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As Required by the Privacy Regulations Created as a Result of
the Health Insurance Portability and Accountability Act of 1996
(HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
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OUR COMMITMENT
TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your
Individually Identifiable Health Information (IIHI). In conducting
our business, we will create records regarding you and the treatment
and services we provide to you. We are required by law to maintain
the confidentiality of health information that identifies you.
We also are required by law to provide you with this notice
of our legal duties and the privacy practices that we maintain
in our practice concerning your IIHI. By federal and state law,
we must follow the terms of the notice of privacy practices
that we have in effect at the time.
We realize that these laws are complicated, but we must provide
you with the following important information:
- How we may use and disclose your IIHI
- Your privacy rights in your IIHI
- Our obligations concerning the use and disclosure of your
IIHI
The terms of this notice apply to all records
containing your IIHI that are created or retained by our practice.
We reserve the right to revise or amend this Notice of Privacy
Practices. Any revision or amendment to this notice will be
effective for all of your records that our practice has created
or maintained in the past, and for any of your records that
we may create or maintain in the future. Our practice will post
a copy of our current Notice in our offices in a visible location
at all times, and you may request a copy of our most current
Notice at any time.
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IF YOU HAVE
QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Office manager at 29 John Street, New York, NY 10038.
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WE MAY USE
AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
(IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which
we may use and disclose your IIHI.
- Treatment. Our practice may use your IIHI
to treat you. For example, we may ask you to have laboratory
tests (such as blood or urine tests), and we may use the results
to help us reach a diagnosis. We might use your IIHI in order
to write a prescription for you, or we might disclose your
IIHI to a pharmacy when we order a prescription for you. Many
of the people who work for our practice — including,
but not limited to, our doctors and nurses — may use
or disclose your IIHI in order to treat you or to assist others
in your treatment. Additionally, we may disclose your IIHI
to others who may assist in your care, such as your spouse,
children or parents.
Finally, we may also disclose your IIHI to other health care
providers for purposes related to your treatment.
- Payment. Our practice may use and disclose
your IIHI in order to bill and collect payment for the services
and items you may receive from us. For example, we may contact
your health insurer to certify that you are eligible for benefits
(and for what range of benefits), and we may provide your
insurer with details regarding your treatment to determine
if your insurer will cover, or pay for, your treatment. We
also may use and disclose your IIHI to obtain payment from
third parties that may be responsible for such costs, such
as family members. Also, we may use your IIHI to bill you
directly for services and items. We may disclose your IIHI
to other health care providers and entities to assist in their
billing and collection efforts.
- Health Care Operations. Our practice may
use and disclose your IIHI to operate our business. As examples
of the ways in which we may use and disclose your information
for our operations, our practice may use your IIHI to evaluate
the quality of care you received from us, or to conduct cost-management
and business planning activities for our practice. We may
disclose your IIHI to other health care providers and entities
to assist in their health care operations.
- Treatment Options. Our practice may use
and disclose your IIHI to inform you of potential treatment
options or alternatives.
- Disclosures Required By Law. Our practice
will use and disclose your IIHI when we are required to do
so by federal, state or local law.
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USE AND DISCLOSURE
OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which
we may use or disclose your identifiable health information:
- Public Health Risks. Our practice may
disclose your IIHI to public health authorities that are
authorized by law to collect information for the purpose
of:
- Maintaining vital records, such as births and deaths
- Reporting child abuse or neglect
- Preventing or controlling disease, injury or disability
- Notifying a person regarding potential exposure to
a communicable disease
- Notifying a person regarding a potential risk for
spreading or contracting a disease or condition
- Reporting reactions to drugs or problems with products
or devices
- Notifying individuals if a product or device they
may be using has been recalled
- Notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or neglect
of an adult patient (including domestic violence); however,
we will only disclose this information if the patient
agrees or we are required or authorized by law to disclose
this information
- Notifying your employer under limited circumstances
related primarily to workplace injury or illness or
medical surveillance.
- Health Oversight Activities. Our practice
may disclose your IIHI to a health oversight agency for
activities authorized by law. Oversight activities can include,
for example, investigations, inspections, audits, surveys,
licensure and disciplinary actions; civil, administrative,
and criminal procedures or actions; or other activities
necessary for the government to monitor government programs,
compliance with civil rights laws and the health care system
in general.
- Lawsuits and Similar Proceedings. Our
practice may use and disclose your IIHI in response to a
court or administrative order, if you are involved in a
lawsuit or similar proceeding. We also may disclose your
IIHI in response to a discovery request, subpoena, or other
lawful process by another party involved in the dispute,
but only if we have made an effort to inform you of the
request or to obtain an order protecting the information
the party has requested.
- Law Enforcement. We may release IIHI
if asked to do so by a law enforcement official:
- Regarding a crime victim in certain situations, if
we are unable to obtain the person’s agreement
- Concerning a death we believe has resulted from criminal
conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court order, subpoena
or similar legal process
- To identify/locate a suspect, material witness, fugitive
or missing person
- In an emergency, to report a crime (including the
location or victim(s) of the crime, or the description,
identity or location of the perpetrator)
- Serious Threats to Health or Safety.
Our practice may use and disclose your IIHI when necessary
to reduce or prevent a serious threat to your health and
safety or the health and safety of another individual or
the public. Under these circumstances, we will only make
disclosures to a person or organization able to help prevent
the threat.
- Military. Our practice may disclose your
IIHI if you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate
authorities.
- National Security. Our practice may disclose
your IIHI to federal officials for intelligence and national
security activities authorized by law. We also may disclose
your IIHI to federal officials in order to protect the President,
other officials or foreign heads of state, or to conduct
investigations.
- Inmates. Our practice may disclose your
IIHI to correctional institutions or law enforcement officials
if you are an inmate or under the custody of a law enforcement
official. Disclosure for these purposes would be necessary:
(a) for the institution to provide health care services
to you, (b) for the safety and security of the institution,
and/or (c) to protect your health and safety or the health
and safety of other individuals.
- Workers’ Compensation. Our practice
may release your IIHI for workers’ compensation and
similar programs.
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YOUR RIGHTS
REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain
about you:
- Confidential Communications. You have
the right to request that our practice communicate with
you about your health and related issues in a particular
manner or at a certain location. For instance, you may ask
that we contact you at home, rather than work. In order
to request a type of confidential communication, you must
make a written request to the HIPAA Compliance Officer specifying
the requested method of contact, or the location where you
wish to be contacted. Our practice will accommodate reasonable
requests. You do not need to give a reason for your request.
- Requesting Restrictions. You have the
right to request a restriction in our use or disclosure
of your IIHI for treatment, payment or health care operations.
Additionally, you have the right to request that we restrict
our disclosure of your IIHI to only certain individuals
involved in your care or the payment for your care, such
as family members and friends. We are not required
to agree to your request; however, if we do agree,
we are bound by our agreement except when otherwise required
by law, in emergencies, or when the information is necessary
to treat you. In order to request a restriction in our use
or disclosure of your IIHI, you must make your request in
writing to the HIPAA Compliance Officer. Your request must
describe in a clear and concise fashion:
- The information you wish restricted;
- Whether you are requesting to limit our practice’s
use, disclosure or both;
- to whom you want the limits to apply.
- Inspection and Copies. You have the right
to inspect and obtain a copy of the IIHI that may be used
to make decisions about you, including patient medical records
and billing records, but not including psychotherapy notes.
You must submit your request in writing to the HIPAA Compliance
Officer in order to inspect and/or obtain a copy of your
IIHI. Our practice may charge a fee for the costs of copying,
mailing, labor and supplies associated with your request.
Our practice may deny your request to inspect and/or copy
in certain limited circumstances; however, you may request
a review of our denial. Another licensed health care professional
chosen by us will conduct reviews.
- Amendment. You may ask us to amend your
health information if you believe it is incorrect or incomplete,
and you may request an amendment for as long as the information
is kept by or for our practice. To request an amendment,
your request must be made in writing and submitted to the
HIPAA Compliance Officer. You must provide us with a reason
that supports your request for amendment. Our practice will
deny your request if you fail to submit your request (and
the reason supporting your request) in writing. Also, we
may deny your request if you ask us to amend information
that is in our opinion: (a) accurate and complete; (b) not
part of the IIHI kept by or for the practice; (c) not part
of the IIHI which you would be permitted to inspect and
copy; or (d) not created by our practice, unless the individual
or entity that created the information is not available
to amend the information.
- Accounting of Disclosures. All of our
patients have the right to request an "accounting of
disclosures." An "accounting of disclosures"
is a list of certain non-routine disclosures our practice
has made of your IIHI for non-treatment, non-payment or
non-operations purposes. Use of your IIHI as part of the
routine patient care in our practice is not required to
be documented. For example, the doctor sharing information
with the nurse; or the billing department using your information
to file your insurance claim. In order to obtain an accounting
of disclosures, you must submit your request in writing
to the HIPAA Compliance Officer. All requests for an "accounting
of disclosures" must state a time period, which may
not be longer than six (6) years from the date of disclosure
and may not include dates before April 14, 2003. The first
list you request within a 12-month period is free of charge,
but our practice may charge you for additional lists within
the same 12-month period. Our practice will notify you of
the costs involved with additional requests, and you may
withdraw your request before you incur any costs.
- Right to a Paper Copy of This Notice.
You are entitled to receive a paper copy of our notice of
privacy practices. You may ask us to give you a copy of
this notice at any time. To obtain a paper copy of this
notice, contact the HIPAA Compliance Officer.
- Right to File a Complaint. If you believe
your privacy rights have been violated, you may file a complaint
with our practice or with the Secretary of the Department
of Health and Human Services. To file a complaint with our
practice, contact the HIPAA Compliance Officer. All complaints
must be submitted in writing. You will not be penalized
for filing a complaint.
- Right to Provide an Authorization for Other Uses
and Disclosures. Our practice will obtain your
written authorization for uses and disclosures that are
not identified by this notice or permitted by applicable
law. Any authorization you provide to us regarding the use
and disclosure of your IIHI may be revoked at any time in
writing. After you revoke your authorization, we will no
longer use or disclose your IIHI for the reasons described
in the authorization. Please note, we are required to retain
records of your care.
Again, if you have any questions regarding this notice or
our health information privacy policies, please contact
the HIPAA Compliance Officer.
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