Notice of Privacy Practices

Jonathan Keigher, Ph.D.

In order to provide you care, Jonathan Keigher, Ph.D. (your “Provider”) must collect, create, and maintain health information about you, which includes any individually identifiable information obtained from you or others that relates to your past, present, or future physical or mental health, the health care you have received, or payment for your health care. Your Provider is required by law to maintain the privacy of this information. This Notice of Privacy Practices (this “Notice”) describes how your health information may be used and disclosed and explains certain rights you have regarding this information. Your Provider is required by law to provide you with this Notice and will abide by the terms of the Notice currently in effect.

How Your Provider Uses and Discloses Your Health Information

Your Provider protects your health information from inappropriate use and disclosure and will use and disclose your health information only for the purposes described below.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

Your Provider may use and disclose your protected health information in order to provide your treatment, obtain payment for services provided to you, and conduct health care operations, as described below.

• Treatment and Care Management. We may use and disclose health information about you to provide treatment and to coordinate and manage your care with other health care providers.
• Payment. We may use and disclose health information about you for our own payment purposes and to assist in the payment activities of other health care providers. Our payment activities include, without limitation, determining your eligibility for benefits and obtaining payment from insurers that may be responsible for providing coverage to you, including federal and state entities.
• Health Care Operations. We may use and disclose health information about you to support health care functions related to treatment and payment, which include, without limitation, care management, quality improvement activities, evaluating our own performance, and resolving any complaints or grievances you may have. We may also use and disclose your health information to assist other health care providers in performing their health care operations.

Uses and Disclosures That May Be Made Without Your Authorization

We may use and disclose your health information without your specific written authorization for the following purposes:

• As required by law. We may use and disclose your health information as required by state, federal, and local law.
• Public health activities. We may disclose your health information to public authorities or other agencies conducting public health activities, such as preventing or controlling disease, injury, or disability; reporting births, deaths, child abuse or neglect, or domestic violence; reporting potential problems with products regulated by the Food and Drug Administration; or reporting communicable diseases.
• Victims of abuse, neglect, or domestic violence. We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect, or domestic violence, and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we make such a disclosure unless we believe that doing so would place you or another person at risk of serious harm.
• Health oversight activities. We may disclose your health information to federal or state health oversight agencies for activities authorized by law, such as audits, investigations, inspections, and licensing surveys.
• Judicial and administrative proceedings. We may disclose your health information in the course of a judicial or administrative proceeding in response to an appropriate order of a court or administrative body.
• Law enforcement purposes. We may disclose your health information to a law enforcement official to respond to a court order, warrant, subpoena, or similar process; to help identify or locate a suspect or missing person; to provide information about a victim of a crime; to report a death that may be the result of criminal conduct; to report criminal conduct on our premises; or, in emergency situations, to report a crime, its location, the victims, or the identity, location, or description of the person who committed it.
• Deceased individuals. We may disclose your health information to a coroner, medical examiner, or funeral director as necessary and as authorized by law.
• Organ or tissue donation. We may disclose your health information to organ procurement organizations and similar entities.
• Research. We may use or disclose your health information for research purposes only with your written authorization, except where an Institutional Review Board or privacy board has reviewed the research proposal, established protocols to protect your privacy, and approved a waiver of the authorization requirement as permitted by law.
• To avert a serious threat to health or safety. We may use or disclose your health information when necessary to prevent or lessen a serious threat to the health or safety of you or the general public. We may also disclose your health information to public or private disaster relief organizations, such as the Red Cross.
• Specialized government functions. We may use or disclose your health information for certain government functions. If you are a member of the armed forces, we may disclose your health information to appropriate military authorities as deemed necessary. We may also disclose your health information to federal officials for lawful intelligence or national security activities as authorized by law.
• Workers’ compensation. We may use or disclose your health information as permitted by the laws governing workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
• Individuals involved in your care. We may disclose your health information to a family member, other relative, or close personal friend assisting you in receiving health care. If you are available, we will give you an opportunity to object, and we will not make these disclosures if you object. If you are not available, we will use our professional judgment to determine whether the disclosure is in your best interest based on the circumstances.
• Appointment reminders and health-related information. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related services that may be of interest to you.
• Incidental uses and disclosures. Incidental uses and disclosures of your health information sometimes occur and are not considered a violation of your rights. These are by-products of otherwise permitted uses or disclosures, are limited in nature, and cannot reasonably be prevented.

Special Treatment of Certain Records

Certain categories of health information receive special confidentiality protection under state and/or federal law that is more restrictive than the protections described above. These may include HIV-related information, genetic testing information, alcohol and substance use disorder treatment records, psychotherapy notes, and other specially protected information. Any use or disclosure of these types of records will be made only in accordance with the additional protections required by applicable law.

Uses and Disclosures That Require Your Written Authorization

Other uses and disclosures of your health information will be made only with your written authorization, including, without limitation: (a) most uses and disclosures of psychotherapy notes; (b) uses and disclosures for marketing purposes; and (c) disclosures that constitute a sale of health information under the Privacy Rule. Your Provider will not use or disclose your health information for any purpose not described in this Notice without your written authorization or the authorization of your legally appointed representative. If you give us your authorization, you may revoke it at any time in writing, after which we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have already relied on your authorization.

Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

• Right to Inspect or Get a Copy of Your Record. You have the right to inspect and request a copy of the health information we maintain about you. Your request should describe the information you want to review and the format in which you wish to receive it. We may charge a reasonable, cost-based fee for copies, not to exceed the maximum permitted by New York law (currently $0.75 per page for paper copies, plus postage). You will not be denied access solely because of an inability to pay, and we will not charge you for copies of records you request to support an application, claim, or appeal for a government benefit or program. We may deny access in certain limited circumstances; where the law provides, you may have the right to have certain denials reviewed.
• Right to Request Changes to Your Record. You have the right to request that we amend health information we maintain about you if you believe it is incorrect or incomplete and you provide a reason supporting your request. We may deny your request in certain cases. If we deny your request, we will notify you in writing and inform you how to have your statement of disagreement included in our records.
• Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures we have made of your health information. The list will not include disclosures made for treatment, payment, or health care operations, disclosures you authorized in writing, or certain other disclosures excluded by law. Your request should specify the time period, which may not exceed six years. The first list you request in any 12-month period will be provided at no cost; we may charge a reasonable, cost-based fee for additional lists within the same period.
• Right to Request Restrictions. You have the right to request restrictions on how we use and disclose your health information for treatment, payment, and health care operations, or to individuals involved in your care. We are not required to agree to most requested restrictions; however, we must agree to your request to restrict disclosure to your health plan of information about a health care item or service for which you have paid us in full out of pocket, except where the disclosure is otherwise required by law.
• Right to Request Confidential Communications. You have the right to ask us to communicate with you about your health information in a different way or at a different location. Your request should specify how or where you wish to be contacted. We will accommodate reasonable requests.
• Right to Receive Notification of a Breach. You have the right to be notified in the event of a breach of your unsecured health information that requires notification under applicable law.
• Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

How to Exercise Your Rights or Obtain More Information

To make any of the requests described above, or for more information about this Notice or our privacy practices, please contact:

Jonathan Keigher, Ph.D. — Privacy Contact

Telephone: 212-729-1080

Email: jonathankeigherphd@gmail.com

Your Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with your Provider using the contact information above, or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against by your Provider for filing a complaint.

Our Duties and Changes to This Notice

Your Provider is required by law to maintain the privacy of your health information, to provide you with this Notice of our legal duties and privacy practices, to abide by the terms of the Notice currently in effect, and to notify you following a breach of your unsecured health information.

We reserve the right to change the terms of this Notice at any time. If we make a material change, the revised terms will apply to all health information we maintain, whether created or received before or after the effective date of the revised Notice. The current Notice will be posted in our office, and a copy is available to you on request.

Effective Date: February 27, 2022

Last Revised: June 15, 2026