Privacy Policy
Notice of Privacy Practices
This page describes how medical information about you may be used and disclosed. Please review it carefully. If you have any questions about this Notice please contact Dr. Mendelsohn.
This Notice of Privacy Practices describes how Dr. Mendelsohn may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Dr. Mendelsohn abides by the terms of this Notice of Privacy Practices. Dr. Mendelsohn may change the terms of this Notice at any time. The new notice will be effective for all protected health information that Dr. Mendelsohn maintains at that time. Upon your request, Dr. Mendelsohn will provide you with any revised Notice of Privacy Practices by placing copies in the waiting room, responding to your call to the office requesting that a revised copy be sent to you in the mail or if you ask for one at the time of your next appointment.
1. Data Collected
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN CONSENT
You will be asked to sign a consent form. Once you have consented to use and disclosure of your protected health information for treatment, payment, and health care operations by signing the consent form, Dr. Mendelsohn may use or disclose your protected health information as described in this Notice. Your protected health information may be used and disclosed by Dr. Mendelsohn, his office staff, and others outside of Dr. Mendelsohn’s office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of Dr. Mendelsohn’s practice.
Following are examples of the types of uses and disclosures of your protected health care information that the physician’s office is permitted to make once you have signed Dr. Mendelsohn’s consent form entitled “Consent for Purposes of Treatment, Payment, and Healthcare Operations.” These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by Dr. Mendelsohn’s office once you have provided consent.
Treatment:
Dr. Mendelsohn will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, Dr. Mendelsohn would disclose your protected health information, as necessary, to another therapist that provides care to the patient. Dr. Mendelsohn will also disclose protected health information to other physicians who may be treating the patient when he has the permission to disclose that protected health information. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
In addition, Dr. Mendelsohn may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of Dr. Mendelsohn, becomes involved in your care by providing assistance with your health care diagnosis or treatment to Dr. Mendelsohn.
The confidentiality of a patient’s protected health information that is transmitted by electronic and/or digital technologies, such as by email or cellular telephone, cannot be guaranteed.
Payment:
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services that Dr. Mendelsohn recommends for you, such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for outpatient psychotherapy may require that the relevant protected health information be disclosed to the health plan to obtain approval for the treatment.
Healthcare Operations:
Dr. Mendelsohn may use or disclose as-needed your protected health information in order to support the business activities of Dr. Mendelsohn’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, psychiatry residents, and other mental healthcare providers, licensing, and conducting or arranging for other business activities.
For example, Dr. Mendelsohn may disclose your protected health information to a pharmacy when communicating a prescription order. Dr. Mendelsohn may disclose your protected health information to psychiatry residents. Dr. Mendelsohn may call you by name in the waiting room when he is ready to see you. Dr. Mendelsohn’s practice may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
Dr. Mendelsohn will share your protected health information with third party “business associates” that perform various activities (e.g., billing, scheduling, transcription services) for Dr. Mendelsohn’s practice. Whenever an arrangement between Dr. Mendelsohn’s office and a business associate involves the use or disclosure of your protected health information, Dr. Mendelsohn will have a written contract that contains terms that will protect the privacy of your protected health information.
Dr. Mendelsohn may use or disclose your protected health information to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. Dr. Mendelsohn may also use and disclose your protected health information for the direct marketing activities of his practice. For example, your name and address may be used to send you new information about Dr. Mendelsohn’s practice and the services he offers. You may contact Dr. Mendelsohn to request that these materials not be sent to you.
2. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that Dr. Mendelsohn or his practice has taken an action in reliance on the use or disclosure indicated in the authorization.
3. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO OBJECT
Dr. Mendelsohn may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then Dr. Mendelsohn may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object. Dr. Mendelsohn may disclose to a member of your family. a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure. Dr. Mendelsohn may disclose such information as necessary if he determines that it is in your best interest based on his professional judgment. Dr. Mendelsohn may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care or general condition. Finally, Dr. Mendelsohn may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Emergencies:
Dr. Mendelsohn may use or disclose your protected health information in an emergency treatment situation. If this happens, Dr. Mendelsohn shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If Dr. Mendelsohn is required by law to treat you and has attempted to obtain your consent but is unable to obtain your consent, he may use or disclose your protected health information to treat you.
Communication Barriers: Dr. Mendelsohn may use and disclose your protected health information if Dr. Mendelsohn attempts to obtain consent from you but is unable to do so due to substantial communication barriers and he determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
4. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO OBJECT
Dr. Mendelsohn may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Required by Law:
Dr. Mendelsohn may use or disclose your protected health information to the extent that the use or disclosure is required by law. You will be notified of any such uses or disclosures.
Public Health:
Dr. Mendelsohn may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability. Dr. Mendelsohn may also disclose your protected health information if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. Communicable Diseases: Dr. Mendelsohn may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Abuse or Neglect:
Dr. Mendelsohn may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, if Dr. Mendelsohn believes that you have been a victim of abuse, neglect, or domestic violence, he may disclose your protected health information to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration:
Dr. Mendelsohn may disclose your protected health information to a person or company as required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products: to enable product recalls: to make repairs or replacements, or to conduct post-marketing surveillance.
Legal Proceedings:
Dr. Mendelsohn may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful process.
Law Enforcement:
Dr. Mendelsohn may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include: (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime or suspicion that death has occurred as a result of criminal conduct, (4) in the event that a crime occurs on the premises of Dr. Mendelsohn’s practice, and (5) medical emergency (not on the practice’s premises) and it is likely that a crime has occurred.
Criminal Activity:
Consistent with applicable federal and state laws, Dr. Mendelsohn may disclose your protected health information if he believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Dr. Mendelsohn may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, Dr. Mendelsohn may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. Dr. Mendelsohn may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers’ Compensation:
Your protected health information may be disclosed by Dr. Mendelsohn as authorized to comply with workers’ compensation laws and other similar legally-established programs. Required Uses and Disclosures: Under the law, Dr. Mendelsohn must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine his compliance with the statutory requirements.
5. YOUR RIGHTS
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. A “designated record set” contains records that Dr. Mendelsohn maintains and uses for making decisions about the patient. Although the patient has a right to inspect and obtain a copy of the protected health information about that patient that is contained in a designated record set (for as long as Dr. Mendelsohn maintains the designated record set), federal law prohibits the inspection or copying of psychotherapy notes. Specifically, under federal law, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. If you have questions about access to your medical record, please contact Dr. Mendelsohn.
You have the right to request a restriction of your protected health information. This means you may ask Dr. Mendelsohn not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Dr. Mendelsohn is not required to agree to a restriction that you may request. If he believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If Dr. Mendelsohn does agree to the requested restriction, he may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with Dr. Mendelsohn. You may request a restriction by stating in writing, the specific restriction requested and to whom you want the restriction to apply. Your written request must be signed, dated and delivered to Dr. Mendelsohn, who will place it in your medical record.
You may have the right to have Dr. Mendelsohn amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as Dr. Mendelsohn maintains this information. In certain cases, Dr. Mendelsohn may deny your request for an amendment. If Dr. Mendelsohn denies your request for amendment, you have the right to file a statement of disagreement with Dr. Mendelsohn and he may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact Dr. Mendelsohn to determine if you have questions about amending your medical record.
Changes in federal law may give you the right to receive an accounting of certain disclosures that Dr. Mendelsohn may make, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures Dr. Mendelsohn may have made to you, to family members or friends involved in your care, or for notification purposes. You may have the right to receive specific information regarding these disclosures that occurred after April 14, 2003 and possibly earlier. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
6. COMPLAINTS
You may complain to Dr. Mendelsohn or to the Secretary of Health and Human Services, if you believe he has violated your privacy rights. You may file a complaint with us by notifying Dr. Mendelsohn of your complaint. For further information about the complaint process, you may contact Dr. Mendelsohn by phone at (954)399-2317.
7. RECEIPT OF NOTICE OF PRIVACY PRACTICES
You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically.
If you have any questions about this Notice or would like further information concerning your privacy rights, please contact Dr. Mendelsohn at (954)399-2317.
8. EFFECTIVE DATE
This Notice is effective as of 1/9/2024. If there are any material changes to this Notice, the revised Notice will be posted in the waiting room and on Dr. Mendelsohn’s website, if applicable.
We appreciate the opportunity to provide you with quality health care services. Protecting your privacy is an essential part of that service.
Sincerely,
Dr. Jared Mendelsohn
(954)399-2317
drjared@ourfamilypsychiatrist.com