

Chasing Serenity Psychotherapy, PLLC (“we,” “us,” “our”) is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We are a fully telehealth practice serving clients in New York, New Jersey, and Connecticut.

We may use and disclose your PHI for the following purposes without your written authorization:

• Treatment. To provide, coordinate, and manage your care, for example, your therapist documenting sessions or consulting with another clinician involved in your care.
• Payment. To bill and obtain payment from you or your health plan, for example, verifying benefits, submitting claims, and providing superbills.
• Health care operations. For quality, supervision, training, and administrative functions necessary to run the practice.

The following generally require your written authorization, which you may revoke at any time in writing:

• Psychotherapy notes (notes recorded during a private session that are kept separate from the rest of your record), except in limited circumstances permitted by law.
• Marketing communications and any sale of PHI.
• Most other uses and disclosures not described in this Notice.

We may use or disclose your PHI without authorization when permitted or required by law, including:

• When required by law or for health oversight activities;
• For public health activities, or to report abuse, neglect, or domestic violence;
• To avert a serious and imminent threat to your health or safety or that of others;
• For judicial and administrative proceedings, or to law enforcement as permitted by law;
• To coroners, medical examiners, or for workers’ compensation as authorized by law.

Where state law (NY, NJ, or CT) provides greater protection, for example, for mental-health records, we follow the more protective rule.

• Access & copy. Inspect and obtain a copy of your record.
• Amend. Request a correction to information you believe is incomplete or inaccurate.
• Accounting of disclosures. Request a list of certain disclosures we have made.
• Request restrictions. Ask us to limit how we use or share your PHI (including restricting disclosure to a health plan for services you paid for out of pocket in full).
• Confidential communications. Ask us to contact you in a specific way or location.
• Paper copy. Receive a paper copy of this Notice on request.
• Breach notification. Be notified if a breach of your unsecured PHI occurs.

• Maintain the privacy and security of your PHI;
• Notify you if a breach of your unsecured PHI occurs;
• Follow the terms of the Notice currently in effect.

We may change this Notice and make the new terms effective for all PHI we maintain. The current Notice will be posted on our website with its effective date.

If you believe your privacy rights have been violated, you may contact us using the information below, or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Privacy Officer: [Privacy Officer name]
Chasing Serenity Psychotherapy, PLLC
Email: [email protected]
Phone: [practice phone]

Please do not include sensitive health details in unsecured email. For clinical matters, use the secure client portal.