PATIENT PRIVACY
Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities.
Effective Date: September 21, 2026
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.
KEEP A COPY
Notice of Privacy Practices
Prefer a printable copy? You may download the current Notice of Privacy Practices for your records.
Effective Date: September 21, 2026
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record.
You can ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to do this. We will provide a copy or summary of your health information as required by law. We may charge a reasonable, cost-based fee when permitted by law.
Ask us to correct your medical record.
You can ask us to correct health information about you that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will explain the reason as required by law.
Request confidential communications.
You can ask us to contact you in a specific way, such as at a particular telephone number, or to send communications to a different location. We will accommodate reasonable requests as required by law.
Ask us to limit what we use or share.
You can ask us not to use or share certain health information for treatment, payment, or health care operations. We are generally not required to agree to every requested restriction.
If you pay for a health care item or service out of pocket in full, you can ask us not to share information about that item or service with your health plan for payment or health care operations. We will honor that request when required by law.
Get a list of certain disclosures.
You can ask for an accounting of certain disclosures of your health information for the period permitted by law. The accounting will not include every type of disclosure, including certain disclosures for treatment, payment, and health care operations.
Get a copy of this Notice.
You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Choose someone to act for you.
If you have given someone medical power of attorney or another person has legal authority to act for you, that person may exercise your rights and make choices about your health information as permitted by law. We may verify that the person has appropriate authority before taking action.
File a complaint if you believe your rights have been violated.
You may complain if you believe we have violated your privacy rights by contacting us using the Privacy Contact information below.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you can tell us your preferences about what we share.
When applicable, you may tell us whether you want us to:
• Share information with family members, close friends, or others involved in your care or payment for your care.
• Share information in a disaster-relief situation.
If you are unable to tell us your preference, such as during an emergency, we may share information when permitted by law if we believe doing so is in your best interest.
Certain uses and disclosures, including certain marketing activities, sale of protected health information, and most uses and disclosures of psychotherapy notes, require your written authorization when required by law.
Fundraising. We may contact you about fundraising as permitted by law, and you may tell us not to contact you again. If we have substance use disorder patient records about you that are subject to 42 CFR Part 2, we will provide the notice and choice required by applicable law before using Part 2 information for fundraising communications.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We typically may use or disclose your health information in the following ways:
Treatment.
We may use your health information and share it with other health care professionals involved in your treatment.
Health Care Operations.
We may use and disclose your health information to operate the practice, coordinate services, improve care, conduct quality activities, and perform other health care operations permitted by law.
Payment.
We may use and disclose your health information for payment-related purposes when applicable, including providing documentation requested in connection with reimbursement or other lawful payment activities.
OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
We may use or disclose your health information when applicable legal requirements are satisfied for purposes such as:
• Public health and safety activities
• Reporting suspected abuse, neglect, or domestic violence when authorized or required by law
• Health oversight activities
• Compliance with applicable laws
• Certain judicial or administrative proceedings
• Certain law-enforcement purposes
• Workers' compensation and similar programs
• Coroners, medical examiners, or funeral directors as permitted by law
• Organ and tissue donation requests, when applicable
• Research when applicable legal requirements have been satisfied
• Preventing or reducing a serious and imminent threat to health or safety when permitted by law
We must meet applicable legal requirements before using or disclosing your information for these purposes.
SUBSTANCE USE DISORDER RECORDS
To the extent that we have your substance use disorder patient records that are subject to 42 CFR Part 2, additional federal confidentiality protections apply.
We will not use or disclose those Part 2 records for civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by applicable law, including when you provide the required written consent or when disclosure is authorized by an appropriate court order and subpoena.
We will comply with additional requirements applicable to Part 2 records when those requirements apply.
USES REQUIRING YOUR AUTHORIZATION
We will obtain your written authorization for uses or disclosures when authorization is required by law.
Most uses and disclosures of psychotherapy notes, certain uses and disclosures for marketing purposes, and disclosures that constitute a sale of protected health information require written authorization, subject to applicable exceptions.
If you provide authorization, you generally may revoke it in writing at any time, except to the extent we have already relied upon it or as otherwise provided by law.
Other uses and disclosures not described in this Notice will be made only as permitted or required by law or with your written authorization.
OUR RESPONSIBILITIES
We are required by law to maintain the privacy and security of your protected health information.
We will notify affected individuals as required by law if a breach occurs that may have compromised the privacy or security of their protected health information.
We must follow the duties and privacy practices described in the Notice currently in effect.
We will provide you with a copy of this Notice as required by law.
We will not use or disclose your information other than as described in this Notice unless you authorize us in writing or another use or disclosure is permitted or required by law.
MORE PROTECTIVE LAWS
Certain health information may receive additional protection under federal or state law.
When another applicable law provides greater privacy protection than HIPAA, we will follow the more protective requirement when required.
This may include laws governing certain mental health information, substance use disorder treatment information, HIV-related information, or other specially protected health information, when applicable.
CHANGES TO THIS NOTICE
We may change the terms of this Notice, and the revised Notice may apply to health information we already maintain as well as information we receive in the future, as permitted by law.
A current Notice will be available upon request and will be posted on our website.
QUESTIONS OR COMPLAINTS
If you have questions about this Notice, wish to exercise a privacy right, or would like to file a complaint regarding our privacy practices, please contact:
Privacy Contact
Nicola Gagliano, MSN, PMHNP-BC
Nicola Gagliano Psychiatry & Wellness, PLLC
Phone: 954-807-2572
Email: info@nicolagaglianopsychiatry.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you for filing a complaint or exercising your privacy rights.
Effective Date: September 21, 2026