Notice of Privacy Practices

Notice of Privacy Practice

Gotham Psychotherapy is conveniently located at two Midtown Manhattan offices: The Chrysler Building and The Chanin Building. Both locations are easily accessible by New York City subways and buses, as well as the Long Island Rail Road, Amtrak, Metro-North, NJ Transit, and PATH.

How We May Use and Disclose Your Information

We may use and disclose your protected health information for the following purposes without your written authorization:

Treatment: To provide, coordinate, or manage your mental health care and related services.
Payment: To obtain payment for services rendered, including communication with your insurance provider.
Health Care Operations: For internal administrative functions, quality assessment, and practice management.
As Required by Law: When required by federal, state, or local law, including mandatory reporting obligations.
Emergencies: To avert a serious and imminent threat to your health or safety or the health or safety of others.

Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health

Right to Inspect and Copy: You may request access to your mental health records.
Right to Amend: You may request that we correct or amend your health information.
Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your information.
Right to Request Restrictions: You may request limits on how we use or disclose your information.
Right to Confidential Communications: You may request that we contact you in a specific way or at a specific location.
Right to a Copy of This Notice: You may request a paper copy of this notice at any time.

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your protected health information not covered by this notice will be made only with your written authorization. You may revoke your authorization at any time in writing, except to the extent that we have already taken action in reliance on your authorization.

Psychotherapy notes are afforded additional protections under New York State law and will not be disclosed without your specific written authorization, except as required by law.

Our Duties

Gotham Psychotherapy is required by law to maintain the privacy and security of your protected health information. We are required to abide by the terms of this notice as currently in effect. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information we maintain. Any revised notice will be posted on our website and made available to you upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Gotham Psychotherapy or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

Contact Our Privacy Officer

Gotham Psychotherapy is required by law to maintain the privacy of your protected health information. For questions about this notice or to exercise any of your rights described above, please contact our Privacy Officer directly.

You may also file a complaint with the U.S. Department of Health & Human Services — you will not be penalized or retaliated against for doing so:

www.hhs.gov/ocr/privacy | 1-800-368-1019

Gotham Psychotherapy | New York, NY