Effective Date: November 1, 2025

Notice of Privacy Practices

This Notice of Privacy Practices describes how Long Island Addiction Treatment Resources may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

Please review this notice carefully.

Our Commitment to Your Privacy

Long Island Addiction Treatment Resources is committed to protecting the privacy and security of your health information. We are required by law to:

• Maintain the privacy of your protected health information
• Provide you with this notice of our legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

What is Protected Health Information (PHI)?

Protected Health Information (PHI) is information about you, including demographic information, that may identify you and relates to:

• Your past, present, or future physical or mental health or condition
• The provision of health care services to you
• The past, present, or future payment for your health care

Examples of PHI include:

• Your name, address, phone number, and email address
• Medical record numbers and health insurance information
• Information about your substance use disorder or mental health condition
• Treatment plans and progress notes
• Billing and payment information
• Communications between you and our staff

How We May Use and Disclose Your PHI

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

We may use and disclose your PHI without your written authorization for the following purposes:

Treatment

We may use and disclose your PHI to:

• Coordinate your care with treatment providers
• Refer you to appropriate rehabilitation facilities
• Verify your eligibility for treatment programs
• Share information with providers involved in your care
• Facilitate continuity of care between providers

Example: We may share your substance use history and insurance information with a detox facility to arrange your admission.

Payment

We may use and disclose your PHI to:

• Verify your insurance coverage and benefits
• Obtain payment authorization from your insurance company
• Process claims and billing
• Coordinate benefits with multiple insurers
• Respond to payment-related inquiries

Example: We may contact your insurance company to verify coverage for inpatient rehabilitation services.

Health Care Operations

We may use and disclose your PHI for:

• Quality assessment and improvement activities
• Staff training and education
• Business planning and development
• Compliance and regulatory activities
• Customer service and satisfaction surveys

Example: We may review referral outcomes to improve our services and ensure quality care coordination.

2. Uses and Disclosures That Require Your Authorization

For uses and disclosures beyond treatment, payment, and health care operations, we will obtain your written authorization, except as described in Section 3 below. You may revoke your authorization at any time by submitting a written request. However, the revocation will not affect any uses or disclosures already made in reliance on your authorization.

We will obtain your authorization before:

• Using or disclosing psychotherapy notes (if applicable)
• Using or disclosing PHI for marketing purposes
• Selling your PHI
• Using or disclosing PHI in ways not described in this notice

3. Uses and Disclosures That May Be Made Without Your Authorization

In certain situations, we may use or disclose your PHI without your authorization:

Required by Law

We may disclose your PHI when required by federal, state, or local law, including:

• Reporting suspected child abuse or neglect
• Reporting suspected elder or dependent adult abuse
• Responding to court orders or subpoenas
• Complying with workers’ compensation laws

Public Health Activities

We may disclose your PHI to public health authorities for:

• Preventing or controlling disease, injury, or disability
• Reporting births and deaths
• Reporting adverse reactions to medications
• Notifying persons of recalls of products they may be using
• Notifying persons who may have been exposed to a disease

Health Oversight Activities

We may disclose your PHI to health oversight agencies for:

• Audits and inspections
• Licensure and certification activities
• Investigations and disciplinary actions
• Civil, administrative, or criminal proceedings

Judicial and Administrative Proceedings

We may disclose your PHI in response to:

• A court order
• An administrative tribunal order
• A subpoena, discovery request, or other lawful process (with certain limitations)

Law Enforcement

We may disclose your PHI to law enforcement officials for:

• Identifying or locating a suspect, fugitive, material witness, or missing person
• Reporting crimes observed on our premises
• Reporting crimes in emergencies
• Complying with court orders or subpoenas

Serious Threats to Health or Safety

We may disclose your PHI if we believe it is necessary to:

• Prevent or lessen a serious and imminent threat to your health or safety
• Prevent or lessen a serious threat to the health or safety of another person or the public

Specialized Government Functions

We may disclose your PHI for:

• Military and veterans’ activities
• National security and intelligence activities
• Protective services for the President and others
• Medical suitability determinations
• Correctional institutions and law enforcement custody

Workers’ Compensation

We may disclose your PHI as authorized by and to comply with workers’ compensation laws and similar programs.

Coroners, Medical Examiners, and Funeral Directors

We may disclose your PHI to:

• Coroners or medical examiners for identification purposes
• Determining cause of death
• Funeral directors to carry out their duties

Organ and Tissue Donation

We may disclose your PHI to organizations involved in organ, eye, or tissue procurement, banking, or transplantation.

Research

We may disclose your PHI to researchers when:

• An institutional review board or privacy board has approved the research
• The researchers have provided written assurances of safeguards
• The research meets other regulatory requirements

Business Associates

We may disclose your PHI to business associates who perform services on our behalf, such as:

• Insurance verification services
• IT support and data storage providers
• Billing and claims processing services
• Legal and accounting services

Business associates are required by contract to protect your PHI and use it only as permitted by law.

Special Protections for Substance Use Disorder Information

42 CFR Part 2 Protections

If you are seeking or receiving substance use disorder treatment services, your records are protected by federal confidentiality regulations (42 CFR Part 2). These regulations provide additional protections beyond HIPAA.

Under 42 CFR Part 2, we cannot disclose information that identifies you as having or seeking treatment for a substance use disorder unless:

1. You provide written consent that includes:

• Your name
• The name of the program making the disclosure
• The name of the person or organization receiving the information
• The purpose of the disclosure
• How much and what kind of information will be disclosed
• A statement that you may revoke consent at any time
• The date, event, or condition upon which consent expires
• Your signature and date

1. A court order is issued after an application showing good cause
2. A medical emergency exists requiring disclosure to medical personnel
3. The disclosure is for qualified audit, evaluation, or research as permitted by law
4. The disclosure is to report suspected child abuse or neglect as required by state law

Violations and Penalties

Violations of 42 CFR Part 2 are a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurred. See 42 U.S.C. § 290dd-2 and 42 CFR Part 2 for more information.

Prohibition on Re-disclosure

Recipients of information disclosed under 42 CFR Part 2 are prohibited from re-disclosing the information unless:

• Further disclosure is expressly permitted by your written consent
• Further disclosure is permitted by 42 CFR Part 2

Your Rights Regarding Your PHI

You have the following rights with respect to your protected health information:

1. Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree to your request, except in the following situation:

• If you pay out-of-pocket in full for a service and request that we not disclose PHI related solely to that service to your health plan for payment or health care operations purposes, we must honor that request unless disclosure is required by law.

To request a restriction, submit your request in writing to our Privacy Officer at the address listed below.

2. Right to Receive Confidential Communications

You have the right to request that we communicate with you about your PHI by alternative means or at alternative locations. For example, you may request that we:

• Contact you only at work
• Send mail to a P.O. Box instead of your home address
• Call a specific phone number

We will accommodate reasonable requests. You do not need to explain the reason for your request. To request confidential communications, submit your request in writing to our Privacy Officer.

3. Right to Inspect and Copy Your PHI

You have the right to inspect and obtain a copy of your PHI contained in a designated record set, which includes:

• Medical and billing records
• Enrollment and claims records
• Case management records

To inspect or obtain a copy of your PHI, submit a written request to our Privacy Officer. We may charge a reasonable, cost-based fee for:

• Copying
• Postage (if you request mailing)
• Preparing a summary (if you agree to a summary instead of full copies)

We will respond to your request within 30 days. In certain limited circumstances, we may deny your request. If we deny your request, we will provide you with a written explanation and information about your right to have the denial reviewed.

4. Right to Amend Your PHI

If you believe that your PHI is incorrect or incomplete, you have the right to request an amendment. To request an amendment:

• Submit a written request to our Privacy Officer
• Include the reason supporting your request

We will respond within 60 days. We may deny your request if:

• The information was not created by us (unless the creator is no longer available)
• The information is not part of the designated record set
• The information is not available for inspection (as permitted by law)
• The information is accurate and complete

If we deny your request, you have the right to submit a written statement of disagreement, which will be included in your record.

5. Right to an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI made by us during the six years prior to your request (or a shorter period if you specify).

The accounting will include:

• The date of the disclosure
• The name and address of the recipient
• A brief description of the information disclosed
• The purpose of the disclosure

The accounting will not include disclosures:

• For treatment, payment, or health care operations
• Made to you or pursuant to your authorization
• For national security or intelligence purposes
• To correctional institutions or law enforcement officials
• Made as part of a limited data set
• Made prior to April 14, 2003

To request an accounting, submit a written request to our Privacy Officer. The first accounting in a 12-month period is free. We may charge a reasonable fee for additional requests.

6. Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically. To obtain a paper copy, contact our Privacy Officer or visit our website at https://longislandaddictionresources.com/hipaa-compliance/.

7. Right to Be Notified of a Breach

You have the right to be notified if a breach of your unsecured PHI occurs. We will notify you:

• Without unreasonable delay
• No later than 60 days after discovery of the breach
• By first-class mail or email (if you have agreed to electronic notice)

The notification will include:

• A description of the breach
• The types of information involved
• Steps you should take to protect yourself
• What we are doing to investigate and mitigate harm
• Contact information for further assistance

8. Right to File a Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint with:

Long Island Addiction Treatment Resources:

Privacy Officer: 521 NY-111 Suite 305 Hauppauge, NY 11788
Phone: (631) 888-6282
Email: help@longislandaddictionresources.com

U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice of Privacy Practices at any time. Any changes will apply to PHI we already have as well as PHI we receive in the future.

When we make a material change to this notice:

• We will post the revised notice on our website with an updated effective date
• We will make copies of the revised notice available upon request
• We will notify you of the change in a reasonable manner

The current version of this notice is always available:

• On our website at https://longislandaddictionresources.com/hipaa-compliance/
• At our office location
• By calling (631) 888-6282
• By emailing help@longislandaddictionresources.com

Contact Information

Privacy Officer:

Long Island Addiction Treatment Resources 521 NY-111 Suite 305 Hauppauge, NY 11788
Phone: (631) 888-6282
Email: help@longislandaddictionresources.com

Hours: Available 24/7 for confidential assistance

Acknowledgment of Receipt

By using our services, you acknowledge that you have received and reviewed this Notice of Privacy Practices. If you have questions or need clarification, please contact our Privacy Officer.

Effective Date: November 1, 2025

Version: 1.0