THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
A COPY OF THE EZRA MEDICAL CENTER PRIVACY PRACTICES NOTICE IS AVAILABLE IN THE CENTER’S ADMINISTRATION OFFICES.

OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain confidentiality of health information that identifies you. We also are required to by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By Federal and New York State law, we must follow the terms of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your IIHI
Your privacy rights in your IIHI
Our obligations concerning the use and disclosure of your IIHI
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. EZRA MEDICAL CENTER will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

Ezra Medical Center is permitted to make use and disclose of protected health information for treatment, payment and health care operations, as described in the following examples:

For treatment – Ezra Medical Center may use and disclose protected health information when making a referral to health care provider for specialty care or diagnostic services.
For payment – Ezra Medical Center may disclose protected health information for billing purposes as with Medicare or Medicaid or health plan.
For health care operations – Ezra Medical Center may disclose PHI to business associates who copy, maintain or create medical records off site. (i.e. electronic medical record creation).

Ezra Medical Center is permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization. Other uses and disclosures will be made only with the Individual’s written authorization, and the individual may revoke such authorization.

Ezra Medical Center intends to engage in one or more of the following activities:

Ezra Medical Center may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or patient.
Ezra Medical Center may contact the individual/Patient to raise funds for Ezra Medical Center; or
A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.
Ezra Medical Center may release your IIHI to a friend or a family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take a child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.

The Individual has the following rights regarding protected health information:

The right to request restrictions on certain uses and disclosures of protected health information. However, Ezra Medical Center is not required to agree to a requested restriction.
The right to receive confidential communications of protected health information, as applicable.
The right to inspect and copy protected health information, as provided in the Privacy Regulation.
The right to amend protected health information, as provided in the Privacy Regulation.
The right to receive an accounting of disclosures of protected health information.
The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.

Ezra Medical Center is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.

Ezra Medical Center will use and disclose your IIHI when we are required to do so by federal, state or local law.

Ezra Medical Center is required to abide by the terms of the Notice currently in effect.

Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information.

Ezra Medical Center reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.

Ezra Medical Center will provide individuals or patients with a revised Notice by publicly displaying revisions to the Privacy Policy.

Our practice may disclose your IIHI to health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, audits, surveys, licensure and disciplinary actions or other activities necessary to monitor government programs.

Practice may use or disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.

Ezra Medical Center may release IIHI if asked to do so by a law enforcement official, regarding a crime victim in certain situations, concerning a death we believe has resulted from criminal conduct, regarding criminal conduct at our offices, in response to a warrant, summons, court order or similar legal process.

Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.

Our practice may release your IIHI to organizations that handle organ, eye, or tissue procurement or transplantation.

Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies criteria. (see Privacy policy)

Individuals may complain to Ezra Medical Center and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. An individual may file a complaint, in writing to the:

Ezra Medical Center’s central contact person for matters relating to Privacy complaints:

Privacy Officer: David Friedman
718-686-7600
1312 38th Street, Brooklyn, NY 11218

Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.

Our practice may disclose your IIHI if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law.

Our practice may disclose your IIHI to correctional institutions or law enforcement official if you are an inmate or under custody of a law enforcement official.

Our practice may release your IIHI for workers’ compensation and similar programs.