Privacy Notice

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully. If you have any questions about this notice please contact us for further information.

This notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised copy in the mail or by asking for one at the time of your next appointment.

  1. Uses and Disclosures of Protected Health Information Without Your Written Authorization.

    Treatment: We will use and disclose your protected health information to provide or manage your health care and related services. This includes the coordination or management of our health care with a third party that has already obtained your permission to have access to your protected health care information. We will also disclose protected health information to other physicians that may be treating you. For example, your protected health information may be provided to a physician whom you have been referred to, to ensure that the physician has the necessary information to diagnose or to treat you. In addition, we may disclose your protected health information to another physician or health care provider (e.g., specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment.

    Payment: Your protected health information may be used to obtain payment for your health care services. This includes certain activities that your health insurance plan may undertake before it approves or pays for health care services we recommend, such as making a determination of eligibility or coverage for insurance for Insurance benefits; reviewing services provided to you for medical necessary, and undertaking utilization reviewing activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

    Healthcare Operations: We may use or disclose your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to quality assessment activities, employee review activities, training of medical student.

    For example, we may disclose your protected health information to medical school students that see patients at our office. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary to contact you to remind you of your appointment.

    We shall share your protected health information with third party business associates for purposes of billing, transcription services, etc. Whenever an arrangement between our office and a business associate involves the use or, disclosure or your protected health information, a written contract that contains terms that will protect the privacy of your protected health information will be constructed.
  2. Other permitted and required use disclosures that may be made unless you object to such uses or disclosures.

    You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician will use professional judgment to determine if the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.

    Others involved in your health care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary. If we determine that it is in your best interest based on our professional judgement, we may use or disclose protected health information to notify or assist In notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate care with family or other individuals involved in your health care.

    Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as possible after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent, he or she may still use or disclose your protected health information to treat you in an emergency situation.

    Communication Barriers: We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you, but is unable to, due to substantial communication barriers.
  3. Other permitted and required use disclosures that may be made without your authorization to comply with legal mandates.

    We may use or disclose your protected health information if required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified of any such uses or disclosures.

    Public Health: We may disclose your protected health information for public health activities and public health authorities that are permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency.

    Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. Health oversight: We may disclose protected health information to a health oversight agency for activities authorized by law; audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, government regulatory programs and civil right enforcement agencies.

    Abuse or Neglect: We are required by law to report suspicions of elder abuse, domestic violence, child abuse or neglect to a governmental entity or agency authorized to receive such information. In each case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

    Food and Drug Administration: We may disclose your protected health information to the Food and Drug Administration to report adverse reactions, product defects, biologic product deviation, track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance.

    Legal Proceedings: We may disclose protected health information for the purpose of any judicial or administrative proceeding, in response to a court order (to the extent such disclosure is expressly authorized), in response to a subpoena, discover request or other lawful process.

    Law Enforcement: We may disclose protected health information as long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes included (1) legal processes required by law, (2) Information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicions that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the practice's premises) and it is likely that a crime has occurred.

    Coroners, Funeral Directors, and Organ Donations: We disclose protected health information to a coroner or medical examiner for identification purposes, determining the cause of death, or for the coroner or medical examiner to perform other duties authorized by law. All permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

    Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information if we believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

    Military Activity: We may use or disclose protected health information of individuals who are part of the Armed Forces for the activities deemed necessary by appropriate military command authorities, for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or to disclose your protected health information to authorized federal officials conducting national security and intelligence activities, including provision of protective services to the president or others legally authorized.

    Workers' Compensation: Your protected health information may be disclosed by us as authorized to comply with workers' compensation laws and similar legally established programs.

    Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.

    Required Uses and Disorders: Under the law, we must make disclosures to you when required by the Secretary of the Department of Health R Human Services to investigate or determine our compliance with the requirements of section 164.500 et. seq
  4. Other uses and disclosures require your authorization.

    Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

    Your Rights
    The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that your physician and the practice uses for making decisions about you Request for copies must be in writing and there will be a charge of $ .75 per page.

    Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable use or anticipation of a civil, criminal or administrative proceeding, and protected health information that is subject to law that prohibits access to protected health Information. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

    You have the right to request a restriction of your protested health information. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purpose as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

    Your physician is not required to agree to a restriction that you may request. If your physician believes it is In your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by putting it in writing.

    You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or another method of contact. We will not request an explanation from you as the basis for the request. Please make this request in writing to our Privacy Officer.

    You have the right to have your physician amend your protected health information. This means that you may request an amendment of protected health information about you in a designated record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us, and we, a rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your medical record.

    You have the right to receive an accounting of certain disclosure we have made, of your protected health information. This right applies to the disclosures for purpose other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosure we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific Information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to exceptions and limitations.

    You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

    Complaints & Grievances
    You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer of your complaint. You have the right to file complaints or grievances without retaliation by those suspected in violation.

    You have the right to have your physician amend your protected health information. This means that you may request an amendment of protected health information.

    You may contact us at 718-272-0977 for further information about the complaint process. This notice was published and becomes effective 05/11, 2008.