NOTICE OF PRIVACY PRACTICES
Child & Adult Psychiatry
Ella Peresechenski, MD
Effective Date: November 9, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices describes how Child & Adult Psychiatry may use and disclose your protected health information and explains your rights regarding that information.
Your Rights
You have certain rights regarding your health information.
Access Your Medical Record
You may ask to see or obtain an electronic or paper copy of your medical record and other health information available to you under applicable law.
We will respond within the timeframe required by law. A reasonable fee may apply when permitted by law.
Certain information may be subject to limitations or exceptions under federal or Virginia law, including certain psychotherapy notes.
Request a Correction
You may ask us to correct or amend health information that you believe is incorrect or incomplete.
We may deny a request when permitted by law. If a request is denied, we will provide information regarding the denial and your applicable rights.
Request Confidential Communications
You may ask us to communicate with you in a particular way or at a particular location. We will accommodate reasonable requests as required by law.
Request Restrictions
You may ask us to limit certain uses or disclosures of your health information for treatment, payment, or healthcare operations.
We are generally not required to agree to every requested restriction. If we agree to a restriction, we will comply with it except as otherwise permitted or required by law.
If you pay for a healthcare service completely out of pocket, you may ask us not to disclose information about that service to your health plan for payment or healthcare operations. We will honor such requests when required by law.
Receive an Accounting of Certain Disclosures
You may request a list of certain disclosures of your health information made during the period permitted by law.
The accounting does not include disclosures that are excluded from this requirement, including many disclosures made for treatment, payment, or healthcare operations.
Receive a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. The current Notice is also available on our website.
Have Someone Act on Your Behalf
If another person has legal authority to act on your behalf, such as a legal guardian, healthcare agent, or other legally authorized personal representative, that person may exercise applicable rights concerning your health information.
We may verify that person's authority before acting on a request.
Special federal and Virginia requirements may apply to minors and their health information.
Your Choices
In certain circumstances, you may tell us your preferences about how your information is shared.
Depending on the circumstances and applicable law, this may include sharing relevant information with family members, caregivers, or others involved in your care or payment for your care.
If you are unable to communicate your preference, we may use professional judgment and applicable law to determine whether a disclosure is appropriate.
We may also use or disclose information when permitted by law to prevent or reduce a serious threat to health or safety.
Uses and Disclosures Requiring Authorization
We will obtain your written authorization when authorization is required by law.
This includes, when applicable:
Most uses and disclosures of psychotherapy notes
Marketing activities requiring authorization
Sale of protected health information
Other uses and disclosures not otherwise permitted or required by law
If you provide written authorization, you may revoke it in writing as permitted by law. Revocation does not affect disclosures already made in reliance on a valid authorization.
How We May Use and Disclose Your Health Information
Treatment
We may use your health information and disclose it to healthcare professionals involved in your treatment when permitted by applicable law.
For example, we may communicate with another treating healthcare professional when information is necessary for coordination of care.
Additional protections may apply to certain psychiatric, psychotherapy, substance-use, minor, or otherwise specially protected records.
Healthcare Operations
We may use and disclose health information as permitted by law to operate the practice, manage services, conduct appropriate administrative activities, and support the quality and safety of care.
Payment and Billing
We may use and disclose health information as permitted for billing and payment-related activities.
Child & Adult Psychiatry is a private-pay practice and does not routinely bill commercial insurance for services. If you request documentation for possible out-of-network reimbursement or other payment purposes, relevant health information may be used or disclosed as permitted or authorized by law.
Telehealth and Video Sessions
Child & Adult Psychiatry may provide psychiatric services through secure video or other telehealth technology when clinically appropriate and permitted by applicable law.
Telehealth involves the electronic transmission of health information, including audio, video, and other information exchanged during a remote visit. The practice uses reasonable administrative, technical, and physical safeguards designed to protect the privacy and security of protected health information and uses telehealth technology in accordance with applicable privacy and security requirements.
Patients are encouraged to participate in telehealth sessions from a private location and to use a secure device and internet connection whenever possible. Because telehealth involves electronic communication, privacy and security risks cannot be completely eliminated.
Telehealth sessions are not routinely recorded. Any recording of a clinical encounter would be handled in accordance with applicable consent, privacy, and recordkeeping requirements.
Technology and Artificial Intelligence-Assisted Tools
Child & Adult Psychiatry may use secure technology, including artificial intelligence-assisted or automated tools, to support certain clinical or administrative functions. Such tools may assist with activities such as clinical documentation, organization of information, administrative workflows, or other functions related to treatment or healthcare operations.
When protected health information is used with a technology vendor acting on behalf of the practice, the practice applies applicable HIPAA privacy and security requirements, including business-associate requirements when required by law.
Artificial intelligence-assisted tools are intended to support, rather than replace, professional clinical judgment. Clinical assessment, diagnosis, treatment recommendations, and prescribing decisions remain the responsibility of the treating clinician.
Protected health information will not be disclosed to an AI or technology vendor for the vendor's independent marketing or other unrelated purposes except as authorized or otherwise permitted by applicable law.
Other Uses and Disclosures Permitted or Required by Law
Federal or state law may permit or require us to use or disclose health information without your written authorization in certain circumstances.
These circumstances may include:
Public-health activities
Reporting suspected abuse or neglect when required or permitted by law
Preventing or reducing a serious threat to health or safety
Health oversight activities
Certain legally authorized law-enforcement or government functions
Workers' compensation matters
Judicial or administrative proceedings
Certain research activities when applicable legal requirements and safeguards have been satisfied
Disclosures to coroners, medical examiners, funeral directors, or organ-procurement organizations when applicable
Other disclosures required or permitted by law
The existence of a subpoena, court order, or other request for information does not necessarily mean that psychiatric or otherwise protected health information will automatically be disclosed. Applicable federal and Virginia confidentiality requirements will be followed.
Mental Health and Psychotherapy Information
Psychiatric records may be protected by federal and state confidentiality laws in addition to HIPAA.
Psychotherapy notes, as specifically defined under HIPAA, receive additional protections and generally require written authorization for disclosure except in limited circumstances permitted by law.
Child & Adult Psychiatry follows applicable federal and Virginia requirements when using or disclosing psychiatric and mental-health information.
Substance Use Disorder Records
Certain substance use disorder records may receive additional protection under federal law, including 42 CFR Part 2.
To the extent that Child & Adult Psychiatry creates, receives, or maintains records protected by Part 2, those records will be handled in accordance with applicable federal requirements.
Part 2-protected records may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against a patient except as permitted by applicable law.
Minors and Personal Representatives
Because Child & Adult Psychiatry treats children and adolescents, special privacy considerations may apply.
Parents and legal guardians generally exercise privacy rights on behalf of minor children when legally authorized to do so. However, federal and Virginia law recognizes circumstances in which a minor may have independent rights regarding particular healthcare services or health information.
Access to and disclosure of a minor patient's information will be determined according to applicable federal and Virginia law and the circumstances of the patient's care.
Our Responsibilities
Child & Adult Psychiatry is required by law to maintain the privacy and security of protected health information.
We will:
Follow the duties and privacy practices described in the current version of this Notice
Maintain appropriate safeguards for protected health information
Notify affected individuals as required by law if a breach occurs that may have compromised the privacy or security of their information
Provide a copy of this Notice upon request
Use or disclose health information only as permitted or required by law or as authorized by you
Changes to This Notice
We may change the terms of this Notice and our privacy practices as permitted by law.
Changes may apply to health information we already maintain as well as information received or created in the future, to the extent permitted by law.
When this Notice is materially revised, the current version will be made available upon request and posted on our website.
Questions or Concerns About Privacy
If you have questions about this Notice or concerns regarding the privacy of your health information, please contact Child & Adult Psychiatry at (703) 987-9877.
You also have the right to submit a complaint regarding privacy practices to the U.S. Department of Health and Human Services, Office for Civil Rights.
Child & Adult Psychiatry will not retaliate against you for exercising your privacy rights or filing a privacy complaint.