Notice of Privacy Practices
Sophia Haeri, Ph.D.
Bellewood Psychology PLLC
Effective date: November 1, 2026
This notice describes how health information about you may be used and disclosed and how you can get access to it. Please review it carefully.
This notice concerns psychotherapy and related clinical services provided by Dr. Sophia Haeri through Bellewood Psychology PLLC. The separate Website Privacy Policy describes the public website. Coaching and professional consultation are separate services; their information practices are addressed in the applicable service agreement.
Privacy contact
Dr. Sophia Haeri
Bellewood Psychology PLLC
Email: drsophiahaeri@bellewoodpsychology.com
Phone: (917) 525-3929
Mailing address: 145 Palisade St, Suite 216, Dobbs Ferry, NY 10522
Contact me using the information above to ask questions, request records, exercise a privacy right, or make a privacy complaint. You may also ask about submitting a request through the SimplePractice Client Portal.
Your rights
You have rights to access your health information, request corrections, ask for confidential communications, request limits on disclosures, receive an accounting of certain disclosures, obtain this notice, and make a complaint. A person with legally recognized authority may act for you after that authority is verified.
Access to records
You may request inspection or an electronic or paper copy of records used to make decisions about your care, including clinical and billing records. A summary may be provided if you agree. I generally provide access or a copy within 30 days, or sooner where applicable state law requires, subject to any legally permitted extension. I will explain any reasonable, cost-based fees permitted by law.
Some material may be excluded from access under law. Psychotherapy notes kept separately from the clinical record are treated differently under HIPAA; applicable state law may provide additional rights. If access is denied, I will explain the reason and any applicable review or appeal rights. Please ask if you need help making a request.
Corrections and confidential communications
You may ask me to amend information you believe is inaccurate or incomplete. Please explain the requested correction and your reason in writing. If I deny an amendment request, I will explain the reason in writing and your right to submit a statement of disagreement. HIPAA generally requires a response within 60 days, with a permitted extension in certain circumstances.
You may ask to be contacted in a particular way or at a different address or number. I will accommodate reasonable requests for confidential communications. Please tell me if a particular way of contacting you could create a privacy concern.
Limits on use and disclosure
You may request restrictions on the information used or disclosed for treatment, payment, or health care operations. I am not required to accept every requested restriction, except where law requires agreement. If you pay for a service in full out of pocket, you may ask that information about that service not be disclosed to your health plan for payment or health care operations. I will honor that restriction unless disclosure is required by law.
Accounting and copies of this notice
You may request an accounting of certain disclosures made during the preceding six years. HIPAA excludes some disclosures from this accounting, including many disclosures for treatment, payment, operations, or made with your authorization. The first accounting in a 12-month period is free. I will explain any permitted charge for an additional accounting before proceeding.
You can receive a paper copy of this notice at any time, even if you agreed to receive it electronically. The current notice is also available on the practice website.
Electronic communications
Electronic communication may create privacy risks. Please discuss your communication preferences with me. Email, text, voicemail, and portal messages should not be used for emergencies.
State confidentiality protections
New York and Connecticut laws may require consent or impose stricter limits than HIPAA on disclosure of psychotherapy information. In New York, identifying information obtained in professional practice generally requires patient consent unless disclosure is authorized or required by law. In Connecticut, mental health communications and records are confidential and generally require specific written consent, subject to statutory exceptions.
I will follow applicable state consent, confidentiality, privilege, and record-access protections. A permission in HIPAA does not override a more protective state rule. Depending on where services are provided and your circumstances, additional laws may apply, including protections concerning reproductive health care, gender-affirming care, or other sensitive information.
Treatment payment and practice operations
Subject to applicable consent and confidentiality requirements, information may be used or disclosed for the following purposes:
Treatment: evaluating your concerns, providing psychotherapy, planning care, and coordinating with another professional involved in your care when authorized or otherwise permitted by law. For example, with required permission, I may discuss treatment coordination with your prescribing clinician.
Payment: explaining charges, collecting payment, and preparing billing records or a superbill. If you request insurance reimbursement or authorize a disclosure for that purpose, information such as a diagnosis and service details may be needed. A superbill you choose to submit to an insurer contains health information.
Practice operations: administering the practice, maintaining records, reviewing care, obtaining professional advice, and arranging necessary services from vendors. When HIPAA requires a business associate agreement, the applicable service provider must have one. State confidentiality requirements also apply.
AI assisted clinical documentation
I use an artificial intelligence assisted documentation service to help prepare psychotherapy progress notes, as described in a separate consent form. The service assists with documentation; it does not independently provide psychotherapy, make diagnoses, or make clinical decisions. I review, edit, and approve the final documentation and remain responsible for your care.
When a vendor processes protected health information on behalf of the practice, applicable privacy and security safeguards, including a Business Associate Agreement when required, apply. The separate AI Assisted Clinical Documentation Consent describes the workflow and your choices. You may decline or withdraw consent for future AI assisted documentation without losing access to psychotherapy. Withdrawal does not affect documentation already created.
Other disclosures permitted or required by law
Disclosure may be permitted or required for purposes such as reporting suspected abuse or neglect; addressing a legally defined threat to safety; responding to authorized health oversight; meeting public health reporting duties; complying with workers' compensation requirements; responding to legally sufficient judicial or administrative process; and providing information to a medical examiner or similar official where authorized.
Each exception has conditions and limits. A request from law enforcement, a family member, an employer, or an attorney does not automatically authorize disclosure. A subpoena alone may be insufficient for privileged mental health records. I will evaluate the request under applicable law and disclose only information legally required or permitted.
Health information may be used for research only when applicable authorization, consent, or other legal requirements are satisfied. This notice does not provide blanket permission to release your records for research.
Family members and others involved in care
You may tell me your preferences about sharing information with a partner, relative, friend, or other person involved in your care or payment. Required consent will be obtained. If you cannot communicate your wishes, information may be shared only under an applicable legal exception and within its limits.
Written authorization and your choices
Uses and disclosures outside this notice, and those requiring permission under applicable law, require your written authorization. Most disclosures of separately maintained psychotherapy notes and marketing uses covered by HIPAA's authorization requirement require authorization, subject to limited legal exceptions. I do not sell your protected health information.
You may revoke an authorization in writing. Revocation applies going forward and does not undo a disclosure already made in reliance on the authorization or another action the law permits. If fundraising communications are used, you may opt out of receiving them. Part 2 records, if any, require additional advance notice and a choice before use in fundraising communications.
Substance use disorder records
Some records received from a substance use disorder treatment program may be protected by 42 CFR part 2. If I have records about you protected by Part 2, I will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your required consent or a qualifying court order and subpoena, as required by law. Other applicable Part 2 restrictions will also be followed.
Practice responsibilities and notice changes
I am responsible for maintaining the privacy and security of protected health information, following applicable privacy law and this notice, and providing notice of a breach when the law requires it. Information may be disclosed to the U.S. Department of Health and Human Services when required for a lawful compliance investigation.
The notice may be revised as permitted by law. Revised terms may apply to information already held by the practice as well as information received later. A revised notice will have an updated effective date and will be available on the website and upon request. A change in this notice does not remove protections required by law.
Questions and complaints
If you believe your privacy rights have been violated, contact me using the information under Privacy contact. You may also complain to the U.S. Department of Health and Human Services Office for Civil Rights at https://www.hhs.gov/hipaa/filing-a-complaint/index.html, by calling 1-877-696-6775, or by writing to 200 Independence Avenue SW, Washington, DC 20201. I will not retaliate against you for making a complaint.