Notice of Privacy Practices
How medical information may be used and disclosed, and how individuals may access it.
Effective date: September 1, 2026
Overview
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who Will Follow This Notice
This Notice of Privacy Practices (hereafter, this “Notice”) addresses the use of your medical information by the practice and your licensed healthcare provider (the “Practice,” “we,” or “us”) and its business associates.
We may use your medical information, also known as protected health information (“PHI”), for treatment, payment, operations, or research purposes as described in this Notice. All employees of the Practice follow these privacy practices. The practitioners on our staff will also follow this Notice when they provide professional services to you on behalf of the Practice.
About This Notice
This Notice will tell you about the ways we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
make sure that medical information that identifies you is kept private
give you this Notice of our legal duties and privacy practices with respect to your medical information
follow the terms of the Notice that is currently in effect; and
notify individuals, either known or reasonably believed to be affected, following a breach of unsecured protected health information
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and give examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one or more of the categories.
For Treatment
We may use medical information about you to provide you with clinical psychology treatment or services. We may disclose medical information about you to healthcare providers including but not limited to physicians, advanced practice registered nurses, psychologists, licensed clinical social workers, , students or other Practice personnel who are involved in your care. Different departments and personnel of the Practice also may share mental health information about you to coordinate the different services you may need, such as prescriptions, lab work. We also may disclose medical information about you to people outside the Practice who may be involved in your medical care. Notwithstanding the foregoing, all such disclosures will be subject to your rights regarding your medical information as specified herein.
For Payment
We may use and disclose medical information about you so that we may bill for treatment and services you receive at the Practice and collect payment from you or another party. We may also disclose information about you to other healthcare facilities for purposes of payment as permitted by law.
For Healthcare Operations
We may use and disclose your medical information, including your mental health information, for operations of the Practice. These uses and disclosures are necessary to run the Practice and make sure that all of our patients receive quality care. For example, we may use your medical information to evaluate the performance of our staff in caring for you or the outcome of your treatment. We may also combine medical information about many patients to decide what additional services the Practice should offer, what services are not needed and whether certain new treatments are effective. We may also combine medical information we have with medical information from other practices to compare our performance and to make improvements in the care and services we offer. We may also disclose information to doctors, nurse practitioners, nurses, technicians, medical students, clinicians and other Practice personnel for educational purposes. We may also disclose information about you to other healthcare facilities as permitted by law.
Appointment Reminders
We may use and disclose medical information to contact you to remind you that you have an appointment for treatment or medical care.
Treatment Alternatives
We may use and disclose medical information to tell you about possible treatment options that may be of interest to you.
Health-Related Benefits and Services
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care
We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family may be notified about your condition, status and location.
As Required by Law
We will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Special Situations
State Law
In certain states, special privacy protections apply to certain information, including genetic, sexually transmitted disease, or mental health information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, and if applicable state laws govern, such information will be further protected pursuant to applicable state law. For further information, please contact us using the contact information listed on the last page of this Notice.
Substance Use Disorder
The confidentiality of alcohol and drug abuse patient records is protected by Federal law and regulations. Generally, a health care provider may not say to a person outside a treatment program that a patient attends a program, or disclose any information identifying a patient as an alcohol or drug abuser unless:
The patient consents in writing
The disclosure is allowed by a court order; or
The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation
Organ and Tissue Donation
If you are an organ or tissue donor, we may release medical information about you to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank.
Military and Veterans
If you are a member of the armed forces of the United States or another country, we may release medical information about you as required by military command authorities.
Workers’ Compensation
We may release medical information about you for workers’ compensation or similar programs.
Public Health Risks
We may disclose medical information about you to authorized public health or government officials for public health activities. These activities generally include the following:
to a person subject to the jurisdiction of the Food and Drug Administration (FDA) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or service
to prevent or control disease, injury or disability
to report disease or injury
to report births and deaths
to report child abuse or neglect
to report reactions to medications and food or problems with products
to notify people of recalls or replacements of products they may be using
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law
Health Oversight Activities
We may disclose medical information about you to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other legal demand by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement
We may release medical information about you if asked to do so by a law enforcement official:
in response to a court order, subpoena, warrant, summons or similar process
to identify or locate a suspect, fugitive, material witness or missing person
about the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement
about a death we believe may be the result of criminal conduct
about criminal conduct at the Practice or by healthcare providers affiliated with the Practice
in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime; and
to authorized federal officials so they may provide protection for the President and other authorized persons or conduct special investigations
Coroners, Medical Examiners and Funeral Directors
We may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information to funeral directors as may be required to carry out their duties.
National Security and Intelligence Activities
We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
To a School
We may disclose information to a school, about an individual who is a student or prospective student of the school, if:
The covered entity obtains and documents the agreement to the disclosure from either:
A parent, guardian, or other person acting in loco parentis of the individual, if the individual is an un-emancipated minor; or
The individual, if the individual is an adult or emancipated minor
Other Uses and Disclosures
Other uses and disclosures not described in this Notice, including all marketing purposes, will be made only with your written authorization. You may revoke such authorization provided under this section at any time, provided that the revocation is in writing, except to the extent that we have taken action(s) in reliance upon your authorization; or if the authorization was obtained as a condition of obtaining insurance coverage.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. This right does not include psychotherapy notes, information compiled for use in a legal proceeding or certain information maintained by laboratories. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer listed at the end of this Notice. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request in writing that the denial be reviewed. To request a review, contact the Privacy Officer. A licensed healthcare professional will conduct the review. We will comply with the outcome of the review.
Right to Amend
If you believe that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is maintained by, or on behalf of, the Practice. To request an amendment to your PHI that you believe is inaccurate or incomplete, your request must be made in writing and submitted to the Privacy Officer for the location at which you were treated, as listed on the last page of this Notice. Your written request must include the reason that you believe your request is necessary to address an inaccurate or incomplete record of information about you. We may deny your request. if you ask us to amend information that:
was not created by us, unless the person or entity that created the information is no longer available to make the amendment
is not part of the medical information kept by or for the Practice
is not part of the information that you would be permitted to inspect and copy; or
is accurate and complete
We will provide you with written notice of action we take in response to your request for an amendment.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of medical information about you. We are not required to account for any disclosures you specifically requested or for disclosures related to treatment, payment or healthcare operations or made pursuant to an authorization signed by you. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer. This contact information is listed at the last page of this Notice. Your request must state a time period, which may not be longer than six years. We will attempt to honor your request. If you request more than one accounting in any 12-month period, we may charge you for our reasonable retrieval, list preparation and mailing costs for the second and subsequent requests. Before we fulfill your request, we will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. Additionally, you may request restrictions on medical information disclosed to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the information pertains solely to a health care item or service for which you, or person other than the health plan on your behalf, has paid us in full. To request a restriction, you must contact the Privacy Officer. This contact information is listed on the last page of this Notice.
We are not required to agree to your request. If we agree to your request, we will comply with your request unless the information is needed to provide emergency treatment to you. You may terminate the restriction at any time. If we terminate the restriction, we will notify you of the termination. We are not able to terminate or refuse your request for restrictions to disclosures to health plans if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the information pertains solely to a health care item or service for which you, or person other than the health plan on your behalf, has paid us in full.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail. To request confidential communications, you must submit a written request to the Privacy Officer. This contact information is listed at the end of this Notice. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will attempt to accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice upon written request to the Practice or at your first treatment encounter with the Practice. You may get an additional copy of this Notice at any time by contacting us. This contact information is listed at the end of this Notice.
Changes to This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information about you that we already have, as well as any information we receive in the future. We will post copies of the current Notice on the Practice’s website. The Notice will indicate the effective date. In addition, each time you register with the Practice for treatment or healthcare services, we will make available copies of the current Notice. Any revisions to our Notice will also be posted on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. To file a complaint with the Practice, please call or write to the Privacy Officer, whose contact information is listed at the end of this Notice. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not described in this Notice or the laws that apply to us will be made only with your written authorization on a Practice authorization form. If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we may continue to use or disclose that information to the extent we have relied on your authorization. You also understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.
Privacy Contact
If you have any questions about this notice, please contact the Privacy Officer at: privacy@braverlyhealth.com.
Phone: 917-960-9608
Braverly Health Inc.
200 Vesey Street, 24th Floor
New York NY 10281