Dear Valued Patient,

This notice describes the office policy for how medical information about you may be used and disclosed, how you can get access to this information, and how your privacy is being protected.

In order to maintain the level of service that you expect from our office and we expect from those who entrust their care to us, we may need to share limited personal medical and financial information with your insurance company, with Worker’s Compensation (and your employer as well in this instance), or with other medical practitioners that you authorize.

Safeguards in place at the office include:

  • Limited access to facilities where information is stored.
  • Policies and procedures for handling information.
  • Requirements for third parties to contractually comply with privacy laws.
  • All medical files and records (including email, regular mail, telephone, and faxes sent) are kept on permanent file.

Types of information that we gather and use

In administering your health care, we gather and maintain information that may include non-public personal information:

  • About your financial transactions with us (billing transactions).
  • From your medical history, treatment notes, all test results, and any letters, faxes, emails or telephone conversations to or from other health care practitioners.
  • From health care providers, insurance companies, workman’s comp and your employer, and other third part administrators (e.g. requests for medical records, claim payment information).
  • In certain states, you may be able to access and correct personal information we have collected about you, (information that can identify you - e.g. your name, address, etc.).

I value our relationship, and respect your right to privacy. If you have questions about the privacy guidelines, please call me during regular business hours (Mon - Friday, 10am - 6pm) at (917) 207-9715.

In good health!

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