Notice of Privacy Practices
Hayat. Allarakhia M.D., P.C.. Effective date: [____].
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who we are
This notice applies to Allarakhia M.D., P.C., the medical practice that provides clinical services through Hayat, and to the business associates that support it, including Signal Therapies, LLC, which operates the Hayat platform under a business associate agreement.
How we may use and disclose your health information
Treatment. We use your health information to provide and coordinate your care, including sharing necessary information with the partner pharmacy that fills your prescriptions and the laboratory that performs your tests.
Payment. We use your health information to administer and process your cash-pay membership and related charges, including preparing a superbill at your request. We do not bill medical insurance.
Healthcare operations. We use your health information for quality improvement, clinician review, and routine business administration.
Other permitted or required uses. We may use or disclose your information when required by law, for public health activities, for health oversight, in response to a court order or other lawful process, to law enforcement in limited circumstances, to avert a serious threat to health or safety, and to business associates who have agreed in writing to protect it.
Uses that require your written authorization
We will not use or disclose your health information for marketing purposes, sell your health information, or share psychotherapy notes without your written authorization. You may revoke an authorization at any time, in writing, except to the extent we have already acted on it. Other uses and disclosures not described in this notice will be made only with your authorization.
Your rights
You have the right to inspect and receive a copy of your health records, in electronic form where we maintain them electronically. You have the right to request corrections to information you believe is inaccurate or incomplete. You have the right to receive an accounting of certain disclosures we have made. You have the right to request restrictions on how we use or share your information, although we are not required to agree to every request. Because you pay for services out of pocket in full, you have the right to require that we not disclose information about those services to a health plan. You have the right to request confidential communications by a specific method or at a specific location. You have the right to a paper copy of this notice on request, even if you agreed to receive it electronically.
Our duties
We are required by law to maintain the privacy and security of your health information, to provide you with this notice of our legal duties and privacy practices, to abide by the terms of the notice currently in effect, and to notify you if a breach compromises the privacy or security of your information.
Changes to this notice
We may change this notice and make the new notice apply to information we already hold. The current notice will always be posted on our website and available on request, with its effective date shown at the top.
Complaints and contact
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, or at www.hhs.gov/ocr. We will not retaliate against you for filing a complaint. Questions and requests may be directed to our Privacy Officer, [name], at [contact].