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WHY ARE YOU GETTING THIS NOTICE?
NYU Hospitals Center (referred to as “our Hospital” or “the
Hospital” in this notice) is required by federal and state law to
protect the privacy of health information that may reveal your identity.
We are also required to provide you with a copy of this notice. It describes
the health information privacy practices of our Hospital, our medical
staff, and affiliated health care providers who work together to provide
health care services with our Hospital.
We will ask you to sign an “acknowledgment” indicating that
you have been provided with this notice.
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WHO FOLLOWS THE POLICIES IN THIS NOTICE?
The privacy practices described in this notice are followed by:
•
Any health care professional who treats you at any of our Hospital
facilities
•
All employees, medical staff, trainees, students, and volunteers at
any of our Hospital facilities |
This notice refers to practices of our Hospital and medical
staff, while you are a patient in the Hospital. It also refers to outpatient
services such as day surgery and physical therapy. If you seek care in
your physician’s private practice, other policies may apply. In
addition, the privacy practices described in this notice do not apply
to members of our medical staff or other members of our workforce when
they treat you at other hospitals or facilities.
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WHAT HEALTH INFORMATION IS PROTECTED?
We are committed to protecting the privacy of information we gather about
you while providing health-related services. Some examples of protected
health information are:
•
Information indicating that you are a patient at the Hospital or that
you are receiving treatment or other health-related services from
our Hospital;
•
Information about your health condition (such as a disease you may
have);
•
Information about health care products or services you have received
or may receive in the future (such as an operation); or
•
Information about your health care benefits under an insurance plan
(such as whether a prescription is covered);
when combined with:
•Demographic
information (such as your name, address, or insurance status);
•
Unique numbers that may identify you (such as your social security
number, your phone number, or your driver’s license number);
or
•
Other types of information that may identify who you are. |
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SUMMARY OF THIS NOTICE
This summary includes references to paragraphs that you
may read for additional information.
1. Written Authorization Requirement.
We are generally required to obtain your written authorization before
we share your health information with others. However, we may use your
health information or share it with others in order to treat your condition,
obtain payment for that treatment, and run our business operations without
your written authorization. (See paragraph 1 on page 4—Treatment,
Payment, and Business Operations.)
2. Authorizing Transfer of Your Records.
You may request that we transfer your records to another person or organization
by completing a written authorization form. This form will specify what
information is being released, to whom, and for what purpose. The authorization
will have an expiration date.
3. Canceling Your Written Authorization.
If you provide us with written authorization, you may revoke, or cancel,
it at any time, except to the extent that we have already relied upon
it. To revoke a written authorization, please write to the Director, Department
of Medical Records.
4. Exceptions to Written Authorization Requirement.
There are some situations in which we do not need your written authorization
before using your health information or sharing it with others. They include:
•
Treatment, Payment, and Business Operations. As mentioned
above, we may use your health information or share it with others
in order to treat you, obtain payment for that treatment, and run
our business operations. (See paragraph 1 on page 4).
•
Patient Directory. If you do not object, we will
include information about you in our Patient Directory. Information
from the Patient Directory is given out when a person calls and asks
for you by name. (See paragraph 2a on page 5).
•
Family and Friends. If you do not object, we will
share information about your health with family and friends involved
in your care. (See paragraph 2b on page 5.).
•
Research. Although we will generally try to obtain your written
authorization before using your health information for research purposes,
there may be certain situations in which we are not required to obtain
your written authorization. (See paragraph 3 on page 6).
•
De-Identified Information. We may use or disclose
your health information if we have removed any information that might
identify you. When all identifying information is removed, we say
that the health information is “completely de-identified.”
We may also use and disclose “partially de-identified”
information if the person who will receive it agrees in writing to
protect your privacy when using the information. (See paragraph 4
on page 6.).
•
Emergencies or Public Need. We may use or disclose
your health information in an emergency or for important public health
needs. For example, we may share information about you with public
health officials at the New York State or city health departments
who are authorized to investigate and control the spread of diseases.
(See paragraph 6 on page 6.). |
5. How To Access Your Health Information.
You generally have the right to inspect and get copies of your health
information. (See paragraph 1 on page 8.).
6. How To Correct Your Health Information.
You have the right to request that we amend your health information if
you believe it is inaccurate or incomplete. (See paragraph 2 on page 9.)
7. How To Identify Others Who Have Received Your Health Information.
You have the right to receive an “accounting of disclosures.”
This is a report that identifies certain persons or organizations to which
we have disclosed your health information. All disclosures are made according
to the protections described in this Notice of Privacy Practices. Many
routine disclosures we make (for example, for treatment, payment, or businesss
operations) will not be included in this report. However, it will identify
any non-routine disclosures of your information. (See paragraph 3 on page
9.)
8. How to Request Additional Privacy Protections.
You have the right to request further restrictions on the way we use your
health information or share it with others. However, we are not required
to agree to the restriction you request. If we do agree with your request,
we will be bound by our agreement. (See paragraph 4 on page 11.)
9. How To Request More Confidential Communications.
You have the right to request that we contact you in a way that is more
confidential for you, such as at home instead of at work. We will try
to accommodate all reasonable requests. (See paragraph 5 on page 11.)
10. How Someone May Act On Your Behalf.
You have the right to name a personal representative who may act on your
behalf to control the privacy of your health information. Parents and
guardians will generally have the right to control the privacy of health
information of minors unless the minors are permitted by law to act on
their own behalf.
11. How to Learn about Special Protections for HIV, Mental Health,
and Genetic Information.
Special privacy protections apply to HIV-related information, mental health
information, psychotherapy notes, and genetic information. Some parts
of this general Notice of Privacy Practices may not apply to these types
of information. (See the Appendix on page 12.)
12. How To Obtain A Copy of This Notice.
If you have not already received one, you have the right to a paper copy
of this notice. You may request a paper copy at any time, even if you
have previously agreed to receive this notice electronically. Just call
our Privacy Officer at 212-263-8488. You may also obtain a copy of this
notice from our website at www.nyumedicalcenter.org or by requesting a copy at your
next visit.
13. How To Obtain A Copy of Revised Notice.
We may change our privacy practices from time to time. If we do, we will
revise this notice so you will have an accurate summary of our practices.
We will post any revised notice in our Hospital admitting area. You will
also be able to obtain your own copy of the revised notice by accessing
our website at www.nyumedicalcenter.org, or calling our Privacy Officer at 212-263-8488.
You may also ask for one at the time of your next visit. The effective
date of the notice is noted in the top right corner of the each page.
We are required to abide by the terms of the notice that is currently
in effect.
14. How To File A Complaint.
If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the United States Department
of Health and Human Services. To file a complaint with us, please write
to our Privacy Officer.
No one will retaliate or take action against you for filing
a complaint.
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HOW WE MAY USE AND DISCLOSE YOUR
HEALTH INFORMATION
1. Treatment, Payment, and Business Operations
We may use your health information or share it with others in order to
treat your condition, obtain payment for that treatment, and run our business
operations.
a. Treatment.
We may share your health information with doctors or nurses at the Hospital
who are involved in taking care of you. They may, in turn, use that information
to diagnose or treat you. A doctor at our Hospital may share your health
information with another doctor inside our Hospital, or with a doctor
at another hospital, to determine how to diagnose or treat you. We may
also share your health information with other doctors who referred you
to us and/or to whom you have been referred for further health care.
b. Payment.
We may use your health information or share it with others so that we
may obtain payment for your health care services. For example, we may
share information about you with your health insurance company. This will
help us obtain reimbursement after we have treated you, or determine whether
your health insurance will cover your treatment. We might also need to
inform your health insurance company about your health condition in order
to obtain pre-approval for your treatment, such as admitting you to the
Hospital for a particular type of surgery. Finally, we may share your
information with other health care providers and payers for their payment
activities.
c. Business Operations.
We may use your health information or share it with others in order to
conduct our business operations. For example, we may use your health information
to evaluate the performance of our staff in caring for you. We may also
use it to educate our staff or medical students and other health care
students on how to improve the care they provide for you. As part of the
affiliation between the Hospital and the School of Medicine, we may share
your health information with health care professionals, medical staff
members, employees, trainees, volunteers, and other staff members at the
NYU School of Medicine for joint training and education activities.
We may also share your health information with other health care providers,
who are required by federal law to protect the privacy of your health
information, to help them with their business operations. For example
we might share your insurance information with an ambulance service or
a doctor’s office if they need that information for their own quality
assessment purposes.
d. Appointment Reminders, Treatment Alternatives, Benefits,
and Services. In the course of providing treatment to you,
we may use your health information to contact you with a reminder that
you have an appointment for treatment or services at our facility. We
may also use your health information in order to recommend possible treatment
alternatives or health-related benefits and services that may be of interest
to you.
e. Fundraising.
To support our business operations, we may use demographic information
about you, in order to contact you to raise money to help us operate.
This may include information about your ageand gender, where you live
or work, and the dates that you received treatment. Because of the close
affiliation between the Hospital and the NYU School of Medicine, you may
be contacted by either the Hospital or the School.
f.
Business Associates.
We may disclose your health information to contractors, agents and other
business associates who need the information in order to assist us with
obtaining payment or carrying out our business operations. For example,
we may share your health information with a billing company that helps us
to obtain payment from your insurance company.
Another example is that we may share your health information with an insurance
company, law firm, or a risk management organization in order to obtain
professional advice about how to manage risk and legal liability, including
insurance or legal claims. We may also share your health information with
an accounting firm in order to obtain advice on legal compliance.
If we do disclose your health information to a business associate, we will
have a written contract to ensure that our business associate also protects
the privacy of your health information.
g. Communications Via E-Mail
In order to communicate information needed to treat you, obtain payment
for services, or conduct our business operations, our staff may communicate
information about you via email. However, you will not be contacted by email
unless we have obtained your permission to do so, or we are responding to
an inquiry that you initiated via email.
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2. Patient Directory/Family and Friends/ Clergy
We may use your health information in, and disclose it from, our Patient
Directory, or share it with family and friends involved in your care,
without your written authorization. We will give you an opportunity to
object unless there is insufficient time because of a medical emergency.
In a medical emergency, we will discuss your preferences with you as soon
as the emergency is over. We will follow your wishes unless we are required
by law to do otherwise.
a. Patient Directory.
If you do not object, we will include information about you in our patient
directory while you are a patient in the Hospital. This information will
include your name, your location in our facility, and your general condition
(e.g., fair, stable, critical, etc.). This directory information may be
released to people who ask for you by name. Your religious affiliation
may be given to a member of the clergy affiliated with the Hospital, such
as a priest or rabbi, so they may visit you if you wish. If you would
prefer not to be listed in the patient directory, please contact the Patient
Representative Department at 212-263-6900 between the hours of 9 a.m.
and 5 p.m., or the Patient Access (Admitting) Department at 212-263-5005
during all other hours.
b. Family and Friends Involved in Your Care.
If you do not object, we may share your health information with a family
member, relative, or close personal friend who is involved in your care
or payment for that care. We may also notify a family member, personal
representative, or another person responsible for your care about your
location and general condition here at the Hospital. In some cases, we
may need to share your information with a disaster relief organization
that will help us notify these persons.
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3. Research
In most cases, we will ask for your written authorization before using
your health information or sharing it with others in order to conduct
research. However, under some circumstances, we may use and disclose your
health information without your written authorization. To do this, we
are required to obtain approval through a special process to ensure that
research without your written authorization poses minimal risk to your
privacy. Under no circumstances, however, would we allow researchers to
use your name or identity publicly.
We may also release your health information without your written authorization
to people who are preparing a future research project, so long as any
information identifying you does not leave our
facility. In the unfortunate event of your death, we may share your health
information with people who are conducting research using the information
of deceased persons, as long as they agree not to remove from our facility
any information that identifies you.
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4. Completely De-identified or Partially De-identified Information.
We may use and disclose your health information if we have removed any
information that has the potential to identify you, so that the health
information is “completely de-identified.” We may also use
and disclose “partially de-identified” health information
about you if the person who will receive the information signs an agreement
to protect the privacy of the information as required by federal and state
law. Partially de-identified health information will not contain any information
that would directly identify you (such as your name, street address, social
security number, phone number, fax number, electronic mail address, website
address, or driver’s license number).
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5. Incidental Disclosures
While we will take reasonable steps to safeguard the privacy of your health
information, certain disclosures of your health information may occur
during or as an unavoidable result of our otherwise permissible uses or
disclosures of your health information. For example, during the course
of a treatment session, other patients in the treatment area may see,
or overhear discussion of, your health information.
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6. Public Need
a. As Required By Law.
We may use or disclose your health information if we are required by law
to do so. We also will notify you of these uses and disclosures if notice
is required by law.
b. Public Health Activities.
We may disclose your health information to authorized public health officials
(or a foreign government agency collaborating with such officials) so
they may carry out their public health activities. For example, we may
share your health information with government officials who are responsible
for controlling disease, injury, or disability.
We may also disclose your health information to a person who may have
been exposed to a communicable disease or be at risk for contracting or
spreading the disease, if a law permits us to do so. And finally, we may
release some health information about you to your employer if your employer
hires us to provide you with a physical exam. This could happen if we
were to discover that you have a work-related injury or disease that your
employer must know about in order to comply with employment laws.
c. Victims of Abuse, Neglect, or Domestic Violence.
We may release your health information to a public health authority that
is authorized to receive reports of abuse, neglect, or domestic violence.
For example, we may report your information to government officials if
we reasonably believe that you have been a victim of such abuse, neglect,
or domestic violence. We will make every effort to obtain your permission
before releasing this information, but in some cases we may be required
or authorized to act without your permission.
d. Health Oversight Activities.
We may release your health information to government agencies authorized
to conduct audits, investigations, and inspections of our facility. These
government agencies monitor the operation of the health care system, government
benefit programs such as Medicare and Medicaid, and compliance with government
regulatory programs and civil rights laws.
e. Product Monitoring, Repair, and Recall.
We may disclose your health information to a person or company that is
regulated by the Food and Drug Administration for the purpose of: (1)
reporting or tracking product defects or problems; (2) repairing, replacing,
or recalling defective or dangerous products; or (3) monitoring the performance
of a product after it has been approved for use by the general public.
f. Lawsuits and Disputes.
We may disclose your health information if we are ordered to do so by
a court or administrative tribunal that is handling a lawsuit or other
dispute.
g. Law Enforcement.
We may disclose your health information to law enforcement officials for
the following reasons:
•
To
comply with court orders or laws that we are required to follow;
•
To assist law enforcement officers with identifying or locating a suspect,
fugitive, witness, or missing person;
•
If you have been the victim of a crime and we determine that: (1) we have
been unable to obtain your general written consent because of an emergency
or your incapacity; (2) law enforcement officials need this information
immediately to carry out their law enforcement duties; and (3) in our
professional judgment disclosure to these officers is in your best interests;
•
If we suspect that your death resulted from criminal conduct;
•
If necessary to report a crime that occurred on our property; or
•
If necessary to report a crime discovered during an offsite medical emergency
(for example, by emergency medical technicians at the scene of a crime).
h. To Avert A Serious And Imminent Threat to Health or Safety.
We may use your health information or share it with others when necessary
to prevent a serious and imminent threat to your health or safety, or
the health or safety of another person or the public. In such cases, we
will only share your information with someone able to help prevent the
threat. We may also disclose your health information to law enforcement
officers: 1) if you tell us that you participated in a violent crime that
may have caused serious physical harm to another person (unless you admitted
that fact while in counseling), or 2) if we determine that you escaped
from lawful custody (such as a prison or mental health institution).
i. National Security and Intelligence Activities or Protective
Services.
We may disclose your health information to authorized federal officials
who are conducting national security and intelligence activities or providing
protective services to the President or other important officials.
j. Military and Veterans.
If you are in the Armed Forces, we may disclose health information about
you to appropriate military command authorities for activities they deem
necessary to carry out their military mission.
We may also release health information about foreign military personnel
to the appropriate foreign military authority.
k. Inmates and Correctional Institutions.
If you are an inmate, or if you are detained by a law enforcement officer,
we may disclose your health information to the prison officers or law
enforcement officers. This may happen if it is necessary to provide you
with health care, or to maintain safety, security, and good order at the
place where you are confined. This includes sharing information that is
necessary to protect the health and safety of other inmates or persons
involved in supervising or transporting inmates.
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7. Workers’ Compensation.
We may disclose your health information for workers’ compensation
or similar programs that provide benefits for work-related injuries.
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8. Coroners, Medical Examiners, and Funeral Directors.
In the unfortunate event of your death, we may disclose your health information
to a coroner or medical examiner. This may be necessary, for example,
to determine the cause of death. We may also release this information
to funeral directors as necessary to carry out their duties.
9. Organ and Tissue Donation.
In the unfortunate event of your death, we may disclose your health information
to organizations that procure or store organs, eyes, or other tissues
so that these organizations may investigate whether donation or transplantation
is possible under applicable laws.
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YOUR
RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION
We want you to know that you have the following rights to access and control
your health information. These rights are important because they will
help you make sure that the health information we have about you is accurate.
They may also help you control the way we use your information and share
it with others, or the way we communicate with you about your medical
matters.
1.
Your Right To Inspect and Obtain Copies of Your Records.
You have the right to inspect and obtain a copy of any of your health
information that may be used to make decisions about you and your treatment
for as long as we maintain this information in our records. This includes
medical and billing records.
a. How to Make Your Request.
To inspect or obtain a copy of your health information, please submit
your request in writing to the Director, Medical Records Department.
b. Cost.
If you request a copy of the information, we may charge a fee for the
costs of copying, mailing or other supplies we use to fulfill your request.
The standard fee is $0.75 per page and must generally be paid before or
at the time we give the copies to you.
c. Response Time.
We will respond to your request for inspection of records within 10 days.
We ordinarily will respond to requests for copies within 30 days if the
information is located in our facility and within 60 days if it is located
off-site at another facility. If we need additional time to respond to
a request for copies, we will notify you in writing within the time frame
above to explain the reason for the delay and when you can expect to have
a final answer to your request.
d. If Your Request is Denied.
Under certain very limited circumstances, we may deny your request to
inspect or obtain a copy of your information. If we do, we will provide
you with a summary of the information instead. We will also provide a
written notice that explains our reasons for providing only a summary
and a complete description of your rights to have that decision reviewed
and how you can exercise those rights. The notice will also include information
on how to file a complaint about these issues with us or with the Secretary
of the United States Department of Health and Human Services. If we have
reason to deny only part of your request, we will provide complete access
to the remaining parts after excluding the information we cannot let you
inspect or copy.
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2. Your Right To Amend Records.
If you believe that the health information we have about you 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 kept in our
records.
a. How to Make Your Request.
To request an amendment, please write to the Director, Medical Records.
Your request should include the reasons why you think we should make the
amendment.
b. Response Time.
Ordinarily we will respond to your request within 60 days. If we need
additional time to respond, we will notify you in writing within 60 days
to explain the reason for the delay and when you can expect to have a
final answer to your request.
c. If Your Request is Denied.
If we deny part or your entire request, we will provide a written notice
that explains our reasons for doing so. You will have the right to have
certain information related to your requested amendment included in your
records. For example, if you disagree with our decision, you will have
an opportunity to submit a statement explaining your disagreement, which
we will include in your records. We will also include information on how
to file a complaint with us or with the Secretary of the United States
Department of Health and Human Services. These procedures will be explained
in more detail in any written denial notice we send you.
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3.
Your Right To An Accounting Of Disclosures.
After April 14, 2003, you have a right to request an “accounting
of disclosures.” This report identifies certain other persons or
organizations to whom we have disclosed your health information. The accounting
does not include routine disclosures we have made for treatment, payment
and operations. It also does not include disclosures we have made with
your written authorization.
a. How to Make Your Request.
To request an accounting of disclosures, please write to the Director,
Medical Records Department. Your request must state a time period within
the past six years (but after April 14, 2003) for the disclosures you
want us to include. For example, you may request a list of the disclosures
that we made between January 1, 2004 and January 1, 2005.
b. Cost.
You have a right to receive one accounting every 12-months without charge.
However, we may charge you for the cost of providing any additional accounting
in that same 12-month period. We will always notify you of any cost involved
so that you may choose to withdraw or modify your request before any costs
are incurred.
c. Response Time.
Ordinarily we will respond to your request for an accounting within 60
days. If we need additional time to prepare the accounting you have requested,
we will notify you in writing about the reason for the delay and the date
when you can expect to receive the accounting. In rare cases, we may have
to delay providing you with the accounting without notifying you because
a law enforcement official or government agency has asked us to do so.
d. What is NOT Included in the Accounting of Disclosures?
An accounting of disclosures does not describe the ways that your health
information has been shared within and between the Hospital and the facilities
listed at the beginning of this notice. We are not required to include
this information as long as all other protections described in this Notice
of Privacy Practices have been followed.
An accounting of disclosures also does not include information about the
following disclosures:
•
Disclosures we made to you or your personal representative;
•
Disclosures we made pursuant to your written authorization;
•
Disclosures we made for treatment, payment, or business operations;
•
Disclosures made from the patient directory;
•
Disclosures made to your friends and family involved in your care or payment
for your care;
•
Disclosures that were incidental to permissible uses and disclosures of
your health information (for example, when information is overheard by
another patient passing by);
•
Disclosures of limited portions of partially de-identified information,
for purposes of research, public health, or our business operations;
•
Disclosures made to federal officials for national security and intelligence
activities;
•
Disclosures about inmates to correctional institutions or law enforcement
officers;
•
Disclosures made before April 14, 2003.
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4. Your Right To Request Additional Privacy Protections
You have the right to request that we further restrict the way we use
and disclose your health information to treat your condition, collect
payment for that treatment, or run our business operations. You may also
request that we limit how we disclose information about you to family
or friends involved in your care. For example, you could request that
we not disclose information about a surgery you had.
a. How to Make Your Request.
To request restrictions, please write to our Privacy Officer. Your request
should include (1) what information you want to limit; (2) whether you
want to limit how we use the information, how we share it with others,
or both; and (3) to whom you want the limits to apply.
b. We are Not Required to Agree.
We are not required to agree to your request for a restriction, and in
some cases the restriction you request may not be permitted under law.
However, if we do agree, we will be bound by our agreement unless the
information is needed to provide you with emergency treatment or comply
with the law. Once we have agreed to a restriction, you have the right
to revoke the restriction at any time. Under some circumstances, we will
also have the right to revoke the restriction as long as we notify you
before doing so. In other cases, we will need your permission before we
can revoke the restriction.
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5.
Your Right To Request Confidential Communications.
You have the right to request that we communicate with you about your
medical matters in a more confidential way by requesting that we communicate
with you by alternative means or at alternative locations. For example,
you may ask that we contact you at home instead of at work.
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How to Make Your Request.
To request more confidential communications, please write to the Director,
Patient Services Department. We will not ask you the reason for your request,
and we will try to accommodate all reasonable requests. Please specify
in your request how or where you wish to be contacted, and how payment
for your health care will be handled if we communicate with you through
this alternative method or location.
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REQUEST
FOR ACKNOWLEDGMENT
Please sign the Notice of Privacy Practices Acknowledgment on the following
page. By signing the Notice of Privacy Practices Acknowledgment, you acknowledge
that you have been provided a copy of the notice.
|
CONTACT
INFORMATION |
Address:
NYU Medical Center
550 First Avenue
New York, NY 10016
Be
sure to include the name of the department to which you are writing.
Phone and Fax Information:
Privacy
Officer:
Phone: 212-263-8488 Fax: 212-263-8437
Medical
Records Department:
Phone: 212-263-5497 Fax: 212-263-7665
Patient
Access (Admitting) Department:
Phone: 212-263-5005 Fax: 212-263-8960
Patient
Representative Department:
Phone: 212-263-6906 Fax: 212-263-8460 |
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APPENDIX:
CONFIDENTIALITY OF HIV-RELATED INFORMATION,
MENTAL HEALTH INFORMATION AND PSYCHOTHERAPY NOTES,
AND GENETIC INFORMATION
The privacy
and confidentiality of some types of information maintained by this Hospital
is protected by Federal and State law and regulations that go beyond the
protections described in this general Notice of Privacy Practices. This
information includes:
HIV-Related Information
Mental Health Information
Psychotherapy Notes
Genetic Information
If there is any conflict between the general Notice of Privacy Practices
and this notice, the protections described in this notice will apply instead
of the protections described in the general Notice of Privacy Practices.
HIV-RELATED
INFORMATION
Confidential HIV-related information is any information indicating that
you had an HIV-related test, have HIV-related illness or AIDS, or have
an HIV-related infection, as well as any information which could reasonably
identify you as a person who has had a test or has HIV infection.
Under New
York State law, confidential HIV-related information can only be given
to persons allowed to have it by law, or persons you have allowed to have
it by signing a specific authorization form. You can ask to see a list
of people who can be given confidential HIV-related information by law
without a specific authorization form.
With your
written consent, confidential HIV-related information about you may be
used by personnel within the Hospital who need the information to provide
you with direct care or treatment, to process billing or reimbursement
records, or to monitor or evaluate the quality of care provided at the
Hospital. Generally this Hospital may not reveal to a person outside of
the Hospital any confidential HIV-related information that the Hospital
obtains in the course of treating you, unless:
•
We obtain your written permission on a specific authorization form;
•The
disclosure is to a person who is authorized under applicable law to make
health care decisions on your behalf and the information disclosed is
relevant to those health care decisions;
•
The disclosure is for treatment or payment purposes, so long as the Hospital
has obtained your general consent to such disclosures;
•
The disclosure is to an external agent of the Hospital who needs the information
to provide you with direct care or treatment, to process billing or reimbursement
records, or to monitor or evaluate the quality of care provided at the
Hospital. In such cases, we will ordinarily obtain your general consent
and have an agreement with the agent to ensure that your confidential
HIV-related information is protected as required under
Federal and State confidentiality laws and regulations;
•
The disclosure is required by law or court order;
•
The disclosure is to an organization that procures body parts for transplantation;
•
You receive services under a program monitored or supervised by a federal,
state or local government agency and the disclosure is made to such government
agency or other employee or agent of the agency when reasonably necessary
for the supervision, monitoring, administration of provision of the program’s
services;
•
The Hospital is required under Federal or State law to make the disclosure
to a health officer;
•
The disclosure is required for public health purposes;
•
If you are an inmate at a correctional facility and disclosure of confidential
HIV-related information to the medical director of such facility is necessary
for the director to carry out his or her functions;
•
For decedents, the disclosure is made to a funeral director who has taken
charge of the decedent’s remains and who has access in the ordinary
course of business to confidential HIV-related information on the decedent’s
death certificate;
•
The disclosure is made to report child abuse or neglect to appropriate
State or local authorities.
Violation
of these privacy regulations may subject the Hospital to civil or criminal
penalties. Suspected violations may be reported to appropriate authorities
in accordance with Federal and State law.
MENTAL
HEALTH INFORMATION
With your written consent, mental health information about you may be
used by personnel within the Hospital (or its business associates) in
connection with their duties to provide you with treatment, obtain payment
for that treatment, or conduct the Hospital’s normal business operations.
Generally the Hospital may not reveal mental health information about
you to other persons outside of the Hospital, except in the following
situations:
•
When the Hospital has obtained your written permission on a specific authorization
form;
•
To a personal representative who is authorized to make health care decisions
on your behalf;
•
To government agencies or private insurance companies in order to obtain
payment for services we provided to you;
•
To comply with a court order;
•
To appropriate persons who are able to avert a serious and imminent threat
to the health or safety of you or another person;
•
To appropriate government authorities to locate a missing person or conduct
a criminal investigation as permitted under Federal and State confidentiality
laws and regulations;
•
To other licensed Hospital emergency services as permitted under Federal
and State confidentiality laws;
•
To the mental hygiene legal service offered by the State;
•
To attorneys representing patients in an involuntary hospitalization proceeding;
•
To authorized government officials for the purpose of monitoring or evaluating
the quality of care provided by the Hospital or its staff;
•
To qualified researchers without your specific authorization when such
research poses minimal risk to your privacy;
•
To coroners and medical examiners to determine cause of death; and
•
If you are an inmate, to a correctional facility which certifies that
the information is necessary in order to provide you with health care,
or in order to protect the health or safety of you or any other persons
at the correctional institution.
PSYCHOTHERAPY NOTES
Psychotherapy notes are notes by a mental health professional that document
or analyze the contents of a conversation during a private counseling
session – or during a group, joint, or family counseling session.
If these notes are maintained separate from the rest of your medical records,
they can only be used and disclosed as follows.
In general,
psychotherapy notes may not be used or disclosed without your special
written authorization, except in the following circumstances.
With your
general written consent, psychotherapy notes about you may be used and
disclosed in the following situations:
•
The mental health professional who created the notes may use them to provide
you with further treatment;
•
The mental health professional who created the notes may disclose them
to students, trainees, or practitioners in mental health who are learning
under supervision to practice or improve their skills in group, joint,
family, or individual counseling;
•
The mental health professional who created the notes may disclose them
as necessary to defend his or herself, or the Hospital, in a legal proceeding
initiated by you or your personal representative;
Psychotherapy
notes may be used and disclosed without your consent or other authorization
in the following situations to comply with the law or meet an important
public need:
•
The mental health professional who created the notes may disclose them
as required by law;
•
The mental health professional who created the notes may disclose the
notes to appropriate government authorities when necessary to avert a
serious and imminent threat to the health or safety of you or another
person;
•
The mental health professional who created the notes may disclose them
to the United States Department of Health and Human Services when that
agency requests them in order to investigate the mental health professional’s
compliance, or the Hospital’s compliance, with Federal privacy and
confidentiality laws and regulations; and
•
The mental health professional who created the notes may disclose them
to medical examiners and coroners if necessary to determine your cause
of death.
All other
uses and disclosures of psychotherapy notes require your special written
authorization.
GENETIC
INFORMATION
A genetic test means a laboratory test of human DNA, chromosomes, genes
or gene products to diagnose the presence of a genetic variation linked
to a predisposition to a genetic disease or disability in the individual
or the individual’s offspring. A genetic test does not include any
test of blood or other medically prescribed test in routine use that has
been or may be found to be associated with a genetic variation unless
it is conducted purposely to identify such genetic information.
All records,
findings and results of any genetic test performed on any person shall
be confidential and generally shall not be disclosed without the written
informed consent of the person to whom such genetic test relates.
With your
consent, the results of your genetic test may be disclosed to a health
insurer or health maintenance organization if the information disclosed
is reasonably required for purposes of claims administration. However,
any further distribution of the information within the insurer or to other
recipients will require your written consent in each case.
Information
derived from your genetic test may not be incorporated into the records
of a non-consenting individual who may be genetically related to you,
and no inferences may be drawn, used or communicated regarding the possible
genetic status of the non-consenting individual.
The results
of your genetic test may be disclosed to specified individuals without
your consent if such disclosure is required by a court order or otherwise
required or authorized by State law.
Your genetic
information shall not be released to any person or organization not specifically
authorized by you without additional written consent. The Hospital is
aware that an individual who might ordinarily be authorized to act as
your personal representative, such as your spouse or a parent, may not
be considered a personal representative for purposes of accessing your
genetic information. For example, if you have authority to provide written
consent on your own, your genetic information should not be released to
your parent or guardian unless you have specifically authorized such a
disclosure. If your parent or guardian is authorized under law to sign
the written consent form on your behalf, the results of the test may be
provided to him or her.
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HOW TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the Department of Health and
Human Services. To file a complaint with us, please contact our Privacy
Officer. No one will retaliate or take action against you for filing a
complaint.
If you experience
discrimination because of the release of confidential HIV-related information,
you may contact the New York State Division of Human Rights at (212) 566-8624
or the New York City Commission of Human Rights at (212) 566-5493. These
agencies are responsible for protecting your rights.
If you have
any questions about the policies in this Appendix or would like further
information, please contact our Privacy Officer at 212-263-8488.
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