Notice of Privacy Practices

Effective date: [SET AT LAUNCH]

Who follows this notice

This notice is followed by Sigma Psychiatry, a telehealth psychiatry practice. In California, your care is provided by Sigma Psychiatry, A Professional Medical Corporation. In New Jersey, your care is provided by Sigma Psychiatry LLC, with services delivered by Dr. Ramy and by Katherine Halpern, PMHNP-BC. In this notice, "we," "us," and "our" mean the Sigma Psychiatry entity that's providing your care, along with the clinicians and staff who work with us to provide and support that care. This notice applies to the protected health information we create and keep about you as your treating practice.

"Protected health information" means health information that identifies you, or could reasonably be used to identify you, and that relates to your physical or mental health, your care, or payment for your care.

Our telehealth practice and the states we serve

We're a telehealth practice. We deliver care by secure video and other electronic means rather than in a physical office. Because care is delivered electronically, your protected health information is created, transmitted, and stored using electronic systems. We use systems and safeguards designed to protect that information consistent with the law.

We provide care to patients located in California and in New Jersey, through the entities described above. The federal privacy law called HIPAA applies to all of our care. Some state privacy laws can give you additional protections, and where a state law that applies to your care is more protective than HIPAA, we follow the more protective law. Mental health and substance use information often receives extra protection under federal and state law, and we treat that information with that heightened care.

How we may use and disclose your health information

The following describes the ways we may use and disclose your protected health information. Not every use or disclosure will be listed, but every way we're permitted to use or disclose information falls into one of the categories below or is otherwise permitted or required by law.

For treatment. We use your health information to provide and coordinate your psychiatric care. For example, your psychiatrist or nurse practitioner reviews your history and current symptoms to make a diagnosis and a treatment plan, and we may share information with another provider involved in your care, such as your primary care physician or a therapist, so that your care is coordinated and safe. For minor patients, we use health information to involve a parent or guardian in care as appropriate and as permitted by law.

For payment. We use and disclose your health information to bill and collect payment for the care we provide. In California, where care is private-pay, this may include providing you with a receipt, a statement, or a good faith estimate. In New Jersey, where we work with health insurance, this may include sending claims and necessary clinical information to your health plan, confirming benefits and eligibility, and obtaining authorization for services.

For health care operations. We use and disclose your health information to run our practice well and keep the quality of care high. For example, we may use information to review and improve the care we provide, to train or evaluate our clinicians and staff, to handle scheduling and recordkeeping, and to work with our business associates as described below.

Business associates. We may share your health information with outside companies that perform services for us, such as a billing service, an electronic health record or telehealth platform, or an information-technology provider. We require each of these business associates, by written contract, to protect your health information and to use it only for the services they perform for us.

Appointment reminders and communications about your care. We may contact you to remind you of an appointment or to give you information about treatment options or health-related services. If we ever propose to send you marketing communications that require your authorization under the law, we'll obtain your written authorization first.

When the law requires or permits it. We may use or disclose your health information without your authorization when the law requires or specifically permits it, including:

For public health activities, such as reporting certain diseases or reactions to medications, as the law requires
To report suspected abuse, neglect, or domestic violence as required or permitted by law
For health oversight activities authorized by law, such as audits and investigations
In response to a court order, subpoena, or other lawful process, subject to the special protections that apply to mental health and substance use records
To law enforcement in the limited circumstances the law allows
To avert a serious and imminent threat to your health or safety or to the health or safety of others
For workers' compensation, to the extent authorized by and necessary to comply with workers' compensation laws
To coroners, medical examiners, and funeral directors as the law permits
For specialized government functions, such as certain military and national security activities, as the law permits

Uses and disclosures that require your written authorization. Most uses and disclosures of psychotherapy notes, any use or disclosure of your information for marketing that the law treats as marketing, and any sale of your information require your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization. If you give us an authorization, you may revoke it at any time in writing, except to the extent we have already acted in reliance on it.

Persons involved in your care. Unless you object, we may share information directly relevant to a person's involvement in your care, such as a family member or friend you have identified, or in an emergency when sharing is in your best interest.

For minors. When we care for a child or adolescent, a parent or guardian generally has the right to act on the minor's behalf with respect to health information. In some situations, state and federal law limit a parent's access, for example for certain confidential services a minor may consent to on their own. We follow the law of the state where the minor receives care.

Your rights regarding your health information

You have the following rights regarding the protected health information we keep about you. To exercise any of these rights, contact us using the contact information at the end of this notice.

The right to request restrictions. You have the right to request that we limit how we use or disclose your health information for treatment, payment, or health care operations, and to people involved in your care. We aren't required to agree to every requested restriction. However, if you pay for a service or item in full, out of your own pocket, you have the right to ask us not to disclose information about that service or item to your health plan, and we must agree to that request unless the law requires the disclosure.

The right to confidential communications. You have the right to ask that we communicate with you about your health in a certain way or at a certain location. For example, you may ask us to contact you only by a specific phone number or email address. We'll accommodate reasonable requests.

The right to inspect and copy. You have the right to inspect and obtain a copy of your health information that we use to make decisions about your care, including in an electronic form when we keep it electronically. We may charge a reasonable, cost-based fee for copies as the law allows. In limited situations the law lets us deny access, and where the law provides, you may ask for a review of a denial.

The right to amend. If you believe health information we have about you is incorrect or incomplete, you have the right to ask us to amend it. We may deny your request in certain circumstances, and if we do, we'll explain why and tell you how to respond.

The right to an accounting of disclosures. You have the right to request a list of certain disclosures we have made of your health information. This accounting doesn't include disclosures we made for treatment, payment, or health care operations, disclosures we made to you, or certain other disclosures the law excludes. The first accounting in any 12-month period is free, and we'll tell you in advance the cost of any additional request.

The right to a paper copy of this notice. You have the right to a paper copy of this notice at any time, even if you agreed to receive it electronically. Contact us and we'll provide one.

The right to be notified of a breach. You have the right to be notified if there's a breach of your unsecured protected health information.

Our duties

We're required by law to:

Maintain the privacy of your protected health information
Give you this notice of our legal duties and privacy practices regarding your health information
Notify affected individuals following a breach of unsecured protected health information
Abide by the terms of the notice that's 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, including information we created or received before the change. If we make a material change, we'll post the revised notice on our website at sigmapsych.net by the effective date of the change and make the revised notice available to you on request. Because our care is delivered electronically, if your first service from us is delivered electronically, we'll provide this notice to you electronically at the time of that first service.

How to complain

If you believe your privacy rights have been violated, you may file a complaint with us, and you may file a complaint with the federal government. We won't retaliate against you in any way for filing a complaint.

To complain to us, contact:

Dr. Ramy, Privacy Contact
Sigma Psychiatry
Email: RamyMD@sigmapsych.net

To complain to the federal government, contact the U.S. Department of Health and Human Services, Office for Civil Rights:

Online: www.hhs.gov/ocr/complaints/index.html
By mail: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201
By phone: 1-800-368-1019 (TDD: 1-800-537-7697)

Who to contact for more information

If you have any questions about this notice or want more information about our privacy practices, contact Dr. Ramy at RamyMD@sigmapsych.net.