C. Your individual rights regarding your medical information
1. 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 our Privacy 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.
2. Request 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 case or disclosure of your IIHI, you must make your request in writing to our privacy officer. Your request must describe in a clear and concise fashion:
(a)the information you wish restricted;
(b)whether you are requesting to limit our practice’s use, disclosure or both; and
(c)to whom you want the limits to apply.
3. 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 our Privacy Officer, in order to inspect and/or obtain a copy of your request. Our practice may deny your request in 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.
You may ask us to amend you 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 our Privacy Officer. You must provide us with a season 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 us 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.
5. 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 of operations purposes. Use of your IIHI as part of routine patient care in our practice is not required to be documented. For example, the doctor shares information with the nurse; or the billing department uses your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to our policy officer. All requests for an “accounting of disclosures” must state a time period, which may not be longer than (6) years from the date of disclosure and may not include dates before 1/3/05. The first list you request within a 12 month period is free of charge, but our practice may charge for additional lists within the same 12 month period. Our practice will notify you of the costs involved and you may withdraw your request before you incur any costs.
6. Rights to a paper copy of this notice.
You are entitled to receive a paper copy of our notice 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 one of our receptionists.
7. 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 Department of Health and Human Services. To file a complaint with our practice; contact the Office Manager, Privacy Officer. All complaints must be submitted in writing. You will no longer use or disclose your IIHI for the reasons described in the 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 our privacy officer:
2001 Marcus Ave., Suite W285
Lake Success, NY 11042