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. If you have any questions about this notice, you may contact our Privacy Officer at 718-289-2107.
This notice describes how our facility, outpatient services any clinics associated with Parker Jewish Institute for Health Care and Rehabilitation uses and discloses our health information. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. Any health care professional authorized to enter information into your file or record and all employees, staff and other personnel will follow the terms of this notice. In addition, all Parker sites and locations may share medical information with each other for treatment, payment or for operations purposes described in this notice.
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care and services you receive in our facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care. We are required by law to:
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 about you as well as any information we receive in the future. We will post a copy of the current notice in our facility and post it on our website. The notice will contain the effective date. In addition, each time you are in our facility for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services. To file a complaint with our facility, contact the Privacy Officer at 718-289-2107. All complaints must be submitted in writing. If you require assistance with putting your complaint in writing, we will have a staff member assist you.
The following categories describe different ways that we use and disclose medical information. Each category of uses or disclosures will be explained but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment: We may use your health information to provide you with medical treatment or services. We may disclose information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you. Different departments of our practice also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside the nursing home who may be involved in your medical care, such as family members that have already obtained your permission to access your health information or others such as home care aides who provide services to you. When required to, we will obtain your authorization before disclosing any of your information. Except with regard to disclosures for treatment, only the minimally necessary information will be revealed during any disclosures.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you. We may also 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.
Healthcare Operations: We may use your health information or share it with others in order to conduct our business activities. These activities include, but are not limited to quality assessment activities, training of medical students, and marketing. Except where a health care provider discusses certain products or services with you in connection with your care and treatment. Parker must obtain your prior permission to market products and services.
Appointment Reminders: We may also use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information to the persons you placed on your notification list. These names may include friends or family members who are involved in your medical care or someone who helps pay for your care. When allowed, we may also tell your family or friends your condition. In addition, we may disclose minimally necessary medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: All research projects are subject to a special approval process. Before we use or disclose medical information to conduct research, you must sign a research authorization form.
As Required By Law: We will disclose minimally necessary medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose minimally necessary medical information about you 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, would only be to someone able to help prevent the threat.
Fundraising: We may use or disclose demographic information (such as name and mailing address) and the dates that you received treatment at Parker, as necessary, to contact you or your family for fundraising activities benefiting the Institute. If you or your family do not wish to receive these materials, you may opt out of receiving future fundraising communications as instructed on each correspondence.
Organ and Tissue Donation: If you are an organ donor, we may release minimally necessary medical information about you 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 minimally necessary information about you as required by military command authorities. We may also release medical information about you to a foreign military authority, if you are a member of a foreign military authority.
Workers’ Compensation: We may release minimally necessary medical information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. State and/or federal law control the release of such information.
Public Health Risks: We may disclose minimally necessary medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities: We may disclose minimally necessary medical 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, government programs, and compliance with civil rights laws.
Lawsuits and Disputes: We may disclose medical information about you in response to a subpoena, discovery request, or other lawful process if a court orders us to do so. If the request for your records is not court-ordered, we may release your records only after we determine 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 minimally necessary medical information about you if asked to do so by a law enforcement official:
Medical Examiners and Funeral Directors: We may also release minimally necessary medical information about you to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release minimally necessary medical information about patient/residents to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release minimally necessary medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
You have the following rights regarding medical information we maintain about you:
Inspect and Obtain a Copy: You have the right to inspect and to obtain a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and/or to obtain a copy of medical information that may be used to make decisions about you, you must complete Parker’s Form ADM.001 – “Authorization to Release Health Information” or OCA Official form 960 “Authorization for the Release of Health Information Pursuant to HIPPA” and submit your written request to the Medical Records Department. In addition, if you wish to obtain a copy of your medical records, Parker may charge a fee for the costs of copying as defined by Section 18 of the New York State Public Health Law and a fee for postage if you request the information to be mailed.
Amend Your Medical Information: If you feel that any of the medical information we create is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is maintained by our facility. To request an amendment, your request must be made in writing and submitted to the Medical Records Department. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we have made of your medical information. We are not required to account for routine disclosures, including disclosures to you or disclosures you have authorized. To request this accounting of disclosures, you must submit your request in writing, to the Medical Records Department. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a twelve-month period will not include a cost of providing the disclosure list. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
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 at work or by mail. To request confidential communications, you must make your request in writing to the Medical Records Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Receive a Copy of This Notice: You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time. To request a copy of this notice, you must make your request in writing to the Privacy Officer.
Request Restrictions: Even though it is Parker’s policy to make only minimally necessary disclosures of your medical information, you have the right to request a restriction or limitation on information we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose to someone who is involved in your care or for the payment of your bill, except those physicians or other health care personnel who are currently treating you and who require medical information to do so. Finally, you have the right to request a restriction on the people who are able to obtain the information we disclose. However, 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 emergency treatment to you.
Parker Jewish Institute for Health Care and Rehabilitation is not required to agree to your request of restrictions. However, we will try to accommodate all reasonable requests. Unless you object, a directory list containing your name, location, and general status will be created for disclosures to any member of the public asking for you by name and to the clergy of your religious preference, unless you include the clergy in your request for restrictions.
You may obtain a ”Request for Restriction” form by contacting our Privacy Officer at 718-289-2107 or asking the Social Work Staff.
271-11 76th Avenue, New Hyde Park, New York 11040-1433 | Tel: 718-289-2100 • 516-247-6500 | Fax: 718-289-2245