Notice of Privacy Practices

Summary of Privacy Practices

In accordance with new HIPPA legislation all physicians’ offices are required to advise patients on how their medical records may be used and how we protect your information.  Our office staff has had training and received policies on protecting the privacy of all patient records.  This notice serves to summarize for you our privacy practices.  This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  If you would like to see our complete Notice of Privacy Practices or obtain a copy of it, please ask the office and it will be provided to you.  If you have any questions about this notice, contact our office.


  • We will not honor requests for medical records unless they are accompanied by a HIPAA Compliant Authorization signed by the patient (or guardian), unless required by law as described below.
  • We will not honor phoned in requests to discuss medical records with anyone but patient (or guardian) unless we have written authorization by the patient.
  • We will nor release “medical records to be picked up” to anyone but patient (or guardian) providing photo ID, unless we have written authorization by patient.

We do not sell your personal information to other companies for their independent marketing purposes.  In addition, we maintain physical, procedural and electronic safeguards to protect you against unauthorized use of your personal information.

Uses and Disclosures of Protected Health Information (PHI)

A – Treatment – We will use and disclose your PHI to provide, coordinate or manage your health care and any related service. (I.e. Other physicians treating you, specialists, labs, home health agencies)

B – Payment – Your PHI will be used, as needed, to obtain payment for healthcare services we provide, and to obtain authorization and approval for services you require.

C – Healthcare Options – We will call you by name in the waiting room.  We will use your PHI to call and remind you about appointments.  Your PHI may be shared with “business associates” (i.e. answering service, billing services).  In this instance your PHI will be protected from use for any purpose other than involvement in your current health problem with a contact between. 

Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object

Only PHI that is relevant to your healthcare will be disclosed.  Physician may, using professional judgment, to determine whether the disclosure is in your best interest.

A – Others Involved In Your Healthcare – Only with your permission, we may disclose to a member of your family, relative or close friend you identify your PHI that directly relates to that person’s involvement in your healthcare.

B – Emergencies – We may use or disclose your PHI in an emergency treatment situation and obtain your authorization as soon as possible afterwards.

Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

If required by law to disclose your PHI in response to a court order for legal proceedings, a law enforcement agency, a public health authority or other branch of government or to comply with worker’s compensation laws, disclosure of your PHI will be limited to relevant requirements of the law.

Your Rights

A – You have the right to inspect and copy your protected health information (PHI).

B – You have the right to request a restriction of your protected health information (PHI).  You may request any part of your PHI not be disclosed to family members who may be involved in your care.  Your written request to our Privacy Contact must state specific restriction requested and when it should apply.

C – You have the right to request to receive confidential communications from our office by alternative means or at an alternate location.  Request must be made in writing to our office.

D – You may have the right to request your physician amend your PHI.  We may or may not honor your request.  If you have a question about amending your medical record, contact our office.

E – You have the right to receive an accounting of certain disclosures we have made, if any, or your PHI.  If applies to disclosures for purposes other than treatment, payment or healthcare operations as described above.

Complaints You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our office of your complaint.  You may contact our Privacy Contact, Arnold S. Breitbart, MD