Notice of Privacy Practices

SalmassiMD Psychiatry

1900 Campus Commons Drive

Suite 100-235

Reston, VA 20191

703-348-0701

This Notice describes how your health information may be used and disclosed, and how you can access this information. Please review it carefully.

Our Responsibilities

SalmassiMD Psychiatry is required by law to:

  • Maintain the privacy of your protected health information (PHI)

  • Provide you with this Notice of Privacy Practices

  • Follow the terms of this Notice currently in effect

We may update this Notice from time to time. The current version will be available upon request and through the patient portal.

How We May Use and Disclose Your Health Information

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

Treatment

To provide, coordinate, or manage your psychiatric care. This may include consultation with other healthcare providers involved in your treatment.

Payment

To obtain payment for services provided, including billing insurance or processing payments.

Health Care Operations

For practice operations such as quality assessment, training, supervision, licensing, audits, and administrative activities.

Other Permitted Uses and Disclosures

We may also use or disclose your PHI without your authorization when required or permitted by law, including:

  • To comply with federal or state laws

  • To report suspected abuse, neglect, or domestic violence

  • To prevent or reduce a serious threat to health or safety

  • For health oversight activities (e.g., audits, investigations)

  • For judicial or administrative proceedings in response to lawful orders

  • For law enforcement purposes as required by law

  • To coroners or medical examiners

  • For workers’ compensation claims

  • For appointment reminders and information about treatment alternatives or health‑related services

Psychotherapy Notes

Psychotherapy notes are kept separately from the medical record as defined by federal law.

  • Uses and disclosures of psychotherapy notes require your written authorization, except in limited circumstances permitted by law (e.g., for treatment, supervision, legal defense, or to prevent serious harm).

Uses and Disclosures Requiring Authorization

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

  • Marketing purposes

  • Sale of your health information

You may revoke an authorization at any time in writing.

Disclosures to Family and Others Involved in Your Care

With your permission, or if you do not object, we may share relevant information with family members or others involved in your care or payment for your care. You may limit or revoke this permission at any time.

Your Rights Regarding Your Health Information

You have the right to:

  • Request restrictions on certain uses or disclosures of your PHI

  • Request confidential communications (e.g., alternative contact methods)

  • Inspect and obtain copies of your medical record (excluding psychotherapy notes)

  • Request amendments to your health information

  • Receive an accounting of certain disclosures

  • Obtain a paper or electronic copy of this Notice

Requests must be submitted in writing. Reasonable, cost‑based fees may apply as permitted by law.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with this practice or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

Acknowledgment of Receipt

By signing below, you acknowledge that you have received a copy of this Notice of Privacy Practices.