Notice of Privacy Practices
Lifter Zeitlin & Co. Therapy, LLC
Jessica Zeitlin
1111 Lincoln Road, Miami Beach, FL 33139
(305) 332-0999 · jessica@lifterzeitlincotherapy.com
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This practice is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
How we may use and disclose your health information
We may use and disclose your protected health information, without your written authorization, for the following purposes:
Treatment. We may use your information to provide, coordinate, or manage your care, including consulting with or referring you to other providers involved in your treatment.
Payment. We may use and disclose your information to obtain payment for services — for example, to bill you or, if applicable, to submit claims to your insurance and provide information they require to process payment.
Health care operations. We may use your information for activities necessary to run the practice, such as quality review, scheduling, and administrative functions.
Uses and disclosures that require your written authorization
Most uses and disclosures of psychotherapy notes, uses for marketing purposes, and disclosures that constitute a sale of your information require your written authorization. Any other uses and disclosures 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 we have already acted in reliance on it.
Uses and disclosures that may be made without your authorization or opportunity to object
We may use or disclose your information without authorization in limited circumstances permitted or required by law, including:
• When required by federal, state, or local law.
• To prevent or lessen a serious and imminent threat to the health or safety of you or others.
• To report suspected abuse, neglect, or domestic violence, as required or permitted by law (including Florida mandatory reporting requirements).
• For certain public health activities, health oversight activities, judicial and administrative proceedings, law enforcement purposes, and to coroners or medical examiners, as permitted by law.
• For specialized government functions and workers’ compensation, as permitted by law.
Your rights regarding your health information
You have the right to:
Request restrictions on certain uses and disclosures of your information. We are not required to agree to a requested restriction except in limited circumstances (for example, where you have paid out of pocket in full for a service and ask us not to disclose that information to your health plan).
Request confidential communications — for example, that we contact you only at a certain phone number or address.
Inspect and copy your health information, with limited exceptions, including the right to receive an electronic copy where applicable.
Request an amendment to your information if you believe it is incorrect or incomplete.
Receive an accounting of certain disclosures we have made of your information.
Receive a paper copy of this Notice upon request, even if you agreed to receive it electronically.
Be notified if a breach of your unsecured protected health information occurs.
To exercise any of these rights, please submit your request in writing to the contact information above.
Our duties
We are required by law to maintain the privacy of your protected health information, provide you with this Notice, and abide by its terms. We reserve the right to change this Notice and to make the revised Notice effective for information we already have as well as information we receive in the future. Any revised Notice will be posted in our office and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the practice using the contact information above, or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
To file a complaint with HHS, visit www.hhs.gov/ocr/privacy/hipaa/complaints/ or call 1-877-696-6775.
Contact
If you have any questions about this Notice or your privacy rights, please contact:
Lifter Zeitlin & Co. Therapy, LLC
1111 Lincoln Road, Miami Beach, FL 33139
(305) 332-0999 · jessica@lifterzeitlincotherapy.com
This Notice is provided for general informational purposes and reflects standard HIPAA privacy practice requirements. It should be reviewed by a qualified healthcare attorney or your professional liability carrier before use to confirm it fits your specific practice and complies with current federal and Florida law.