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Notice of Privacy Practices

Title II – Administrative Simplification of the Health Insurance Portability and Accountability Act of 1996 defines any information that identifies a patient uniquely as protected health information.

 

PhysioAge Medical Group, in compliance with HIPAA Privacy Rule, has developed office policies and procedures which prevent any wrongful use or disclosure of your protected health information. Our privacy practices are outlined in this document.

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU

MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

 

PLEASE, REVIEW THIS NOTICE CAREFULLY.

 

TREATMENT:

Your protected health information may be used by our staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment.

 

PAYMENT:

Your protected health information may be used to seek payment for treatment from your from credit card companies. For example, we may be required to submit your telephone number together with your credit card number to the credit company in order to facilitate your payment.

 

HEALTHCARE OPERATIONS:

Your protected health information may be used as necessary to support the day-to-day activities and management of The Practice. For example, information on the services you received may be used to support budgeting and financial reporting, and activities intended to evaluate and promote quality.

 

LAW ENFORCEMENT:

Your protected health information may be disclosed to law enforcement agencies in compliance with possible government audits, inspections, or investigations.

 

PUBLIC HEALTH REPORTING:

Your protected health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.

 

OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

Disclosure of your protected health information or its use for any purpose other than those listed above, requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

 

APPOINTMENT REMINDERS:

As a matter of practice, we will use your protected health information to send you appointment reminders or contact you by phone for appointment confirmation. In case we are unable to reach you by telephone, we will leave a message on your answering machine. If such practice is unacceptable to you, please make suitable arrangements with our Privacy Compliance Officer.

 

Additional Uses of Information

 

INFORMATION ABOUT TREATMENTS:

Your protected health information may be used to send you information, which you may find to be of interest about the treatment and management of your medical condition. We may also send you information describing other health-related goods and service that we believe may interest you. If you wish to maintain privacy regarding the use of your name on postal labels, please make suitable arrangements with our Privacy Compliance Officer.

 

The Privacy Rule requires us to maintain the privacy of your protected health information and to provide you with this Notice of Privacy Practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.

 

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Regardless of the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.

 

Under the federal privacy standards, you have certain rights. These include:

 

  • The right to request restrictions on the use or disclosure of your protected health information
  • The right to receive confidential communications concerning your medical condition and treatment
  • The right to inspect and copy your protected health information
  • The right to amend or submit corrections to your protected health information
  • The right to receive an accounting of how and to whom your protected health information has been disclosed
  • The right to receive a printed copy of this notice

 

As required by federal regulation, your requests to inspect or copy protected health information must be submitted in writing. You may obtain a form to request access to your records by contacting our Receptionist or our Privacy Compliance Officer.

 

You have the right to amend your protected health information (PHI). Your request to amend information in your record must be submitted in writing. We will review your request and issue a decision:

 

  • If the Privacy Compliance Officer determines that the amendment you have requested should be made:

 

    1. Your records will be updated as required by federal regulations
    2. You will be notified in writing of any amendments made to your PHI

     

  • If the Privacy Compliance Officer determines that the information in our records is complete and accurate, your request will be denied:

 

    1. A written notice of this decision will be sent to you as required by federal regulations.
    2. You will have an opportunity to send us a written statement explaining your disagreement with this decision.  Your statement will be included in your records, along with any response that we believe is necessary to help future users of the information understand that information.
    3. You will be given a copy of any response that we include in the record.

     

Complaints

If you would like to submit a comment or a complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

 

Jerry Fortunato
Privacy Compliance Officer

PhysioAge Medical Group

30 Central Park South, Suite 8D

New York, NY 10019

If you believe that your privacy rights have been violated, you should bring the matter to our attention by sending a letter describing the cause of your concern to the same address.

 

You will not be penalized or otherwise retaliated against for filing a complaint.

 

Contact

The name and address of the person you can contact for further information concerning our privacy practices is:

 

Jerry Fortunato
Privacy Compliance Officer

PhysioAge Medical Group

30 Central Park South, Suite 8D

New York, NY 10019

(212) 888-7074

Effective Date

This Notice is effective on or after April 14, 2003.