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.
We are Committed to Your Privacy
Midtown Ophthalmology, P.C. is committed to maintaining the privacy of your
health information. We use a secure electronic health record to store your information. We will only use or disclose (share) your health information as described in this Notice. You will be asked to
sign an acknowledgement that you have received this Notice.
We reserve the right to change this notice at any time and to make the
revised or changed notice effective in the future. A copy of our current notice will always be in the waiting area. You may also obtain your own copy by accessing our website at
www.visionphysicians.com or calling the Privacy Officer at (212)687-0265.
Who Follows This Notice
All employees, medical staff, trainees, students, volunteers, and agents of
Midtown Ophthalmology, P.C. at our office location at 225 E 38th St. in Manhattan, NY follow these privacy practices. If our healthcare professionals provide you with treatment at other locations the
Notice of Privacy Practices you receive there will apply.
Using and Sharing Your Information
This section describes the different ways that we may use and share your
information. We will usually contact you for these purposes by phone, but if you have given us your email address or permission to send a text message, we may contact you that
We mainly use and share your information for treatment, payment, and health
care operation purposes. This means we use and share your health information: with other health care providers who are treating you or with a pharmacy that is filling your prescription; with your
insurance plan to collect payment for health care services or to get pre-approval for your treatment; and to run our business, improve your care, educate our professionals, and evaluate provider
performance. We may also disclose PHI to other providers involved in your treatment; including secure disclosures made electronically through a Health Information Exchange (“HIE”). For example: if
you receive a blood test from one provider in the HIE, but then are treated by a different provider - also in the same HIE - both of your treating providers can share your test result electronically
through the HIE network, as long as they are otherwise authorized to do so. If you opt-out of the HIE, your Protected Health Information will continue to used in accessed and released as needed to
provide treatment to you, but will not be made electronically available for such purpose through the HIE.
Sometimes we may share your information with our business associates, such
as a billing service, who help us with our business operations. All our business associates must protect the privacy and security of your health information just as we do.
We may also use or share your information to contact you: about
health-related benefits or services. about your upcoming appointments; to see if you would like to take part in research projects or about future fundraising for Midtown Ophthalmology,
You have the right to opt out of future fundraising communications. You can
do this by contacting us. 212-687-0265
If you do not wish to be notified of research projects you may be able to
participate in, you can contact us at 212-687-0265.
Special protections apply if we use or share sensitive health information.
This includes HIV related information, mental health information, alcohol or drug abuse treatment information, or genetic information. For example, under New York State Law, confidential HIV-related
information can only be shared with persons allowed to have it by law, or persons you have allowed to have it by signing a specific authorization form. If your treatment involves this information,
you may contact the Privacy Officer for further explanation.
We are also allowed, and sometimes required by law, to share your
information in other ways. We have to meet many conditions in the law before we can share your information for the following reasons. Some examples of each include:
Public health and safety: reporting diseases, births, or deaths; reporting
suspected abuse, neglect, or domestic violence; to avoid a serious threat to health or public safety; monitoring product recalls; and reporting information for safety and quality
Research: analyzing health record projects that have been approved by our
institutional review board (IRB) and are of low risk to your privacy; preparing for a research study; studies that only involve decedents’ information.
Judicial and administrative proceedings: responding to a court or
administrative order. Workers’ compensation and other government requests: workers’ compensation claims payment or hearings; health oversight agencies for activities authorized by law; special
government functions (military, national security).
Law enforcement: with a law enforcement official to identify or find a
suspect or missing person.
Comply with the law: to the Department of Health and Human Services to see
if we are complying with federal privacy law.
Disaster relief situation: sharing your location and general location for
the purpose of notifying your family, friends, and agencies chartered by law to assist in emergency situations.
To organizations that handle organ, tissue, or eye donation or
To a coroner, medical examiner, or funeral director as needed to do their
Health Information Exchange (HIE). Midtown Ophthalmology along with other
health care providers - participate in HIEs that allow patient information to be shared electronically. HIEs gives your health care providers who participate immediate electronic access to your
pertinent medical information necessary for treatment, payment and operations. If you do not opt-out of the HIE, your information will be available through the HIE to your authorized participating
providers in accordance with this Notice of Privacy Practices and the law. If you opt-out of the HIE, your Protected Health Information will continue to be used in accordance with this HIPAA Notice
and the law, but will not be made electronically available through the HIE.
Incidental to a permitted use or disclosure: calling your name in a waiting
area for an appointment and others in the waiting area may hear your name called. We make reasonable efforts to limit these incidental uses and disclosures.
In the following situations, we may use or share your information, unless
you object or if you specifically give us permission. If for some reasons you are not able to tell us your preferences, for example if you are unconscious, we may share your information if we believe
it is in your best interest: with your family, friends, or others involved in your care or payment for your care.
In the following situations, we will only use or share your information if
you give us permission:
For marketing purposes; Sale of your information or payments from a third
party; Most sharing of psychotherapy notes; Any other reasons not described in this Notice
You can revoke (take back) that permission, except when we have already
relied on it, by contacting the Privacy Officer.
When it comes to your health information, you have certain rights. You
Review or get an electronic or paper copy of your medical record, including
billing records. You may be charged a reasonable cost based fee which will not be higher than 75 cents per page for paper copies or a reasonable cost for the provision of electronic media for
electronic records (plus postage if you request your records to be mailed). Records will be provided within 10 days of your request. We will let you know about any delay. You may at some point in the
future access your health information directly using a secure patient portal.
Request confidential communications. You can ask us to contact you in a
certain way, for example, by cell phone. We will say “yes” to all reasonable requests.
Ask us to limit what we use or share for your treatment, payment, and
healthcare operations. We are not required to agree to your request, but we will review it. When you pay for services out-of-pocket, in full, and ask us not to share the information with your
insurance plan, we will agree unless a law requires us to share that information.
With regard to opting out of the HIE only, if you do not wish to allow
otherwise authorized doctors, nurses and other clinicians involved in your care to electronically share your Protected Health Information with one another through an HIE as explained in this HIPAA
Notice, you can complete, sign and submit a “Request for Restrictions” form to us, or by fax or mail and any Opt-Out selection that you make will be honored. Although opting out of the HIE will
prevent your information from being shared electronically through the HIE, it will not impact how your information is otherwise typically accessed and released in accordance with this HIPAA Notice
and the law.
Ask us to correct your medical record if it is inaccurate or incomplete. We
may say “no” to your request, but we will tell you why in writing within 60 days.
Get a list of those with whom we have shared information. You can ask
for a list (accounting) of the times we shared your information and why for the six years prior to your request.
Not all disclosures will be included in this list, such as those made
for treatment, payment, or health care operations. You have the right to get this list one time every 12 months without charge, but we may charge you for the cost of providing additional lists during
Get a copy of this privacy Notice. Just ask us and we will give you a copy
in the format you would like (paper or electronic).
Choose someone to act for you. This “personal representative” can exercise
your rights and make choices about your health information. Generally, parents and guardians of minors will have this right for the child, unless the minor is permitted by law to act on their own
File a complaint if you feel your rights have been violated. You may
contact the Midtown Ophthalmology Privacy Officer or the Secretary of the United States Department of Health and Human Services. We will not retaliate or take action against you for filing a
Request additional privacy protections with respect to your electronic
We are required by law to maintain the privacy of your protected health
We will notify you if a breach occurs that may have compromised the privacy
or security of your identifiable information.
We must follow the practices described in this Notice and give you a copy of
We reserve the right to change the terms of this Notice and the changes will
apply to all information we have about you. The new Notice will be available upon request and on our website at www.visionphysicians.com
Questions or Concerns
If you have a question or wish to exercise your rights described in this
Notice, please contact the Privacy Officer at: 225 E38th St New York, New York 10016, Attention: Privacy Officer, by phone to 1-212-687-0265.
Most requests to exercise your rights must be made in writing to the Privacy
Officer. For more information, contact the Privacy Officer at 212-687-0265
This Notice is effective as of 07/01/2018.