​Ann Garczynski Altoonian, Psy.D., Licensed Psychologist 

Office in Phelps, NY

  315-458-3239

Former office locations

I regret that I am no longer offering services in the metro Rochester, NY area or the metro Syracuse, NY area

• Individual psychotherapy
• Couples counseling
• Telehealth (secure videoconference sessions)
• Contracted evaluations 

Health Insurance

News:  

September, 2024

New office opening in Ontario County, NY

I'm pleased to announce that a new physical office location will be available in Phelps, NY. It will use the phone number from the former Syracuse location, 315-458-3239. Please call for information about openings for in-person appointments in the near future.

Ann Altoonian, Psy.D. Licensed Psychologist

Mailing address:

789 Pre Emption Road

Ste 300-396

Geneva, NY 14456

Phone: 315-458-3239

 Phelps is in Ontario County, NY and the office is a short 6 minute drive off Thruway Exit 42 (Map below is the mailing address that is located in Geneva, NY; office address will be provided upon making an appointment)

Notice of Clinician’s Policies and Practices to Protect the Privacy of Your Health Information

Ann Garczynski Altoonian, Psy.D.
THIS NOTICE DESCRIBES HOW PSYCHOLOGICAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW  IT CAREFULLY.


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


I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions: 

    ∙ “PHI” refers to information in your health record that could identify you. 
    ∙ “Treatment, Payment and Health Care Operations”

- Treatment is when I provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist.

- Payment is when I obtain reimbursement for your healthcare.  Examples of payment are when I disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

- Health Care Operations are activities that relate to the performance and operation of my practice.  Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

    ∙ “Use” applies only to activities within my practice group such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
    ∙ “Disclosure” applies to activities outside of my practice group, such as releasing, transferring, or providing access to information about you to other parties. 


II.  Uses and Disclosures Requiring Authorization 


I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information.  I will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record.  These notes are given a greater degree of protection than PHI.


You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.


III.  Uses and Disclosures with Neither Consent nor Authorization


I may use or disclose PHI without your consent or authorization in the following circumstances: 

                    (page 1 of 4)

    ∙ Child Abuse: If, in my professional capacity, a child comes before me which I have reasonable cause to suspect is an abused or maltreated child, or I have reasonable cause to suspect a child is abused or maltreated where the parent, guardian, custodian or other person legally responsible for such child comes before me in my professional or official capacity and states from personal knowledge facts, conditions or circumstances which, if correct, would render the child an abused or maltreated child, I must report such abuse or maltreatment to the statewide central register of child abuse and maltreatment, or the local child protective services agency. 

    ∙ Health Oversight: If there is an inquiry or complaint about my professional conduct to the New York State Education Department Office of the Professions, I must furnish to the New York Commissioner of Education, your confidential mental health records relevant to this inquiry.

    ∙ Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that I have provided you and/or the records thereof, such information is privileged under state law, and I must not release this information without your written authorization, or a court order.  This privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered.  I must inform you in advance if this is the case.

    ∙ Serious Threat to Health or Safety: I may disclose your confidential information to protect you or others from a serious threat of harm by you.

    ∙ Worker’s Compensation: If you file a worker’s compensation claim, and I am treating you for the issues involved with that complaint, then I must furnish to the chairman of the Worker’s Compensation Board records which contain information regarding your psychological condition and treatment.

        • Business Associates Providing Services:  I may disclose the minimum necessary health                  information to my business associates that perform functions on my behalf or provide me with                  services, if the information is necessary for such functions or services. My business associates                  sign agreements to protect the privacy of your information and are not allowed to use or disclose                  any information other than as specified in our contract.

IV.  Patient’s Rights and Clinician’s Duties

Patient’s Rights:

    ∙ Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request. 

    ∙ Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me.  Upon your request, I will send your bills to another address.) 

    ∙ Right to Inspect and Copy – You have the right to inspect or obtain (or both) an electronic or paper copy of PHI and
    ∙ (page 2 of 4)
    ∙ psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. On your request, I will
    ∙  discuss with you the details of the request and denial process. Records must be requested in writing, and a release of information form must be completed. There is a copying fee of $0.75 per page. Please make your request well in advance and allow 2 weeks to receive the copies.

    ∙ Right to Amend – You have the right to request an amendment of PHI if you believe the information  is incorrect and/or missing, for as long as the PHI is maintained in the record. I may deny your request.  On your request, I will discuss with you the details of the amendment process. You must make this request in writing. 

    ∙ Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice).  On your request, I will discuss with you the details of the accounting process.  You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

    We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

    ∙ Right to a Paper Copy – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

    ∙ Right to Choose Someone to Act for You— If you have a legal guardian, that person can exercise your rights and make choices about your health information. I will make sure the person has this authority before I take any action.

    ∙ Right to Choose—You have the right to decide not to receive services with me. If you wish, I will provide you with the names of other qualified professionals.

    ∙ Right to Terminate— You have the right to terminate therapeutic services with me at any time without any legal or financial obligations other than those already accrued. I ask that you discuss your decision with me in session before terminating, or at least contact me by phone letting me know you are terminating services.

    ∙ Right to Release Information with Written Consent— With your written consent, any part of your record can be released to any person or agency you designate. If the person is not a health care provider currently involved in your treatment, there may be a charge of $0.75 per page. Together, we will discuss whether I think releasing the information in question to that person or agency might be harmful to you.

Clinician’s Duties:
    ∙ I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
    ∙ I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect. 
    ∙ If I revise my policies and procedures, I will advise you during your session (also see below).

(Page 3 of 4)


V.  Questions and Complaints

If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact me at 315-458-3239.

If you believe that your privacy rights have been violated and wish to file a complaint with me, you may 

send your written complaint to my attention at 789 Pre Emption Road, #300-396, Geneva, NY 14456. 

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.  I can provide you with the appropriate address upon request, or the New York State Office of Mental Health Customer Relations at 800-597-8481

If you have a complaint, you need not be concerned that your health care will be compromised in any way.

VI. Effective Date, Restrictions and Changes to Privacy Policy


This  notice will go into effect on April 14, 2003.


I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain.  I will provide you with a revised notice either in person, or by U.S. Mail.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

v.11/24


(page 4 of 4)

Services

I accept most public and private insurance plans. I also offer special pricing for cash-paying patients for most services.

Contact

​

Office Hours

by appointment only

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