NOTICE OF PRIVACY PRACTICES

Effective Date: [Insert Date]

Practice Name: MK Care Inc.

Address: [Insert Address]

Phone: [Insert Phone Number]

Email: [Insert Email]

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.

MK Care Inc. is required by federal and New York State law to maintain the privacy of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). We are required to:

•Maintain the privacy of your PHI

•Provide you with this Notice

•Follow the terms of this Notice currently in effect

•Notify you if a breach of your unsecured PHI occurs.

I. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your mental health care and related services.
Examples:

Consultation with another healthcare provider
Referrals to psychiatrists, primary care providers, or specialists
Care coordination with other providers involved in your treatment

2. Payment

We may use and disclose your PHI to obtain payment for services provided.
Examples:

Submitting claims to your insurance company
Determining eligibility or coverage
Responding to insurance audits or utilization reviews

3. Healthcare Operations

We may use and disclose PHI for business activities necessary to run our practice.
Examples:

Quality assessment and improvement
Supervision and training
Compliance reviews
Legal and accounting services

II. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

We will not use or disclose your PHI for the following purposes without your written authorization:

Psychotherapy notes (as defined by HIPAA)
Marketing purposes
Sale of PHI
Most disclosures of substance use disorder (SUD) treatment records
Other uses not described in this Notice

III. SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS

Records related to the diagnosis, treatment, or referral for treatment of a substance use disorder are subject to additional federal confidentiality protections.

Such records generally may not be used or disclosed without your written consent except as permitted by law. Once disclosed pursuant to your consent, federal law may allow certain redisclosures for treatment, payment, and healthcare operations consistent with applicable regulations.

You have the right to receive an accounting of disclosures of your SUD records.

You may revoke an authorization at any time in writing, except to the extent we have already relied on it.

If you pay fully out-of-pocket and request that we not disclose information to your health plan, we will honor that request unless required by law.

IV. USES AND DISCLOSURES WITHOUT AUTHORIZATION

We may disclose PHI without your authorization in the following circumstances:

Required by Law

When disclosure is mandated by federal or New York State law.

Public Health and Safety

To prevent or lessen a serious and imminent threat
Reporting abuse, neglect, or domestic violence

Health Oversight

Audits, investigations, licensure reviews, or disciplinary actions.

Judicial and Administrative Proceedings

In response to a court order, subpoena, or lawful process.

Law Enforcement

As required by law or court order.

Workers’ Compensation

As authorized by law.

V. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights:

1. Right to Access

You may request to inspect or receive a copy of your PHI, with limited exceptions (e.g., psychotherapy notes).

2. Right to Request Amendment

If you believe information is incorrect or incomplete, you may request an amendment.

3. Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made.

4. Right to Request Restrictions

You may request limits on how we use or disclose your PHI. We are not required to agree, except in specific out-of-pocket payment situations.

5. Right to Confidential Communications

You may request that we contact you at a specific phone number, email, or mailing address.

6. Right to a Paper Copy

You may request a paper copy of this Notice at any time.

VI. ELECTRONIC COMMUNICATION & TELEHEALTH

If you engage in telehealth services:

We use HIPAA-compliant platforms when required.
Electronic communication (email, text) may carry some risk.
By consenting to telehealth, you acknowledge understanding these risks.

VII. MINORS (NEW YORK STATE)

Under New York law, minors may consent to certain types of treatment (e.g., mental health services under specific circumstances). Privacy rights for minors may vary depending on the type of service and consent given. We comply with all applicable New York State laws governing minor confidentiality.

VIII. CHANGES TO THIS NOTICE

We reserve the right to revise this Notice at any time.
Revised Notices will apply to all PHI we maintain and will be available in our office and on our website.

IX. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer:
MK Care Inc.
[Insert Contact Information]

You may also file a complaint with the U.S. Department of Health and Human Services.

You will not be retaliated against for filing a complaint.

Updated by February 16th, 2026