Notice of privacy practices

The Health Insurance Portability & Accountability Act (HIPAA) of 1996 is a federal program that requires all medical records and other individually identifiable health information, used or disclosed by us in any form (whether electronically, on paper, or orally), to be kept properly confidential. This Act protects your rights to understand and control how your health information is used. HIPAA penalizes covered entities that misuse personal health information. 

Our Responsibility. This practice is dedicated to maintaining the privacy of your PHI. Protected health information is information about you, including 1) demographic information, which may identify you, 2) information which relates to your past, present, or future physical or mental health or condition, 3) the provision of health care to you, or 4) payment for your health care. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of PHI which identifies you. In this notice, we have described how we may use and disclose your PHI to carry out treatment, payment, and health care operations as well as for other purposes which are permitted or required by law. This notice also describes your rights to access and control your PHI. 

This Notice is effective as of June 16, 2022. We reserve the right to revise or amend this notice. Any revision or amendment to this notice will be effective from a date of revision or amendment forward. This practice will post a copy of our current notice online at all times or in a visible location for in person treatment as applicable, and you may also request a current copy at any time. 

Treatment, Payment, Healthcare Operations. The following uses and disclosures are permitted under HIPAA and other applicable laws and may be made without your specific written authorization. Under most circumstances, we will not share your PHI with anyone without your express permission. However, this practice is permitted by federal privacy laws to use and disclose your PHI for the following purposes:

Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. This includes coordination or management of your health care with another current provider, such as another physician who may be treating you or to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. We may recommend lab tests and we may receive and use those tests to help us reach a diagnosis. We might use PHI to write a prescription for you or when speaking to a pharmacy to order a prescription for you.

Payment might mean submitting information to your insurance company should you choose to involve them. We will submit only the minimum amount of information necessary for this purpose. Payment may also include submitting PHI to obtain payment from third parties that may be responsible for costs (such as family members) or to other health care entities and collection agencies engaged for billing and collection efforts.

Healthcare operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost management analysis, and customer services. An example would be an internal quality assessment review. We may use the emergency contact information you provided to contact you or the emergency contact in the case of a suspected emergency. We may contact you via phone or the patient portal to remind you of a patient’s upcoming appointment. We may contact you to discuss treatment alternatives or other health related benefits that may be of interest. We will share your PHI with third party “business associates” that perform various activities (for example, maintain the electronic health record). Whenever an arrangement between a business associate and Evergreen involves the use or disclosure of your HPI, we will have a written contract which contains terms to protect your PHI’s privacy.

Minors- if you are unemancipated, there may be times when your PHI is disclosed to your parent/guardian according to legal and ethical standards. Parents- if you are the parent of an unemancipated minor and are acting as the minor’s personal representative, we may disclose your child’s PHI to you under certain circumstances. In some circumstances, we may not disclose health information about a minor to their parent. For example, if your child is legally authorized to consent to mental health treatment without parent/guardian permission (age 14 in Pennsylvania, age 16 in New Jersey), consents to such treatment, and does not request that you be treated as his or her personal representative, we may not disclose health information to you about your child without your child’s authorization. In general, a legal guardian should be involved with the care of any unemancipated minor under the age of 18.

We may also create and distribute de-identified health information by removing all references to individually identifiable information.

Additional Purposes. Additional purposes for which PHI might be disclosed without your written consent include:

Abuse, neglect, or domestic violence. As required or permitted by law, we 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, professional judgment will be used in deciding whether or not to make such a report. If feasible, we will promptly inform you that a report/disclosure has been made.
Appointment reminders and other health services. We may disclose PHI to remind you about an appointment 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.

Public health activities such as reporting information about diseases, adverse effects, and product defects to government officials in charge of collecting such information. We may disclose PHI to prevent, control or report disease, injury or disability as permitted by law. We might disclose PHI to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.

Health oversight such as facilitating auditing, inspection, or investigation related to our provision of health care or the healthcare system.

Legal Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding, in accordance with our legal obligation. In Pennsylvania, the law requires that when a patient’s records are subpoenaed or otherwise made subject to discovery proceedings in a court proceeding, and the patient has not consented to release of the records, no records shall be released in the absence of an additional order of court.

Law Enforcement/Criminal Activity. We may disclose PHI for certain law enforcement purposes, as required and allowed by HIPAA and state laws. For example, we may disclose the minimum necessary PHI to report a death or criminal conduct on our premises.

Coroners, Funeral Director and Organ Donation. We may disclose health information as authorized by law about you to a coroner or medical examiner, for example, to assist in the identification of a decedent or determining cause of death.

Food and Drug Administration. We may disclose your PHI to the FDA or an entity regulated by the FDA, in order, for example, to report an adverse event or a defect related to a drug or medical device.

Personal Representative. If you are an adult or emancipated minor, we may disclose your PHI to a personal representative authorized to act on your behalf in making decisions about your health care.

Public Safety. Consistent with legal and ethical obligations, we may disclose your PHI based on a good faith determination that such disclosure is necessary to prevent  serious and imminent threat to the public or to identify or apprehend an individual sought by law enforcement.

Required by Law. We may disclose your PHI as required by federal, state, or other applicable law.

Specialized government functions. We may disclose your PHI for certain specialized government functions such as military command, determination of veteran’s benefits, national security and intelligence activities, protection of the President and other officials, and the health, safety and security of correctional institutions.

Worker’s Compensation. We may disclose health information about you for purposes related to workers compensation as required and authorized by law.

Serious threat. In order to avoid a serious threat to the health or safety of you, another person or the public, we may provide PHI to law enforcement personnel or personnel able to prevent or lessen such harm.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing; we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

Decedents. In certain circumstances, we may disclose PHI about a decedent to family or others involved in the decedent’s health care or payment for health care. Other disclosures may require written authorization from the executor or administrator of the decedent’s estate.

Your Rights. You have the following rights with respect to your protected health information, which you can exercise by presenting a written request.

Restrictions. You have the right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it. You do have the right to ask us to restrict the disclosure of your PHI to your health plan for a service which we provide to you where you have directly paid us (out of pocket, in full) for that service, in which case we are required to honor your request.

Alternative Communication. You have the right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. This request must be made in writing.

Inspect and Copy. You have the right to inspect and copy your protected health information. The request must be made in writing. We will respond within 30 days after receiving the request. In certain situations, we may deny the request. If we do, we will tell you in writing our reasons for the denial and explain your right to have the denial reviewed when applicable. If you request a copy of your information, we may charge you reasonable fees for the costs of copying, mailing or other cost incurred by us in complying with your request. Instead of providing the PHI you requested, we may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance. Please note: If you are the parent or legal guardian or a minor, certain portions of the minor’s records may not be accessible to you. For example, records relating to care and treatment to which the minor is permitted to consent himself/herself (without your consent) may be restricted unless the minor patient provides an authorization for such disclosure. You may not inspect or copy the following records: psychotherapy notes; or information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding.

Amendments. You have the right to amend your protected health information. You must make your request for amendment of your PHI in writing, including a reason to support the request. We may deny your request if it is not in writing, does not include a reason to support the request, if we did not create the PHI in question, if it is not part of the record kept by us, if it is not subject to inspection or copying, or if it is accurate and complete. If we deny your request for changes in your HPI, we will notify you in writing with a reason for the denial. You may request that we disclose your request for amendment and the denial any time we subsequently discloses the information that you wanted changed.

Accounting of Disclosures. You have the right to receive an accounting of disclosures of protected health information. This does not include disclosures to carry out treatment, payment, or healthcare operations, disclosures to you, disclosures to persons involved in your care, disclosures for national security or intelligence purposes, or disclosures to correctional institutions or law enforcement officials. You must make your request for an accounting of disclosures in writing and must include the time period of the accounting requested.

Paper Copy. You have the right to obtain a paper copy of this notice from us upon request. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. You may do so by calling Dr. Favini’s practice at 302-499-3127.

Complaint. You have recourse if you feel that our privacy protections have been violated. You have the right to file a written complaint with our office, or with the Department of Health & Human Services, Office of Civil 5 Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
Please contact us for more information at the address listed at the bottom of the page. For more information about HIPPA or to file a complaint:

Andrea Favini Psychiatry, PLLC
18 Campus Boulevard, Suite
100Newtown Square, PA 19073


Centralized Case Management Operations
The U.S. Dept. of Health & Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201