Notice of Privacy Practices

NOTICE OF PSYCHOLOGISTS’ POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION

THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. HEALTH CARE PROVIDERS ARE REQUIRED BY THE HEALTH INSURANCE PORTABILITY AND CONFIDENTIALITY ACT (HIPAA) TO ADVISE THEIR PATIENTS OF THEIR PRIVACY RIGHTS IN WRITING.

Claire Golden, Ph.D., PLLC is referenced in this document as “Grove Psychology”.

“You” refers to the client/patient or the client’s/patient’s parent(s) or guardian(s)

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

Grove Psychology may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:

“PHI” refers to information in your health record that could identify you.

“Treatment, Payment and Health Care Operations”

Treatment is when Grove Psychology provides, coordinates, or manages your health care and other services related to your health care. An example of treatment would be when Grove Psychology consults with another care provider such as your family physician or another psychologist.
Payment is when Grove Psychology provides reimbursement for your healthcare. Examples of payment are when Grove Psychology discloses your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
Health Care Operations are activities that relate to the performance and operation of Grove Psychology. Examples of heath care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

“Use” applies only to activities within Grove Psychology, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

“Disclosure” applies to activities outside of Grove Psychology, such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

Grove Psychology may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is permission above and beyond the general consent that permits only specific disclosures. In those instances when Grove Psychology is asked for information for purposes outside of treatment, payment, and health care operations, Grove Psychology will obtain an authorization from you before releasing this information. Grove Psychology will also need to obtain an authorization from you before releasing this information. Grove Psychology will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes Grove Psychology has made about our conversation during a private individual, group, joint, or family counseling session, which I have kept separate from the rest of your medical record. These notes are given a greater degree of protection than PHI. It is Grove Psychology’s policy not to keep separate psychotherapy notes. All documentation kept are a part of your clinical chart.

Grove Psychology will also obtain an authorization from you before using or disclosing PHI in a way that has not been described in this notice. Grove Psychology will not use your PHI for marketing or sales purposes under any conditions.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided revocation is in writing. You may not revoke an authorization to the extent that (1) Grove Psychology has relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

Grove Psychology may use or disclose your PHI without your consent or authorization in the following circumstances:

Child Abuse: If Grove Psychology has reasonable cause to believe that a minor child is suffering physical or emotional injury resulting from abuse inflicted upon him or her which causes harm or substantial risk of harm to the child’s health or welfare (including sexual abuse), or from neglect, including malnutrition, she must immediately report such a condition to the New York City Administration for Children’s Services (ACS).

Health Oversight: If there is an inquiry or complaint about Grove Psychology’s professional conduct to the New York State Board for Psychology, she must furnish to the New York Commissioner of Education, your confidential mental health records relevant to this inquiry.

Judicial or Administrative Proceedings: If you are involved in a court proceeding, a request is made for information about the professional services that Grove Psychology has provided you and/or the records thereof, such information is privileged under state law, and she must not release this information without your written authorization, or a court order. This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. Grove Psychology must inform you in advance if this is the case.

Serious Threat to Health or Safety: Grove Psychology may disclose your confidential information to protect you or others from a serious threat of harm.

Worker’s Compensation: If you file a worker’s compensation claim, and Grove Psychology is treating you for the issues involved with that complaint, then she must furnish to the chairman of the Worker’s Compensation Board records which contain information regarding your psychological condition and treatment.

IV. Notice on the Use of Generative AI

Generative AI will be used solely to summarize your mental health data, such as medical and mental health history, behavioral observations, existing medical records, and assessment results, to provide a clear overview for your mental healthcare provider. The AI’s role is limited to data summarization or aggregation and will not include making any diagnostic decisions or clinical judgments. Grove Psychology will use these summaries to aid in reviewing your case but will retain full responsibility for all diagnostic and treatment decisions.

Your participation in using generative AI for data summarization is voluntary. You may withdraw your consent at any time without affecting your medical care. Grove Psychology will oversee all aspects of your treatment, ensuring that AI-generated summaries are used appropriately and do not replace professional psychological judgment.

V. Patient’s Rights and Psychologist’s Duties

Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, Grove Psychology is not required to agree to any restriction you request.

Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. For example, you may not want a family member to know that you are seeing me. Upon request, Grove Psychology will send correspondence to another address.

Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in Grove Psychology’s mental health and billing records used to make decisions about your for as long as the PHI is maintained in the record. Grove Psychology may deny your access to PHI under certain circumstances, but, in some cases, you may have this decision reviewed. On your request, Grove Psychology will discuss with you the details of the request and denial process.

Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Grove Psychology may deny your request. On your request, Grove Psychology will discuss with you the details of the amendment process.

Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, Grove Psychology will discuss with you the details of the accounting process.

Right to a Paper Copy – You have the right to obtain a paper copy of the notice from Grove Psychology upon request, even if you have agreed to receive the notice electronically.

Psychologist’s Duties: Grove Psychology is required by law to maintain the privacy of PHI and to provide you with a notice of her legal duties and privacy practices with respect to PHI. Grove Psychology reserves the right to change the privacy policies and practices described in this notice. Unless Grove Psychology notifies you of such changes, however, she is required to abide by the terms currently in effect. If Grove Psychology revises her policies and procedures, she will mail the revised Notice to you, as well as make it available in her office.

VI. Questions and Complaints

If you have questions about this notice, disagree with a decision Grove Psychology makes about access to your records, believe that your privacy rights have been violated, or have other concerns about your privacy rights, you may send a written complaint to Claire Golden, PhD, at 300 Cadman Plz W Fl 12 Brooklyn New York 11201-3226 or email to claire@grovepsychology.care.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The person listed above can provide you with the appropriate address upon request.

You have specific rights under the Privacy Rule. Grove Psychology will not retaliate against you for exercising your right to file a complaint.

VII. Effective Date, Restrictions, and Changes to Privacy Policy