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Notice of Privacy
Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 ("HIPAA")
is a federal program that requires that all medical records and other
individually identifiable health information used or disclosed by us in any
form, whether electronically, on paper, or orally, are kept properly
confidential. This Act gives you, the patient, significant new rights to
understand and control how your health information is used. "HIPAA"
provides penalties for covered entities that misuse personal health
information.
As required by "HIPAA", we have prepared this explanation of how
we are required to maintain the privacy of your health information and how we
may use and disclose your health information.
We may use and disclose your medical records only for each of the following
purposes: treatment, payment and health care operations.
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Treatment means providing, coordinating, or managing health care and
related services by one or more health care providers. An example of this
would include a physical examination.
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Payment means such activities as obtaining reimbursement for services,
confirming coverage, billing or collection activities, and utilization review.
An example of this would be sending a bill for your visit to your insurance
company for payment.
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Health care operations include the business aspects of running our
practice, such as conducting quality assessment and improvement activities,
auditing functions, cost-management analysis, and customer service. An example
would be an internal quality assessment review.
We may also create and distribute de-identified health information by
removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may
be of interest to you.
Any other uses and disclosures will be made only with your written
authorization. You may revoke such authorization in writing and we are
required to honor and abide by that written request, except to the extent that
we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health
information, which you can exercise by presenting a written request to the
Privacy Officer:
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The right to request restrictions on certain uses and disclosures of
protected health information, including those related to disclosures to family
members, other relatives, close personal friends, or any other person
identified by you. We are, however, not required to agree to a requested
restriction. If we do agree to a restriction, we must abide by it unless you
agree in writing to remove it.
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The right to reasonable requests to receive confidential communications of
protected health information from us by alternative means or at alternative
locations.
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The right to inspect and copy your protected health information.
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The right to amend your protected health information.
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The right to receive an accounting of disclosures of protected health
information.
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The right to obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health
information and to provide you with notice of our legal duties and privacy
practices with respect to protected health information.
This notice is effective April 14, 2003 and we are required to abide by the
terms of the Notice of Privacy Practices currently in effect. We reserve the
right to change the terms of our Notice of Privacy Practices and to make the
new notice provisions effective for all protected health information that we
maintain. We will post and you may request a written copy of a revised Notice
of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been
violated. You have the right to file a written complaint with our office, or
with the Department of Health & Human Services, Office of Civil Rights,
about violations of the provisions of this notice or the policies and
procedures of our office. We will not retaliate against you for filing a
complaint.
Please contact our Privacy Officer for more information:
Teri Manno 516-487-9454
If you believe your privacy rights have been violated and wish to file a
complaint with the practice's Privacy Officer, or with the Office for Civil
Rights, U.S. Department of Health and Human Services. The address for the OCR
is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
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