Notice of HIPAA Privacy Practices

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. HIPAA is a federal law that requires us to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy policies with respect to your protected health information. This notice describes how health information may be used and disclosed and how you can get access to this information. We are required by law to abide by the terms of this Notice of Privacy Practices.


Our Pledge Regarding Health Information

At Create Outcomes, we understand that health information about you and your health care is personal. We are strongly committed to protecting health information about you. We create a record of the care and services you receive from this agency. This is to provide you with quality care and to comply with certain legal requirements. Your “Protected Health Information” (PHI) broadly includes any health information, oral, written or recorded, that is created or received by us, other healthcare providers, and health insurance companies or plans, that contains data, such as your name, address, social security or patient identification number, and other information, that could be used to identify you as the individual patient who is associated with that health information.

We are required by law to:

— Make sure that protected health information (“PHI”) that identifies you is kept private.

— Give you this notice of our legal duties and privacy practices with respect to health information.

— Follow the terms of the notice that is currently in effect.

— We can change the terms of this Notice, and such changes will apply to all information about you. The new Notice will be available upon request and on our website at


How We May Use and Disclose Health Information About You

Generally, we may not “use” or “disclose” your PHI without your permission, and must use or disclose your PHI in accordance with the terms of your permission.  “Use” refers generally to activities within our office.  “Disclosure” refers generally to activities involving parties outside of our office. In all cases, we are required to limit such uses or disclosures to the minimal amount of PHI that is reasonably required. 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 of the categories.

The following are the circumstances under which we are permitted or required to use or disclose your PHI without your written authorization in order to provide you with the treatment you require or request, to collect payment for our services, and to conduct other related health care operations as follows:

Treatment Activities Include: (a) use within our office by our professional staff for the provision, coordination, or management of your health care at our office; and (b) our contacting you to provide appointment reminders or information about treatment alternatives or other health-related services that may be of interest to you. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Payment Activities Include: (a) if you initially consent to treatment using the benefits of your contract with your health insurance plan, we will disclose to your health plans or plan administrators, or their appointed agents, PHI for such plans or administrators to determine coverage, for their medical necessity reviews, for their appropriateness of care reviews, for their utilization review activities, and for adjudication of health benefit claims; (b) disclosures for billing for which we may utilize the services of outside billing companies and claims processing companies with which we have Business Associate Agreements that protect the privacy of your PHI; and (c) disclosures to attorneys, courts, collection agencies and consumer reporting agencies, of information as necessary for the collection of our unpaid fees, provided that we notify you in writing prior to our making collection efforts that require disclosure of your PHI.

Healthcare Operations Include: (a) use within our office for training of our professional staff and for internal quality control and auditing functions (b) use within our office for general administrative activities such as filing, typing, etc.; and (c) disclosures to our attorney, accountant, bookkeeper and similar consultants to our healthcare operations, provided that we shall have entered into Business Associate Agreements with such consultants for the protection of your PHI.

Please note that unless you request otherwise, and we agree to your request, we will use or disclose your personal health information for treatment activities, payment activities, and healthcare operations as specified above, without written authorization from you.

Minimum Necessary Rule: We will use or disclose your PHI without your authorization for the above purposes only to the extent necessary, and will release only the minimum necessary amount of PHI to accomplish the purpose.


Certain Uses and Disclosures Require Your Authorization

Except as otherwise permitted or required as described above, we may not use or disclose your PHI without your written authorization. Written authorization is required, among other uses and disclosures, for (1) most uses and disclosures of Psychotherapy Notes, (2) uses and disclosures for marketing purposes, (3) uses and disclosures that involve the sale of PHI and (4) other uses and disclosures not described in this Notice.  Further, we are required to use or disclose your PHI consistent with the terms of your authorization.  You may revoke your authorization to use or disclose any PHI at any time, except to the extent that we have taken action in reliance on such authorization, or, if you provided the authorization as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy. We will not sell your PHI or use your PHI for paid marketing or fundraising purposes without your written authorization; we do not plan to use your PHI in marketing or fundraising.

Psychotherapy Notes: Your therapist will keep “psychotherapy notes”, which are defined as records of communications during individual or family counseling which may be maintained in addition to and separate from medical or healthcare records. Any use or disclosure of such notes requires your Authorization except in limited instances, including: (a) for our use in treating you, for our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy; (b) for our use in defending ourselves in legal proceedings instituted by you; (c) for use by the Secretary of Health and Human Services to investigate our compliance with HIPAA, (d) required by law and the use or disclosure is limited to the requirements of such law, (e) required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes, (f) required by a coroner who is performing duties authorized by law, or required to help avert a serious threat to the health and safety of others. Health insurers may not condition treatment, payment, enrollment, or eligibility for benefits on obtaining authorization to review, or on reviewing, Psychotherapy Notes.

Disclosures to family, friends, or others: We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

Marketing Purposes or Sale of PHI: We will not use or disclose your PHI for marketing purposes. We will not sell your PHI in the regular course of business.


Certain Uses and Disclosures Do Not Require Your Authorization

In limited circumstances, we may use or disclose your PHI without your written authorization and in accord with HIPAA or as required by law.  Examples include:

(a) disclosures regarding reports of child abuse or neglect, including reporting to social service or child protective services agencies;

(b) disclosures to State authorities of imminent risk of danger presented by patients to self or others for the purpose of restricting patient access to firearms;

(c) health oversight activities including audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, or civil, administrative, or criminal proceedings or actions, or other activities necessary for appropriate oversight of government benefit programs;

(d) judicial and administrative proceedings in response to an order of a court or administrative tribunal, or other lawful process;

(e) to the extent necessary to protect you or others from a serious imminent risk of danger presented by you;

(f) for worker’s compensation claims,

(g) as required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulations, including those regarding government programs providing public benefits,

(h) for research projects where your PHI has been de-identified, that is no longer identifies you by name or any distinguishing marks, and cannot be associated with you,

(i) to a public or private entity to assist in disaster relief efforts authorized by law,
(j) to family members, friends and others involved in your care, but only if you are present and give oral permission


You Have the Following Rights with Respect to Your PHI

1. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask your therapist or this organization not to use or disclose certain PHI for treatment, payment, or health care operations purposes. While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your protected healthcare information in violation of such restriction, except in certain emergency situations.   We will not accept a request to restrict uses or disclosures that are otherwise required by law.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: If you have paid for our services in full yourself, out-of-pocket, then we must comply with your request to restrict those disclosures of your PHI that would otherwise be made for payment or healthcare operations, that are unnecessary because of your manner of payment. 

We require that all requests for restrictions be in writing and specify (1) the information to be restricted, (2) the type of restriction being requested, and (3) to whom the limits apply. You must also state a reason for the request.  We will respond in writing to all requests within 30 days or receipt.

3. The Right to Choose How We Send PHI to You: You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests. We must agree to your request if you inform us that certain of means of communicating with you will place you in danger.

4. The Right To Inspect and Copy Your Protected Health Information, Including In Electronic Format: You have the right of access in order to inspect, and to obtain a copy of your PHI, including any PHI maintained in electronic format, except for (a) personal notes and observations of the treating provider, (b) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding, (c) health information maintained by us to the extent to which the provision of access to you is at our discretion, and we exercise our professional judgment to deny you access, and (d) health information maintained by us to the extent to which the provision of access to you would be prohibited by law.  We require written requests for copies of your PHI; they should be sent to our mailing address below. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

5. The Right to Get a List of the Disclosures we Have Made: You have the right to receive a written accounting of all disclosures of your PHI for which you have not provided an authorization that we have made within the six (6) year period immediately preceding the date on which the accounting is requested.  You may request an accounting of such disclosure for a period of time less than six (6) years from the date of the request. We require that you request an accounting in writing on a form that we will provide to you.

The accounting of disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure or, instead of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accountings of disclosures for the following purposes: (a) treatment, payment, and healthcare operations, (b) disclosures pursuant to your authorization, (c) disclosures to you, (d) to other healthcare providers involved in your care, (e) for national security or intelligence purposes, (f) to correctional institutions, and (g) with respect to disclosures occurring prior to 4/14/2003. We reserve the right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law.  We will provide the first accounting to you in any twelve (12) month period without charge, but will impose a reasonable cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period.  All requests for an accounting shall be sent to  our Privacy-Security Officer at the mailing address below.

If we maintain any PHI in electronic form, then you may also request and receive an accounting of any disclosures of your electronic health records made for purposes of treatment, payment and health operations during the prior three (3) year period.  Upon request, one list will be provided for free every twelve (12) months.

6. The Right to Correct or Update Your PHI: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request. If we deny your request, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement disagreeing with the denial, and a description of how you may file a complaint with us and/or the Secretary of the U.S. Department of Health and Human Services (DHHS).  If we accept your request for amendment, we will make reasonable efforts to provide the amendment within a reasonable time to persons identified by you as having received PHI of yours prior to amendment and persons that we know have the PHI that is the subject of the amendment and that may have relied, or could foreseeably rely, on such information to your detriment. All requests for amendments shall be sent to our mailing address below.

7. The Right to Get a Paper or Electronic Copy of this Notice: You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

8. Right To Notification If There Is A Breach of Your Protected Health Information: If there is a breach in our protecting your PHI, we will follow HIPAA guidelines to evaluate the circumstances of the breach, document our investigation, retain copies of the evaluation, and where necessary, report breaches to DHHS.  Where a report is required to DHHS, we will also give you notification of any breach.


Business Associate Rule

Business Associates are entities that in the course of our business with them will obtain access to your PHI.  They may use, transmit, or view your PHI on our behalf.  Business Associates are prohibited from re-disclosing your PHI without your written consent, or unless disclosure is required by law.  We enter into confidentiality agreements with our Business Associates called Business Associate Agreements, and they in turn enter into confidentiality agreements with their subcontractors, if any.



You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated.  Please submit any complaint to us in writing by mail to our Privacy-Security Officer at the mailing address below.  A complaint must name the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Notice of Privacy Practices.  A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred.  You will not be retaliated against for filing any complaint.   To file a complaint with the Secretary of DHHS, write or call:

The US Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201


Ammendments to This Notice of Privacy Practices

We reserve the right to revise or amend this Notice of Privacy Practices at any time.  These revisions or amendments may be made effective for all PHI we maintain even if created or received prior to the effective date of the revision or amendment. Upon your written request, we will provide you with notice of any revisions or amendments to this Notice of Privacy Practices, or changes in the law affecting this Notice of Privacy Practices, by mail or electronically within 60 days of receipt or your request.


Ongoing Access to Notice of Privacy Practices

We will provide you with a copy of the most recent version of this Notice of Privacy Practices at any time upon your written request sent to our mailing address below.  For any other requests or for further information regarding the privacy of your PHI, and for information regarding the filing of a complaint, please contact us at the address, telephone number, or e-mail address listed above.

To Contact Us — This is our contact information referred to above:

Mailing Address:
22 Oakwood Road
Huntington, NY 11743

Telephone: ︎︎︎866-232-7328 
Email: ︎︎︎
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