Effective April 14, 2003
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
We are required by law to protect the privacy of health information that may reveal your identity, and to provide you with a copy of this notice which describes the health information privacy practices of our physician private practice (“practice” or “office”) and its staff. A copy of our current notice will always be posted in our reception area. You will also be able to obtain your own copy by HERE or calling our office at (212) 570-6800 or by asking for one at the time of your next visit.
If you have any questions about this notice or would like further information, please contact our Privacy Officer at (212) 570-6800.
WHAT HEALTH INFORMATION IS PROTECTED
We are committed to protecting the privacy of information we gather about you while providing you with health care. Some examples of protected health information are:
” information indicating that you are a patient of our practice or receiving treatment or other health-related services from us;
” information about your health condition (such as a disease you may have);
” information about health care products or services you have received or may receive in the future (such as an operation or a CT scan); or
” information about your health care benefits under an insurance plan (such as whether a prescription is covered);
when combined with:
” demographic information (such as your name, address, or insurance status);
” unique numbers that may identify you (such as your social security number, your phone number, or your driver’s license number); or
” other types of information that may identify who you are.
REQUIRED PERMISSIONS TO USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We will obtain a one-time general written consent to use and disclose your health information in order to treat you, obtain payment for that treatment, and conduct our business operations. This general written consent will be obtained the first time we provide you with treatment or services. This general written consent is a broad permission that does not have to be repeated each time we provide treatment or services to you.
We will generally obtain your written authorization before using your health information or sharing it with others outside of our practice. You may also ask that we transfer your records to another person by completing a written authorization form. If you provide us with written authorization, you may revoke that written authorization at any time, except to the extent that we have already relied upon it or taken action to do what you asked us to do. To revoke a written authorization, please write to our Privacy Officer at New York Urological Associates, P.C., 245 East 54th Street #2N, New York, N.Y. 10022.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
With your general written consent, we may use your health information or share it with others in order to treat your condition, obtain payment for that treatment, and run our business operations. In some cases, we may also disclose your health information for payment activities and certain business operations of another health care provider or payor. Below are further examples of how your information may be used and disclosed for these purposes.
- Treatment, Payment And Business Operations
- Emergencies Or Public Need
- Incidental Disclosures
YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION
We want you to know that you have the following rights to access and control your health information. These rights are important because they will help you make sure that the health information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your medical matters.
- Right To Inspect And Copy Records
- Right To Amend Records
- Right To An Accounting Of Disclosures
- Right To Request Additional Privacy Protections
- Right To Request Confidential Communications
- Right To Have Someone Act On Your Behalf
- Right To Obtain A Copy Of Notices
- Right To File A Complaint
- How To Learn About Special Protections For HIV, Alcohol and Substance Abuse, Mental Health, And Genetic Information