Effective Date: November 6, 2026

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Calm Horizon NP in Psychiatry PLLC is committed to protecting the privacy and confidentiality of your Protected Health Information (PHI).

We are required by federal and applicable New York State law to maintain the privacy of your health information, provide you with this notice of our legal duties and privacy practices, and follow the terms of the Notice of Privacy Practices currently in effect.

This notice explains your rights, our responsibilities, and the circumstances under which your health information may be used or disclosed.

Scope of Services

Calm Horizon NP in Psychiatry PLLC provides psychiatric and mental health services exclusively to adults ages 18 and older. This notice applies to Protected Health Information created, received, or maintained in connection with healthcare services provided by our practice.

The privacy rights described in this notice also apply to legally authorized personal representatives when recognized under applicable federal and New York State law.

1. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding the health information we maintain about you.

A. Right to Access Your Medical Records

You have the right to inspect and obtain a copy of your medical records and other Protected Health Information maintained in our designated record sets, subject to applicable legal exceptions.

You may request your records in paper or electronic format, where available. You may also request that we send a copy of your records directly to another person or healthcare provider.

New York State Access Requirements

Under New York Public Health Law Section 18, when applicable, a written request generally entitles you to an opportunity to inspect covered patient information within 10 days after we receive your request.

If you request copies, we will provide them within a reasonable time in accordance with applicable New York State law. Applicable fees may be charged as permitted by law. Certain exceptions and fee limitations may apply.

You will not be denied access solely because you cannot afford permitted copying or inspection charges.

If we deny access to records covered by New York Public Health Law Section 18, you may have the right to appeal the denial through the appropriate Medical Record Access Review Committee. We will provide information about applicable appeal rights and procedures when required.

Federal HIPAA Requirements

Under HIPAA, we generally must act on your access request within 30 calendar days after receiving it.

If additional time is legally necessary, we may take one additional 30-day extension. We will provide written notice explaining the reason for the delay and the expected completion date within the original 30-day period.

We may deny access only when permitted by law. When applicable, you may request a review of certain access denials by a qualified licensed healthcare professional who was not involved in the original denial.

Certain separately maintained psychotherapy notes and other legally excluded information are not subject to the ordinary HIPAA right of access.

B. Right to Request Amendments

If you believe that information in your medical record is incorrect or incomplete, you may request that we amend or correct it.

Your request should explain why you believe the information needs to be corrected.

We generally must act on your request within 60 days. If additional time is needed, we may take one additional 30-day extension by providing written notice explaining the delay.

We may deny your request in certain circumstances permitted by law, such as when the information was not created by our practice, is not part of the records maintained by us, or is already accurate and complete.

If we deny your request, we will explain the reason in writing and inform you of your right to submit a written statement of disagreement.

C. Right to Request Confidential Communications

You may request that we communicate with you through a specific method or at a particular location.

For example, you may request that we:

  • Contact you using a particular telephone number.
  • Send correspondence to a different mailing address.
  • Contact you through a specific communication method.
  • Avoid leaving voicemail messages or sending certain communications to shared devices.

We will accommodate reasonable requests as required by law. You do not need to provide a reason for requesting confidential communications if you clearly explain that ordinary communication could endanger you.

D. Right to Request Restrictions

You may request that we limit how we use or disclose your health information for treatment, payment, or healthcare operations.

We are not required to agree to every restriction request.

However, if you pay for a healthcare service or item entirely out of pocket and request that we not disclose information about that service to your health insurer for payment or healthcare operations purposes, we are generally required to honor that request, unless disclosure is otherwise required by law.

If we agree to an additional restriction, we will follow that restriction except when disclosure is necessary for emergency treatment or otherwise permitted by applicable law.

E. Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your health information made by our practice during the applicable six-year period before the date of your request.

This accounting generally does not include disclosures made for:

  • Treatment, payment, or healthcare operations.
  • Disclosures made directly to you.
  • Disclosures made with your written authorization.
  • Certain other disclosures excluded by law.

Your request should specify the period for which you would like the accounting.

We will provide the accounting in accordance with applicable HIPAA requirements and any additional requirements that apply under federal or New York State law.

F. Right to Receive a Copy of This Notice

You may request a paper or electronic copy of this Notice of Privacy Practices at any time.

You are entitled to receive a copy even if you previously agreed to receive it electronically.

You may also request a copy by contacting our practice using the information provided at the end of this notice.

G. Right to Choose Someone to Act for You

If you have legally authorized someone to act on your behalf, such as a healthcare representative, guardian, or person holding a valid healthcare power of attorney, that individual may exercise certain privacy rights on your behalf.

We will verify the individual’s legal authority before providing access to your information or accepting requests on your behalf, as required by applicable law.

H. Right to File a Privacy Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint with our practice or with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).

You may also have the right to file a complaint concerning violations involving records protected under 42 CFR Part 2, where applicable.

We will not retaliate against you for filing a complaint, exercising your privacy rights, or raising a concern about how your health information is handled.

I. Right to Receive Breach Notifications

You have the right to receive notification when a breach of your unsecured Protected Health Information requires notification under applicable law.

If a reportable breach occurs, we will notify affected individuals without unreasonable delay and no later than 60 calendar days after discovery, as required by federal law.

The notification will generally explain:

  • What happened and when the breach occurred or was discovered.
  • The types of information involved.
  • Steps you can take to protect yourself.
  • What our practice is doing to investigate, address, and prevent further incidents.
  • How you can contact us for additional information.

Additional notifications may be required to the U.S. Department of Health and Human Services and, in certain circumstances, the media.

2. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your Protected Health Information for certain healthcare-related purposes without obtaining your separate written authorization, as permitted or required by law.

A. Treatment

We may use and disclose your health information to provide, coordinate, and manage your psychiatric and mental healthcare.

For example:

  • Reviewing your medical and psychiatric history.
  • Documenting evaluations and treatment plans.
  • Coordinating care with other healthcare professionals involved in your treatment.
  • Discussing medications and treatment options.
  • Providing appropriate follow-up care.

B. Payment

We may use and disclose your health information to obtain payment for healthcare services.

Examples include:

  • Processing insurance claims.
  • Verifying insurance eligibility and benefits.
  • Obtaining payment from insurance providers.
  • Billing and collecting payment for services.
  • Responding to payment-related inquiries.

C. Healthcare Operations

We may use and disclose health information to support the administrative and operational activities of our practice.

Examples include:

  • Quality assessment and improvement.
  • Practice administration.
  • Auditing and compliance activities.
  • Staff training and professional oversight.
  • Business planning and operational management.
  • Reviewing and improving healthcare services.

D. Business Associates

We may share Protected Health Information with service providers, known as Business Associates, who perform services on behalf of our practice and require access to this information to perform their work.

These may include providers involved in:

  • Electronic health record management.
  • Medical billing and payment processing.
  • Secure healthcare communication.
  • Information technology and data storage.
  • Administrative and operational support.

Business Associates are required to protect the information they receive and comply with applicable HIPAA requirements under appropriate contractual agreements.

E. Appointment Reminders and Healthcare Communications

We may use your contact information to send appointment reminders, scheduling updates, treatment-related communications, or other healthcare-related notifications.

We will make reasonable efforts to respect your communication preferences and confidentiality requests.

F. Individuals Involved in Your Care

When permitted by law, we may share relevant health information with family members, caregivers, or other individuals involved in your care or payment for your care.

Where required, we will give you an opportunity to agree or object before making these disclosures.

If you are unable to express your preference due to an emergency or other circumstances recognized by law, we may disclose limited information when appropriate and in your best interest.

G. Public Health and Safety

We may disclose health information when permitted or required by law for public health and safety purposes.

Examples include:

  • Reporting certain diseases or health conditions.
  • Preventing or controlling serious threats to public health or safety.
  • Reporting suspected abuse, neglect, or domestic violence when legally required or permitted.
  • Preventing or reducing a serious and imminent threat to an individual’s health or safety.

H. Legal and Regulatory Requirements

We may disclose your health information when required by federal, state, or local law.

This may include responding to valid court orders, lawful government requests, regulatory investigations, and other legal processes permitted under applicable privacy laws.

Disclosures involving mental health records, substance use disorder records, or other specially protected health information will be made only when permitted or required by applicable federal and New York State law. Additional authorization, court-order requirements, or other legal safeguards may apply.

I. Healthcare Oversight Activities

We may disclose information to authorized government agencies for activities involving healthcare oversight, licensing, inspections, audits, investigations, and regulatory compliance, as permitted by law.

J. Lawsuits and Legal Proceedings

We may disclose health information in response to court or administrative orders and other lawful legal processes, subject to applicable privacy protections and restrictions.

Disclosures involving specially protected mental health or substance use disorder records will be subject to any additional legal requirements that apply.

K. Other Permitted Disclosures

We may disclose health information when permitted by law for purposes such as workers’ compensation, certain law enforcement activities, medical examiner or coroner functions, organ and tissue donation, and certain national security or governmental activities.

Any such disclosure will be limited to the information and circumstances permitted by applicable law, including additional protections that may apply to specially protected records.

3. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Certain uses and disclosures of your health information require your written authorization.

A. Marketing

We will not use or disclose your Protected Health Information for marketing purposes requiring authorization without obtaining your written permission.

B. Sale of Protected Health Information

We will not sell your Protected Health Information without your written authorization, except where otherwise permitted by law.

C. Psychotherapy Notes

Psychotherapy notes receive special protection under HIPAA.

Psychotherapy notes generally refer to notes recorded by a mental health professional that document or analyze the contents of conversations during private, group, joint, or family counseling sessions and are maintained separately from the individual’s general medical record.

These notes are distinct from ordinary clinical documentation.

Psychotherapy notes do not include:

  • Medication prescriptions and monitoring.
  • Counseling session start and stop times.
  • The types and frequency of treatment provided.
  • Results of clinical tests.
  • Summaries of diagnoses, symptoms, functional status, treatment plans, prognosis, or progress.

Ordinary psychiatric progress notes and clinical documentation maintained as part of a patient’s medical record are not automatically considered separately maintained psychotherapy notes.

For example, routine clinical documentation of supportive psychotherapy provided as part of psychiatric appointments, including treatment interventions, symptoms, assessments, and progress, is generally part of the regular clinical record rather than separately maintained psychotherapy notes.

Where applicable, we will obtain your written authorization before using or disclosing separately maintained psychotherapy notes, except in limited circumstances specifically permitted by law.

D. Other Uses and Disclosures

Any use or disclosure of your Protected Health Information not described in this notice will require your written authorization unless otherwise permitted or required by law.

You may revoke a written authorization at any time by submitting a written request to our practice.

Revocation will not affect actions already taken in reliance on your authorization.

4. ADDITIONAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS

Certain substance use disorder (SUD) treatment records may receive additional confidentiality protections under federal law, including 42 CFR Part 2.

These protections apply to records covered by Part 2, including records created, received, or maintained by federally assisted substance use disorder programs and other entities subject to these requirements. Part 2 does not automatically apply to every healthcare provider who treats a person with a substance use disorder.

If our practice creates, receives, maintains, or handles records subject to Part 2, we will follow the applicable federal confidentiality protections.

A. Consent for Use and Disclosure

Part 2 generally requires patient consent for uses and disclosures of protected SUD records, subject to specific exceptions permitted by law.

A patient may provide a single consent for future uses and disclosures of Part 2 records for treatment, payment, and healthcare operations, when permitted under the applicable requirements.

When Part 2 records are disclosed to a HIPAA covered entity or Business Associate under an appropriate consent, the recipient may generally redisclose those records in accordance with HIPAA requirements, subject to applicable Part 2 restrictions.

B. Restrictions on Legal Proceedings

Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against a patient without the patient’s specific written consent or an appropriate court order that satisfies applicable Part 2 requirements.

A general consent for treatment, payment, or healthcare operations does not authorize the use of Part 2 records in proceedings against the patient.

C. Notice Regarding Redisclosure of Substance Use Disorder Records

Records protected under 42 CFR Part 2 may not be used or disclosed in a manner prohibited by applicable federal law.

When Part 2 records are disclosed pursuant to a valid consent, recipients must be informed of the applicable federal restrictions on further use and disclosure.

A general consent for treatment, payment, and healthcare operations does not authorize the use or disclosure of Part 2 records in proceedings against a patient.

D. SUD Counseling Notes

Separately maintained SUD counseling notes receive additional protection under Part 2.

These notes generally require specific written consent for use or disclosure, except where an applicable legal exception permits otherwise.

They are distinct from ordinary SUD treatment and medical records.

E. Breach Notification

If a breach involving unsecured Part 2 records occurs and notification is required, we will follow applicable federal breach notification requirements.

F. Patient Rights and Complaints

Where Part 2 applies, individuals have rights regarding records protected under 42 CFR Part 2, including rights to receive information about permitted uses and disclosures, request restrictions where available, receive an accounting of certain disclosures, and file complaints concerning violations of applicable federal confidentiality requirements.

Individuals may submit applicable complaints to the U.S. Department of Health and Human Services, Office for Civil Rights, in accordance with applicable federal procedures.

We will not retaliate against individuals for exercising their rights or filing a privacy complaint.

5. OUR RESPONSIBILITIES TO PROTECT YOUR INFORMATION

Calm Horizon NP in Psychiatry PLLC is required by law to:

  • Maintain the privacy and security of your Protected Health Information.
  • Provide you with this notice describing our legal duties and privacy practices.
  • Follow the terms of the Notice of Privacy Practices currently in effect.
  • Notify you following a breach of unsecured Protected Health Information when notification is required by law.
  • Use and disclose your information only as permitted or required by applicable law.
  • Require appropriate safeguards from Business Associates who handle Protected Health Information on our behalf.

We will not use or disclose your health information for purposes not described in this notice without your written authorization, except when permitted or required by law.

We reserve the right to revise this notice and our privacy practices as permitted by law.

6. TELEHEALTH AND ELECTRONIC COMMUNICATIONS

Our practice provides psychiatric services through telehealth.

During the delivery of telehealth services, your health information may be created, received, stored, or transmitted electronically through healthcare platforms and communication systems used by our practice.

We take reasonable steps to protect the confidentiality and security of electronic health information.

Where applicable, third-party service providers that handle Protected Health Information on our behalf must comply with appropriate contractual and legal privacy and security requirements.

Please understand that electronic communication involves certain privacy and security risks. We encourage patients to use designated secure communication channels for sensitive healthcare information.

7. NEW YORK STATE PRIVACY PROTECTIONS

In addition to federal HIPAA requirements, our practice follows applicable New York State privacy and confidentiality laws.

New York Public Health Law Section 18 provides certain rights concerning access to patient information for records and providers covered by that law. These rights may include the opportunity to inspect covered records and obtain copies, subject to applicable requirements and exceptions.

New York State law may provide additional confidentiality protections for certain mental health records and other sensitive health information. Access to and disclosure of these records may be subject to specific statutory requirements, exceptions, and authorization procedures.

Where applicable to our practice and the records involved, we will follow additional protections under New York law, including requirements governing access to and disclosure of confidential mental health information.

Where federal and state laws impose different requirements, our practice will follow the applicable legal requirements, including any law that provides greater privacy protection.

8. CHANGES TO THIS NOTICE

We reserve the right to change this Notice of Privacy Practices and make revised provisions applicable to all Protected Health Information maintained by our practice, as permitted by law.

If we make a material change to our privacy practices, we will update this notice accordingly.

The revised notice will be made available on our website and upon request.

You may request a current copy of this notice at any time.

9. HOW TO EXERCISE YOUR RIGHTS OR FILE A PRIVACY COMPLAINT

If you would like to:

  • Request access to your medical records.
  • Request corrections to your health information.
  • Request confidential communications.
  • Request restrictions on certain uses or disclosures.
  • Request an accounting of disclosures.
  • Obtain a copy of this notice.
  • Ask questions about our privacy practices.
  • File a complaint regarding a privacy concern.

Please contact our practice and request assistance from the Privacy Officer.

Practice Name: Calm Horizon NP in Psychiatry PLLC

Privacy Contact: Privacy Officer

Phone: (516) 475-9570

Email: hello@calmhorizonpsych.net

Location: Virtual Telehealth Services – New York

For medical record requests, please identify the records you are requesting and specify whether you wish to inspect the records, receive copies, or have copies sent to another authorized person.

Filing a Complaint with the U.S. Department of Health and Human Services

You also have the right to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).

Office for Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Phone: 1-877-696-6775

Online Complaint Portal:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html

You may submit a complaint without fear of retaliation.

Our practice will not retaliate against you for filing a complaint or exercising your privacy rights.

10. ACKNOWLEDGMENT OF RECEIPT

Our practice may ask you to acknowledge that you have received this Notice of Privacy Practices.

Your acknowledgment confirms receipt of the notice. It does not mean that you have authorized any additional use or disclosure of your Protected Health Information.

If you decline to sign the acknowledgment, our practice will document the circumstances as required by applicable law.

Calm Horizon NP in Psychiatry PLLC

Your privacy, confidentiality, and trust are important to us. We are committed to protecting your health information and respecting your rights as a patient.