This notice describes how medical information about you may be used and disclosed, how it is safeguarded, and how you can get access to this information. Please review it carefully.
The confidentiality of your personal health information is very important to me. Your health information includes records that I create and obtain when I provide you care, such as a record of your symptoms, examination, test results, diagnoses, treatments, and referrals for further care. It also includes bills, insurance claims, or other payment information that I maintain related to your care.
This notice describes how I handle your health information and your rights regarding this information. I am required by law to:
If you need further information, have a question about this Notice, or want to contact me for any reason regarding the handling of your health information, please contact:
Joseph A. Pereira, MD, Privacy Officer Pereira Psychiatry, PLLC 441 West End Ave Suite 2C, New York NY 10024 Phone (646) 475-7620 · contact@pereirapsychiatry.com
Although under federal law I am permitted to use and disclose personal health information without your consent or authorization for purposes of treatment, payment, and health care operations, under New York State law and regulations, I will not release your personal health information to any third party except in the following circumstances:
With your express consent for treatment and payment. This consent may be in writing, oral, or implied. Examples:
Pursuant to your written authorization for purposes other than treatment or payment. Example: I receive a request for medical information from your potential employer.
As otherwise permitted or required by federal or state law or regulation. Examples: in an emergency situation; for child abuse and neglect reporting and investigation.
For health care operations. In the course of providing treatment to you, I may need to share information with consultants to engage in the operations of my medical office. I will share with my business associates only the minimum amount of personal health information necessary for them to assist me. Examples: for proper operations of my computer systems; to provide medical coverage when I am not available.
In addition to uses and disclosures related to treatment, payment, and health care operations, I may also use and disclose your personal information without your express consent or authorization for the following additional purposes. Not every use or disclosure in this category will be listed. However, additional uses and disclosures may include:
Abuse, Neglect, or Domestic Violence. As required or permitted by law, I may disclose health information about you to a state or federal agency to report suspected abuse, neglect, or domestic violence. If such a report is optional, I will use my professional judgment in deciding whether or not to make such a report. If feasible, I will inform you promptly that I have made such a disclosure.
Appointment Reminders and Other Health Services. I may use or disclose your health information to remind you about appointments or to inform you about treatment alternatives or other health-related benefits and services that may be of interest to you, such as case management or care coordination.
Business Associates. I may share health information about you with business associates who are performing services on my behalf. For example, I may contract with a company to handle billing or provide answering services. My business associates are obligated to safeguard your health information. I will share with them only the minimum amount of health information necessary for their assistance.
Communicable Diseases. To the extent permitted or required by law, I may disclose information to a public health official or a person who may have been exposed to a communicable disease or is otherwise at risk of spreading a disease or condition.
Communications with Family and Friends. I may disclose information about you to a person involved in your care or payment for your care, such as family members, relatives, or close personal friends. Additionally, I may notify a family member, your personal representative, or another person responsible for your care, of your location, general condition, or death. Any such disclosure will be limited to information directly related to the person’s involvement in your care. If you are available, I will provide you an opportunity to object before disclosing such information. If you are unavailable, for example, because you are incapacitated or due to another emergency circumstance, I will use my professional judgment to determine what is in your best interest regarding any such disclosure.
Coroners, Medical Examiners, and Funeral Directors. In the event of your death, I may disclose health information about you to a coroner or medical examiner, for example, to assist in identification or determining cause of death. I may also disclose health information to funeral directors to enable them to carry out their duties.
Disaster Relief. I may disclose health information about you to government entities or private organizations (such as the Red Cross) to assist in disaster relief efforts. If you are available, I will provide you an opportunity to object before disclosing such information. If you are unavailable, for instance, due to incapacitation, I will use my professional judgment to determine what is in your best interest and whether disclosure may be necessary to ensure an adequate response to the emergency circumstances.
Food and Drug Administration (FDA). I may disclose health information about you to the FDA or to an entity regulated by the FDA, for example, to report an adverse event or a defect related to a drug or medical device.
Health Oversight. I may disclose health information about you for oversight activities authorized by federal or state law. For example, this may include auditing, inspection, or investigation related to my provision of health care or to the health care system.
Judicial or Administrative Proceedings. I may disclose health information about you pursuant to a court order in connection with a judicial or administrative proceeding, in accordance with my legal obligations.
Law Enforcement. I may disclose health information about you to a law enforcement official for certain law enforcement purposes without your consent, but only if you are incapacitated or in an emergency situation.
Minors. If you are an un-emancipated minor under New York law, there may be circumstances in which I disclose health information about you to a parent, guardian, or other person acting in loco parentis, in accordance with my legal and ethical responsibilities.
Parents. If you are a parent of an un-emancipated minor and are acting as the minor’s personal representative, I may disclose health information about your child to you under certain circumstances. For example, if I am legally required to obtain your consent as your child’s personal representative for your child to receive care from me, I may disclose health information about your child to you. In some circumstances, I may not disclose health information about an un-emancipated minor to you. For example, if your child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as their personal representative, I may not disclose health information about your child to you without your child’s written authorization.
Personal Representative. If you are an adult or emancipated minor, I may disclose health information about you to a personal representative authorized to act on your behalf in making decisions about your health care.
Public Health Activities. As required or permitted by law, I may disclose health information about you to a public health authority, for example, to report disease, injury, or vital events such as death.
Public Safety. Consistent with my legal and ethical obligations, I may disclose health information about you based on a good faith determination that such disclosure is necessary to prevent a serious and imminent threat to yourself, to identified individuals, or to the public, or in an emergency situation.
Required By Law. I may disclose health information about you as required by federal, state, or other applicable law.
Specialized Government Functions. I may disclose health information about you for certain specialized government functions, as authorized by law and depending on the particular circumstances. Examples of specialized government functions include military activities, determination of veterans’ benefits, and emergency situations involving the health, safety, and security of public officials.
Workers’ Compensation. I may disclose health information about you for purposes related to workers’ compensation, as required and authorized by law.
Psychotherapy Notes. I maintain “psychotherapy notes” as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your authorization unless the use or disclosure is:
Marketing Purposes. I will not use or disclose your health information for marketing purposes.
Sale of Health Information. I will not sell your health information.
All Other Uses and Disclosures. Uses and disclosures of your health information not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent that I have already acted in reliance on it.
Under the law, you have certain rights regarding the health information that I collect and maintain about you. These rights include the ability to:
To exercise any of your rights described above, you must submit your request in writing to me. If you have questions about your rights, please speak with me.
If you believe your privacy rights have been violated, you may file a written complaint by mailing or delivering it to me at the address above. You may also file a complaint with the Secretary of Health and Human Services (HHS) by writing to:
Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, Washington, D.C. 20201
Or by calling 1-800-368-1019, or online at www.hhs.gov/ocr/complaints.
I cannot, and will not, make you waive your right to file a complaint with HHS as a condition of receiving care from me, nor will I penalize you for filing a complaint with HHS.
I reserve the right to amend the terms of this Notice. If this Notice is revised, the amended terms shall apply to all health information that I maintain, including information about you collected or obtained before the effective date of the revised Notice.
If I revise or update this Notice with a material change, I will re-distribute the updated Notice to you. For non-material revisions or updates, I will provide the new Notice to all new patients at their first date of service and to all current patients upon request.
This Notice takes effect on November 1, 2026. It replaces the Notice dated April 15, 2025.