Notice of Privacy Practices
EMPIRE STATE COLON & RECTAL SURGERY, LLC
1928 Bay Avenue, Suite 200, Brooklyn, NY 11230
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This Notice will tell you about the ways we may use and disclose health information that identifies you (“Health Information”). We also describe your rights and certain obligations we have regarding the use and disclosure of Health Information. We are required by law to maintain the privacy of Health Information that identifies you; give you this Notice of our legal duties and privacy practices with respect to your Health Information and follow the terms of our Notice that are currently in effect. This Notice covers Empire State Colon & Rectal Surgery, LLC (“Empire”) including its healthcare providers and support staff.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe different ways that we may use and disclose Health Information.
For Treatment
We may use Health Information about you to provide you with medical treatment or services. We may disclose Health Information to doctors, nurses, technicians, or other personnel who are involved in taking care of you.
For Payment
We may use and disclose Health Information so that we may bill for treatment and services you receive at Empire and can collect payment from you, an insurance company or other third party. For example, we may need to give your health plan information about your treatment in order for your health plan to pay for such treatment. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. In the event a bill is overdue we may need to give Health Information to a collection agency as necessary to help collect the bill or may disclose an outstanding debt to credit agencies.
For Healthcare Operations
We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use Health Information to review the treatment and services you receive to check on the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians and other personnel for educational and learning purposes.
Appointment Reminders/Treatment Alternatives/Health Related Benefits and Services
We may use and disclose Health Information to contact you to remind you that you have an appointment for treatment or medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care
We may release Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location and general condition or disclose such information to an entity assisting in a disaster relief effort.
Research
Under certain circumstances, we may use and disclose Health Information for research purposes. Before we use or disclose Health Information for research, however, we will ask for your specific written permission if the researcher will have access to your name, address or other information that reveals who you are.
As Required by Law
We will disclose medical information about you when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to prevent the threat.
Business Associate
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation
If you are an organ donor, we may release Health Information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Worker’s Compensation
We may release Health Information for worker’s compensation or similar programs. Those programs provide benefits for work-related injuries or illness.
Public Health Risks
We may disclose Health Information for public health activities. These activities generally include disclosures to: a person subject to the jurisdiction of the Food and Drug Administration (“FDA”) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity; prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence and the patient agrees or we are required or authorized by law to make such disclosure.
Health Oversight Activities
We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, governmental programs, and compliance with civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law enforcement
We may release Health Information if asked by a law enforcement official for the following reasons: in response to a court order, subpoena, warrant, summons or similar process; limited information to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are able to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and in emergency circumstances to report a crime, the location of the crime or victims, or identity, description or location of the person who committed the crime.
National Security and Intelligence Activities and Protective Services
We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We also may disclose Health Information to authorized federal officials so they may conduct special investigations and provide protection to the President, other authorized persons and foreign heads of state.
Coroners, Medical Examiners and Funeral Directors
We may release Health Information to a coroner, medical examiner or funeral director so that they can carry out their duties.
How to Learn About Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information
Special privacy protections apply to HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. Some parts of this Notice may not apply to these types of information. If your treatment involves this information, you may contact our office for more information about the protections.
Other Uses of Health Information
Other uses and disclosures of Health Information not covered by this Notice or the laws that apply to us will be made only with written permission at any time by submitting a written request to our office, except to the extent that we acted in reliance on your permission.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights, subject to certain limitations, regarding Health Information we maintain about you.
Right to Inspect and Copy
You have the right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Request Amendments
If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information and you must tell us the reason for your request. You have the right to request an amendment for as long as the information is kept by or for Empire. A request for amendments must be submitted, in writing, to the office at the address provided in this Notice.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures” of Health Information. This is a list of certain disclosures we made of Health Information. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions
You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request unless we terminate our agreement or the information is needed to provide you with emergency treatment.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. You may request a copy of this Notice at any time from the office.
How to Exercise Your Rights
To exercise your rights described in this Notice, contact the office.
Changes to This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed notice effective for Health Information we already have as well as any information we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Empire or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
1928 Bay Avenue, Suite 200, Brooklyn, NY 11230
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This Notice will tell you about the ways we may use and disclose health information that identifies you (“Health Information”). We also describe your rights and certain obligations we have regarding the use and disclosure of Health Information. We are required by law to maintain the privacy of Health Information that identifies you; give you this Notice of our legal duties and privacy practices with respect to your Health Information and follow the terms of our Notice that are currently in effect. This Notice covers Empire State Colon & Rectal Surgery, LLC (“Empire”) including its healthcare providers and support staff.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe different ways that we may use and disclose Health Information.
For Treatment
We may use Health Information about you to provide you with medical treatment or services. We may disclose Health Information to doctors, nurses, technicians, or other personnel who are involved in taking care of you.
For Payment
We may use and disclose Health Information so that we may bill for treatment and services you receive at Empire and can collect payment from you, an insurance company or other third party. For example, we may need to give your health plan information about your treatment in order for your health plan to pay for such treatment. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. In the event a bill is overdue we may need to give Health Information to a collection agency as necessary to help collect the bill or may disclose an outstanding debt to credit agencies.
For Healthcare Operations
We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use Health Information to review the treatment and services you receive to check on the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians and other personnel for educational and learning purposes.
Appointment Reminders/Treatment Alternatives/Health Related Benefits and Services
We may use and disclose Health Information to contact you to remind you that you have an appointment for treatment or medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care
We may release Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location and general condition or disclose such information to an entity assisting in a disaster relief effort.
Research
Under certain circumstances, we may use and disclose Health Information for research purposes. Before we use or disclose Health Information for research, however, we will ask for your specific written permission if the researcher will have access to your name, address or other information that reveals who you are.
As Required by Law
We will disclose medical information about you when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to prevent the threat.
Business Associate
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation
If you are an organ donor, we may release Health Information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Worker’s Compensation
We may release Health Information for worker’s compensation or similar programs. Those programs provide benefits for work-related injuries or illness.
Public Health Risks
We may disclose Health Information for public health activities. These activities generally include disclosures to: a person subject to the jurisdiction of the Food and Drug Administration (“FDA”) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity; prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence and the patient agrees or we are required or authorized by law to make such disclosure.
Health Oversight Activities
We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, governmental programs, and compliance with civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law enforcement
We may release Health Information if asked by a law enforcement official for the following reasons: in response to a court order, subpoena, warrant, summons or similar process; limited information to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are able to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and in emergency circumstances to report a crime, the location of the crime or victims, or identity, description or location of the person who committed the crime.
National Security and Intelligence Activities and Protective Services
We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We also may disclose Health Information to authorized federal officials so they may conduct special investigations and provide protection to the President, other authorized persons and foreign heads of state.
Coroners, Medical Examiners and Funeral Directors
We may release Health Information to a coroner, medical examiner or funeral director so that they can carry out their duties.
How to Learn About Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information
Special privacy protections apply to HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. Some parts of this Notice may not apply to these types of information. If your treatment involves this information, you may contact our office for more information about the protections.
Other Uses of Health Information
Other uses and disclosures of Health Information not covered by this Notice or the laws that apply to us will be made only with written permission at any time by submitting a written request to our office, except to the extent that we acted in reliance on your permission.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights, subject to certain limitations, regarding Health Information we maintain about you.
Right to Inspect and Copy
You have the right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Request Amendments
If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information and you must tell us the reason for your request. You have the right to request an amendment for as long as the information is kept by or for Empire. A request for amendments must be submitted, in writing, to the office at the address provided in this Notice.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures” of Health Information. This is a list of certain disclosures we made of Health Information. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions
You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request unless we terminate our agreement or the information is needed to provide you with emergency treatment.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. You may request a copy of this Notice at any time from the office.
How to Exercise Your Rights
To exercise your rights described in this Notice, contact the office.
Changes to This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed notice effective for Health Information we already have as well as any information we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Empire or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.