This notice describes how your medical information may be used and disclosed and how you can get access to this information. If you have any questions about this notice, please contact the Practice Administrator at 718-340-3611.
This notice will tell you about the ways we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
All of the employees, staff, including medical staff, and other personnel of The Kofinas Fertility Group and entities involved in the organized healthcare arrangement follow these privacy practices. Everyone on our staff is required to sign a confidentiality statement.
The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within or more one of the categories.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Hospital personnel who are involved in taking care of you.
Different departments of the Hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We may also disclose medical information about you to people outside the Practice who may be involved in your medical care.
For Payment: We may use and disclose medical information about you so that we may bill for treatment and services you receive at the Practice. For example, we may need to give information about surgery you received at the Hospital to your health plan so that the plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may also disclose information about you to other healthcare facilities for purposes of payment as permitted by law.
For Healthcare Operations: We may use and disclose medical information about you for operations of the Practice and entities involved in an organized healthcare arrangement. We may also combine medical information about many patients to decide what additional services the Practice should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other Hospital personnel for educational purposes. We may also combine medical information we have with medical information from other hospitals to compare our performance and to make improvements in the care and services we offer. We may also disclose information about you to other healthcare facilities as permitted by law.
Business Associates: We may use and disclose your medical information to outside companies that perform services for us such as accreditations, auditing, legal services, etc.. They are called “business associates” and are required by law to keep your information confidential.
Appointment Reminders: We may use and disclose medical information to contact you to remind you that you have an appointment for treatment or medical care.
Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Inpatient Directory: We may include certain limited information about you in the Hospital directory while you are a patient at the Hospital so your family, friends and clergy can visit you in the Hospital and generally know how you are doing. This information may include your name, location in the Hospital, your general condition (e.g., fair, stable, etc.).
Individuals Involved in Your Care or Payment for Your Care: We may share your medical information with other physicians or treatment providers in order to improve your medical care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process.
As Required By Law: We will disclose medical information about you in the course of any judicial or administrative proceeding when required to do so by federal, state or local law (i.e. court orders, subpoena, etc.)
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Public Health Risks: We may disclose to authorized public health or government officials medical information about you for public health activities. These activities generally include the following to:
Marketing Health-Related Services: We will obtain your written authorization in order to use your information for marketing purposes.
Alcohol and Substance Abuse – Mental Health – HIV-related information: The Practice and organized healthcare arrangements will not release or share your health information related to the above mentioned except as specifically required by law.
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. In order to inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the practice administrator listed at the end of this Notice. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Once the request is approved, the copies will be mailed to you.
Right to Amend: If you think that medical 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 by or for the Practice. To request an amendment, your request must be made in writing and submitted to the practice administrator listed at the end of this Notice. In addition, you must give a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of medical information about you. We are not required to account for any disclosures you specifically requested or for disclosures related to treatment, payment, healthcare operations, or made pursuant to an authorization signed by you. Your request must state a time period that may not be longer than three (3) years.
Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree to your request. If we agree to your request, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at your first treatment encounter at the Hospital. You may get an additional copy of this Notice at any time by contacting the Practice Administrator listed at the end of this Notice. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
You may obtain a copy of this notice electronically at our website: www.kofinasfertility.com
Right to Restrict if You Have Paid Out of Pocket: You have a right to restrict certain disclosures about your health information, to a health plan, if you have paid out of pocket for the treatment for that health information.
Right to Receive Notification in Case of Breach: You have a right to receive notification, and will receive notification, in the event that your health information is breached. A breach is a disclosure of your health information that is unauthorized and unhelpful to you.
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information about you we already have as well as any information we receive in the future. We will post copies of the current Notice in the Practice. Any revisions to our Notice will also be posted on our website.
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the U.S. Department of Health and Human Services.
You will not be penalized for filing a complaint. To file a complaint with the Practice, call 718-736-2218, or mail your complaint to:
Kofinas Fertility Group
506 6th Street 4KP
Brooklyn, NY 11215.
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization.
Revoking An Authorization
If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we may continue to use or disclose that information to the extent we have relied on your authorization or in an emergency. You also understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.
Request for forms or inquiries regarding this notice should be directed to:
Kofinas Fertility Group
506 6th Street 4KP
Brooklyn, NY 11215.
Fax: (718) 780-5085