Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice explains how medical information about you may be used and disclosed, how you may obtain access to that information, and the responsibilities of NH Psychiatry regarding your protected health information. Please review it carefully.

To the extent NH Psychiatry receives or maintains substance-use-disorder patient records protected by 42 CFR Part 2, additional federal protections apply. Those records generally cannot be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or the legal process required by federal law.

Your Rights

You have rights concerning your health information. These include the rights described below.

Access Your Medical Record

You may ask to inspect or receive an electronic or paper copy of your medical record and other health information maintained about you. We generally provide a copy or summary within 30 days of a valid request. A reasonable, cost-based fee may apply when permitted by law.

Request a Correction

If you believe health information in your record is incorrect or incomplete, you may ask us to amend it. We may deny a request when permitted by law. If a request is denied, we will provide the required written explanation. We generally respond to amendment requests within 60 days, subject to any extension allowed by law.

Request Confidential Communications

You may ask us to contact you in a particular way or at a particular location, such as using a specific telephone number or mailing address. We will accommodate reasonable requests.

Request Restrictions

You may ask us not to use or disclose certain health information for treatment, payment, or health care operations. We are not generally required to agree to every requested restriction. If we agree, an exception may apply when information is needed for emergency treatment or disclosure is otherwise permitted or required by law.

If you pay in full out of pocket for a health care service, you may ask us not to disclose information about that service to your health plan for payment or health care operations. We will honor the request when required by law unless another law requires disclosure.

Receive an Accounting of Certain Disclosures

You may request an accounting of certain disclosures of your protected health information made during the six years before your request. The accounting does not include every disclosure, including many disclosures for treatment, payment, health care operations, or disclosures you requested or authorized.

One accounting within a 12-month period is provided without charge. A reasonable, cost-based fee may apply to additional accountings requested within the same 12-month period, when permitted by law.

Receive a Copy of This Notice

You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Choose Someone to Act for You

If another person has legal authority to act as your personal representative, that person may exercise applicable privacy rights on your behalf. We may require documentation confirming the person’s authority before acting on a request.

File a Privacy Complaint

You may contact NH Psychiatry if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. NH Psychiatry will not retaliate against you for filing a complaint.

Your Choices

In certain situations, you may tell us how you want your information shared. This may include sharing relevant information with family members, close friends, caregivers, or others involved in your care or payment for your care.

If you are unable to tell us your preference, we may use professional judgment and applicable law to determine whether a limited disclosure is appropriate and in your best interest. We may also disclose information when permitted by law to prevent or reduce a serious and imminent threat to health or safety.

Uses Requiring Written Authorization

We will obtain your written authorization when required by law. Written authorization is generally required for the sale of protected health information, certain marketing activities, and most uses or disclosures of psychotherapy notes when those notes meet the HIPAA definition of psychotherapy notes.

You may revoke an authorization in writing, except to the extent that we have already acted in reliance on it.

NH Psychiatry does not sell protected health information and does not use protected health information for fundraising communications.

How We Typically Use and Disclose Health Information

Treatment

We may use and disclose your health information to provide, coordinate, or manage your health care. For example, we may communicate with another health care professional involved in your treatment when permitted by law.

Health Care Operations

We may use and disclose health information as necessary to operate the practice and support the quality and administration of care. This may include quality improvement, care coordination, credentialing, compliance activities, business administration, and other health care operations permitted by law.

Payment

We may use and disclose health information to obtain payment for services. This may include providing necessary information to a health plan for claims, eligibility, benefits, prior authorization, or other payment-related activities.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose health information without your written authorization when permitted or required by law. Depending on the circumstances and applicable legal requirements, this may include public-health activities; reporting abuse, neglect, or domestic violence; preventing or reducing a serious threat to health or safety; health oversight; workers’ compensation; certain law-enforcement purposes; judicial or administrative proceedings; medical examiners or funeral directors; organ or tissue donation; research permitted by law; certain government functions; or other activities specifically authorized or required by law.

We will comply with additional legal requirements or limitations that apply to a particular type of information.

Mental Health and Other Specially Protected Information

Because NH Psychiatry provides psychiatric care, some information may be subject to protections that are more restrictive than the general HIPAA rules. Certain mental health information, psychotherapy notes, substance-use-disorder information, HIV-related information, genetic information, or other specially protected information may require additional authorization or may be disclosed only under specific circumstances.

When state or federal law provides greater privacy protection than HIPAA, NH Psychiatry will follow the more protective requirement.

Substance Use Disorder Records and 42 CFR Part 2

To the extent NH Psychiatry receives or maintains substance-use-disorder patient records that are protected by 42 CFR Part 2, additional federal confidentiality protections apply.

Records subject to Part 2 generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you based on the content of those records unless you provide written consent or the disclosure is authorized through the court order and subpoena process required by federal law.

NH Psychiatry will comply with applicable Part 2 requirements when such records are received or maintained.

Our Responsibilities

NH Psychiatry is required by law to maintain the privacy and security of protected health information and to follow the privacy practices described in the Notice of Privacy Practices currently in effect.

We will notify affected individuals when required by law if a breach occurs that compromises the privacy or security of protected health information.

We will not use or disclose your health information in a manner inconsistent with this notice unless the use or disclosure is otherwise permitted by law or you authorize it in writing. If you provide written authorization, you may revoke that authorization in writing as permitted by law.

Changes to This Notice

NH Psychiatry may change the terms of this Notice of Privacy Practices. Changes may apply to protected health information already maintained by the practice as well as information received in the future.

When the notice is materially revised, the current version will be available upon request, at the office, and on the NH Psychiatry website.

Privacy Contact

For questions about this Notice of Privacy Practices, requests concerning your privacy rights, or privacy complaints, contact:

Privacy Officer
NH Psychiatry
A division of Granite State Behavioral Health PLLC
119 Main Street
Alton, NH 03809
Mail: PO Box 600, Alton, NH 03809
Phone: 603-515-1700

Complaints to the U.S. Department of Health and Human Services

You may also submit a privacy complaint to the U.S. Department of Health and Human Services, Office for Civil Rights:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775

Online complaint information: HHS Office for Civil Rights complaint portal

NH Psychiatry will not retaliate against you for filing a complaint.