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.
In this Notice, we use terms like "we," "us" or "our" to refer to NYOH, its physicians, employees, staff and other personnel. All of the sites and locations of NYOH follow the terms of this Notice and may share health information with each other for treatment, payment or health care operations purposes as described in this Notice.
Purpose of this Notice
This Notice describes how we may use and disclose your health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also outlines our legal duties for protecting the privacy of your health information and explains your rights to have your health information protected. We will create a record of the services we provide you, and this record will include your health information. We need to maintain this information to ensure that you receive quality care and to meet certain legal requirements related to providing you care. We understand that your health information is personal, and we are committed to protecting your privacy and ensuring that your health information is not used inappropriately.
We are required by law to maintain the privacy of your health information and provide you notice of our legal duties and privacy practices with respect to your health information. We are also required to notify you of a breach of your unsecured protected health information. We will abide by the terms of this Notice.
How We May Use or Disclose Your Health Information
The following categories describe examples of the way we use and disclose health information:
For Treatment: We may use and disclose your health information to provide you with medical treatment or services. For example, your health information will be disclosed to the oncology nurses who participate in your care. We may disclose your health information to another oncologist for the purpose of a consultation. We may also disclose your health information to your primary care physician or another healthcare provider to be sure those parties have all the information necessary to diagnose and treat you.
For Payment: We may use and disclose your health information to others so they will pay us or reimburse you for your treatment. For example, a bill may be sent to you, your insurance company or a third party payer. The bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your health plan will cover the treatment. With your permission, we may share your health information with pharmaceutical company patient assistance programs and patient support organizations in order to assist you in obtaining payment for your care or payment for certain parts of your care.
For Health Care Operations: We may use and disclose your health information in order to support our business activities. For example, we may use your health information for quality assessment activities, training of medical students, necessary credentialing, and for other essential activities.
We may ask you to sign your name to a sign-in sheet at the registration desk and we may call your name in the waiting room when we call you for your appointment.
We may disclose your health information to a third party that performs services, such as billing and collection, on our behalf. In these cases, we will enter into a written agreement with the third party to ensure they protect the privacy of your health information.
Individuals Involved in Your Care or Payment for Your Care: If you agree to the use or disclosure and in certain other situations, we may make the following uses and disclosures of your health information. We may disclose to a family member, close personal friend, or anyone else whom you identify who is involved in your medical care or who helps pay for your care health information relevant to that person's involvement in your care or paying for your care. If you would like us to refrain from releasing your health information to a family member or friend, please notify the NYOH Privacy Officer at (518) 373-3919. We may also make these disclosures after your death, unless doing so is inconsistent with any prior expressed preference made by you that is known to us.
We may use or disclose your health information to notify or assist innotifying a family member, personal representative or any other person responsible for your care regarding your physical location within the Practice, general condition or death. We may also disclose your health information to disaster relief organizations so that your family or other persons responsible for your care can be notified about your condition, status and location.
We are also allowed, to the extent permitted by applicable state and federal law, to use and disclose your health information without your authorization for the following purposes:
As Required by Law: We may use and disclose your health information when required to do so by federal, state or local law.
Judicial and Administrative Proceedings: If you are involved in a legal proceeding, we may disclose your health information in response to a court or administrative order. We may also release your 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, and only if authorized by applicable state and federal law.
Health Oversight Activities: We may use and disclose your health information to health oversight agencies for activities authorized by law. These oversight activities are necessary for the government to monitor the health care system, government benefit programs, compliance with government regulatory programs, and compliance with civil rights laws.
Law Enforcement: We may disclose your health information, within limitations, to law enforcement officials only when authorized by applicable state and federal law.
Public Health Activities: If authorized by applicable state and federal law, we may use and disclose your health information for public health activities, including the following:
Serious Threat to Health or Safety: If there is a serious threat to your health or safety or the health or safety of the public or another person, we may use and disclose your health information to someone able to help prevent the threat or as necessary for law enforcement authorities to identify or apprehend an individual, as authorized by applicable state and federal law.
Organ Tissue Donation: If you are an organ donor, we may use and disclose your health information to organizations that handle procurement, transplantation or banking of organs, eyes or tissues as authorized by applicable state and federal law.
Coroners. Medical Examiners, and Funeral Directors: We may use and disclose health information to a coroner or medical examiner as authorized by applicable state and federal law. This disclosure may be necessary to identify a deceased person or determine the cause of death. We may also disclose health information, as necessary and as authorized by applicable state and federal law, to funeral directors to assist them in performing their duties.
Workers' Compensation: We may disclose your health information as authorized by and to the extent necessary to comply with laws related to workers' compensation or similar programs that provide benefits for work-related injuries or illness.
Victims of Abuse. Neglect. or Domestic Violence: We may disclose health information to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by applicable state and federal law.
Military and Veterans Activities: If you are a member of the Armed Forces, we may disclose your health information to military command authorities as authorized by applicable state and federal law. Health information about foreign military personnel may be disclosed to foreign military authorities as authorized by applicable state and federal law.
National Security and Intelligence Activities: As authorized by applicable state and federal law, we may disclose your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others: As authorized by applicable state and federal law, we may disclose your health information to authorized federal officials so they may provide protective services for the President and others, including foreign heads of state.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information, as authorized by applicable state and federal law, to the correctional institution or law enforcement official to assist them in providing you health care, protecting your health and safety or the health and safety of others, or for the safety of the correctional institution.
Research: As authorized by applicable state and federal law, we may use and disclose your health information for certain limited research purposes without your authorization. For example, we might use some of your health information to decide if we have enough patients to conduct a cancer research study. For certain research activities, an Institutional Review Board (IRB) or Privacy Board may approve uses and disclosures of your health information without your authorization. We may disclose your health information to people preparing to conduct a research project; for example, to help them look for patients with specific medical needs, so long as the health information they review does not leave the Practice.
Other Uses and Disclosures of Your Health Information: Other uses and disclosures of your health information not covered by this Notice or the laws that apply to us will be made only with your authorization. Some examples include:
If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information as specified by the revoked authorization, except to the extent that we have taken action in reliance on your authorization.
Your Rights Regarding Your Health Information
You have the following rights regarding health information we maintain about you:
Right to Reguest Restrictions: You have the right to request restrictions on how we use and disclose your health information for treatment, payment or health care operations. In most circumstances,we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing and submit it to our NYOH Privacy Officer at 449 Route 146, Suite 101, Clifton Park, NY 12065. We are required to agree to a request that we restrict a disclosure made to a health plan for payment or health care operations purposes that is not otherwise required by law, if you, or someone other than the health plan on your behalf, paid for the service or item in question out-of-pocket in full.
Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain manner or at a certain location regarding the services you receive from us. For example, you may ask that we only contact you at work or only by mail. To request confidential communications, you must make your request in writing and submit it to our NYOH Privacy Officer at 449 Route 146,Suite 101, Clifton Park, NY 12065. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests.
Right to Inspect and Copy: Except in limited circumstances, you have the right to inspect and copy health information that may be used to make decisions about your care. To inspect and copy your health information, you must make your request in writing by filling out the appropriate form provided by us and submitting it to NYOH Privacy Officer at 449 Route 146, Suite 101, Clifton Park, NY 12065. You may request access to your health information in a certain electronic form and format and access may be granted in that requested form and format if it is readily producible, or, if not readily producible, in a mutually agreeable form and format. Further, you may request in writing that we transmit a copy of your health information to any person or entity you designate. Your written, signed request must clearly identify such designated person or entity and where you would like us to send the copy. If you request a copy of your health information, we may charge a cost-based fee for the labor, supplies, and postage required to meet your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed by a licensed health care professional chosen by us. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that your health information is incorrect or incomplete, you may request that we amend your information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request in writing by filling out the appropriate form provided by us and submitting it to NYOH Privacy Officer at 449 Route 146, Suite 101, Clifton Park, NY 12065.
We may deny your request for an amendment. If this occurs, you will be notified of the reason for the denial and given the opportunity to file a written statement of disagreement with us.
Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures we make of your health information. Please note that certain disclosures, such as those made for treatment, payment or health care operations, need not be included in the accounting we provide to you.
To request an accounting of disclosures, you must make your request in writing by filling out the appropriate form provided by us and submitting it to our NYOH Privacy Officer at 449 Route 146, Suite 101, Clifton Park, NY 12065. Your request must state a time period which may not be longer than six years, and which may not include dates before April 4, 2003. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact our NYOH Privacy Officer at (518) 373-3919. You may also obtain a paper copy of this Notice at our website, www.nyohpc.com.
Right to Complain: If you have any questions about this Notice or would like to file a complaint about our privacy practices, please direct your inquiries to: NYOH Privacy Officer at 449 Route 146, Suite 101, Clifton Park, NY 12065 (518) 373-3919. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be retaliated against or penalized for filing a complaint.
Changes to this Notice
We reserve the right to change the terms of this Notice at any time. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. We will post a copy of the current Notice in all Waiting Areas and Treatment Rooms. Each version of the Notice will have an effective date listed on the first page. Updates to this Notice are also available at our website, www.nyohpc.com.