Upper West Side Endoscopy

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Patient Privacy

NOTICE OF PRIVACY PRACTICES 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. 

PELASE REVIEW IT CAREFULLY. 

State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with the Notice. We must follow the privacy practices as described below. This Notice will take effect on 1/1/2019 and will remain in effect until it is amended or replaced by us. 

It is our right to change our privacy practices provided law permits the changes. Before we make a significant change, this Notice will be amended to reflect the changes and we will make the new Notice available upon request. We reserve the right to make any changes in our privacy practices and the new terms of our Notice effective for all health information maintained, created and/or received by us before the date changes were made. 

You may request a copy of our Privacy Notice at any time by contacting our Privacy Officer, Stephanie Porter. Our information on contacting us can be found at the end of this Notice. 

TYPICAL USES AND DISCLOSURES OF HEALTH INFORMATION 

We will keep your health information confidential, using it only for the following purposes: 

Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary” or “need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement. 

Disclosure: We may disclose and/or share your healthcare information with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends and/or other persons you choose to involve in your care, only if you agree that we may do so. 

Payment: we may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business office staff and may include insurance organization s or other businesses that may become involved in the process of mailing statements and/or collecting unpaid balances. 

Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of any emergency involving your care, your location, your general condition or death. If at all possible, we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated, we will use our professional judgement to disclose only that information directly relevant to your care. We will also use our professional judgement to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, x-rays or other similar forms of health information and/or supplies, unless you have advised us otherwise. 

Healthcare Operations: We will use and disclose your health information to keep our practice operable. Examples of personnel who have access to this information include, but are not limited to, our medical records staff, outside health or management reviewers, and individuals performing similar activities. 

Required by Law: We may use or disclose your health information when we are required to do so by law (court or administrative orders, subpoena, discovery request, or other lawful process). We will use and disclose your information when requested by national security, intelligence and other State and Federal officials and/or if you are in an inmate or otherwise under the custody of law enforcement. 

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence, or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others. 

Public Health Responsibilities: We will disclose your healthcare information to report problems with products, reactions to medication, product recalls, disease/infection exposure, and to prevent and control disease, injury and/or disability. 

Marketing Health Related Services: We will not use your health information for marketing purposes unless we have your written authorization to do so. 

National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.

HIPPAA Notice of Privacy Practices
This form does not constitute legal advice and covers only federal, not state, law 

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including, but not limited to voicemail messages, postcards or letters. 

YOUR PRIVACY RIGHTS AS OUR PATIENT 

Access: Upon written request, you have the right to inspect and receive copies of your health information (and that of an individual for whom you are a legal guardian). There will be some limited exceptions. If you with to examine your health information, you will need to complete and submit an appropriate request form. Contact our Privacy Officer for a copy of the Request Form. You may also request access by sending us a letter to the address at the end of this Notice. Once approved, an appointment can be made to review your records. Copies, if requested, will be $0 for each page and the staff time charged will be $0 per hour including the time required to locate and copy your health information. If you want the copies mailed to you, postage will also be charged. If you prefer a summary or an explanation of your health information, we will provide it for a fee. Please contact our Privacy Officer for a fee and/or explanation of our fee structure. 

Amendment: You have the right to amend your healthcare information, if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, you request may be denied. 

Non-Routine Disclosures: You have the right to receive a list of non-routine disclosures we have made of your health care information. When we make a routine disclosure of your information to a professional for treatment and/or payment purposes, we do not keep a record of routine disclosures: therefore, these are not available. You have the right to a list of instances in which we, or our business associates, disclosed information for reasons other than treatment, payment or healthcare operations. You can request non-routine disclosures going back years starting on April 14, 2003. Information prior to that date would not have to be released. Example: if you request information on May 15, 2004, the disclosure period would start on April 14, 2003 up to May 14, 2004. Disclosures prior to April 14, 2003 do not have to made available. 

Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We do not have to agree to these additional restrictions, but if we do, we will abide by our agreement (except in emergencies). Please contact our Privacy Officer if you want to further restrict access to your health information. This request must be submitted in writing 

QUESTIONS AND COMPLAINTS 

You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you may complain to us in writing. Request a Complaint Form from our Privacy Officer. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. 

HOW TO CONTACT US 

Practice Name: Upper West Side Endoscopy Center
Privacy Officer: Stephanie Porter
Telephone: 1-914-677-0200

Address: 230 W 74th St., New York, NY 10023

HIPPAA Notice of Privacy Practices
This form does not constitute legal advice and covers only federal, not state, law