Notice of Privacy Practices DBA IDCC Health Services

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.

IDCC HEALTH SERVICES is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.  Among its other obligations, if a breach occurs involving your unsecured protected health information, IDCC HEALTH SERVICES will notify you promptly that your health information was compromised. IDCC HEALTH SERVICES is required to abide by the terms of its Notice of Privacy Practices currently in effect.

If you have questions about any part of this notice or if you want more information about the privacy practices at IDCC HEALTH SERVICES, please contact:

Angella Matatov
Privacy Officer, IDCC HEALTH SERVICES
Tel: (718) 621-1811
201 Kings Highway
Brooklyn, NY 11223

Effective Date of This Notice: April 14, 2003
Revised: April 1, 2021

I. What is Protected Health Information, or PHI 

Protected Health Information (PHI) is information that may identify you with your healthcare or treatment.  Some examples of PHI are:

• Information about your health condition (e.g. medical conditions or test results);
• Information about health care services you have received or may receive in the future;
• Geographic information;
• Demographic information (e.g. race, gender, ethnicity, or marital status);
• Unique identification number (e.g. social security number, phone number, or driver’s license number);
• Biometric identifiers (e.g. fingerprints); and
• Full-face photographs.

 II. How IDCC HEALTH SERVICES May Use or Disclose Your Health Information

• IDCC HEALTH SERVICES collects health information from you and stores it in a chart and on a computer.  This is your medical record.  The medical record is the property of IDCC HEALTH SERVICES, but the information in the medical record belongs to you.  IDCC HEALTH SERVICES protects the privacy of your health information. The law permits IDCC HEALTH SERVICES to use or disclose your health information without your consent in certain circumstances, however, IDCC HEALTH SERVICES will take reasonable steps to limit the use or disclosure of PHI to the minimum necessary to accomplish the intended purposes.  PHI can be disclosed for the following purposes:
  1. Treatment, Payment, and Health Care Operations.

IDCC HEALTH SERVICES may share your health data with other treating physicians, for payment, or for IDCC HEALTH SERVICE’s normal health care operations.  IDCC HEALTH SERVICES will take reasonable steps to share the minimum necessary to accomplish its intended purposes.

Treatment.  IDCC HEALTH SERVICES may share your PHI with other health care providers to the extent necessary to treat or diagnose your medical condition.  In addition, your PHI may be shared to other health care practitioners or facilities that need to know with respect to your treatment outside of IDCC HEALTH SERVICES.  Furthermore, your PHI may be shared for a consultation.  For example, providers working for IDCC HEALTH SERVICES may consult with each other regarding your treatment.

Payment.  IDCC HEALTH SERVICES may use or share your PHI with others to obtain payment for health care services provided to you.  For example, IDCC HEALTH SERVICES may disclose PHI to obtain eligibility verification, pre-authorization, or ongoing authorization from other providers, agencies, or insurance companies.  Your PHI may be shared with Medicaid and Medicare administrations in connection with reimbursement claims, as appropriate.  Additionally, IDCC HEALTH SERVICES may disclose your PHI for collection and billing to other providers, agencies, and insurance companies. 

Heath Care Operations.  Your PHI may be used or disclosed to conduct IDCC HEALTH SERVICES health care operations.  This includes internal administration, planning, and various activities that improve the quality and cost effectiveness of the care that we provide to you.  For example, IDCC HEALTH SERVICES may use your information to evaluate the quality and competence of its physicians and other health care workers.  Additionally, your PHI may be used for legal and auditing services and site visits pertaining to the licensing and accreditation of IDCC HEALTH SERVICES.

• • • 2. Directory.

IDCC HEALTH SERVICES may list your name, where you are in our facilities, your general medical condition and your religious affiliation in a directory.  This information may be provided to members of the clergy.  This information, except your religious affiliation, may be provided to other people who ask for you by name.  Upon admission, you will be given the opportunity to limit or withhold information about you in the Directory.

• • • 3. Notification and communication with family.

IDCC HEALTH SERVICES may disclose your PHI to a family member, personal friend, or any other person identified by you, provided that you are present for, or otherwise available prior to the disclosure, you have the capacity to make your own health care decisions, and you have been given the opportunity to object to the disclosure and have not done so.  We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death.  If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification.  If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

• • • 4. Required by law.

As required by law, we may use and disclose your health information.  This includes:

Judicial and administrative proceedings.  We may disclose your health information during an administrative or judicial proceeding.

Law enforcement.  We may disclose your health information to a law enforcement official for certain purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.  IDCC HEALTH SERVICES may also disclose your PHI to law enforcement officials for the following reasons:

• • To comply with a court order, grand jury subpoena, or administrative subpoena that is legally enforceable;
  • To report certain types of wounds or physical injuries if required to do so by law;
  • You are the victim of a crime and (1) we have been unable to obtain your consent because of an emergency or your incapacity; (2) law enforcement officials represent that they need this information immediately to carry out their law enforcement duties; and (3) in IDCC HEALTH SERVICES’s professional judgment, disclosures to these officers is in your best interest;
  • In the event of your death, if IDCC HEALTH SERVICES suspects that your death resulted from criminal conduct;
  • It is necessary to report a crime that occurred on our property; or
  • It is necessary to report a crime discovered by IDCC HEALTH SERVICES when providing offsite emergency medical care.

Victims of abuse, neglect, or domestic violence.  Your PHI may be released to a public health authority that is authorized to receive reports of abuse, neglect, or domestic violence.  For example, if IDCC HEALTH SERVICES reasonably believes that you have been a victim of abuse, neglect, or domestic violence, we may report your information.  We will make every effort to obtain your permission before releasing this information, but in some cases, IDCC HEALTH SERVICES may be required or authorized to act without your permission.

Public safety.   We may disclose your health information to appropriate persons to prevent or lessen a serious and imminent threat to the health or safety of you, a particular person, or the general public.

Specialized government functions.      We may disclose your health information for military, national security, prisoner, and government benefits purposes.

Business Associates.  We may share your PHI with third parties that perform various business functions for IDCC HEALTH SERVICES. Some of these business associates may utilize overseas subcontractors to perform these activities for IDCC HEALTH SERVICES and may have access to your PHI. Any PHI that we release to business associates must be kept confidential and be limited to what is minimally required to perform the designated function for us.

• 5. Permitted by law.

Deceased person information.  We may disclose your health information to coroners, medical examiners, and funeral directors.

Organ donation.  We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Research.  We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or IDCC HEALTH SERVICES’s privacy board.  If PHI will be disclosed, the process will ensure that the disclosure will pose minimal risk to your privacy.

Worker’s compensation.  We may disclose your health information as necessary to comply with worker’s compensation laws or similar programs that provide benefits for work-related injuries.

6. Public health activities

Public health.  As required by law, we may disclose your health information to public health authorities for purposes related to:  preventing or controlling disease, injury, or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. 

Health oversight activities.  We may disclose your health information to health agencies during audits, investigations, inspections, licensure and other proceedings.

7. Change of Ownership. If IDCC HEALTH SERVICES is sold or merged with another organization, your health information/record will become the property of the new owner.

 

III. When IDCC HEALTH SERVICES May Not Use or Disclose Your Health Information


Except as described in this Notice of Privacy Practices, IDCC HEALTH SERVICES will not use or disclose your health information without your written authorization.  If you do authorize IDCC HEALTH SERVICES to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

Your Health Information Rights

1. Right to inspect and receive copies of records.

You, or your legally authorized representative, have the right to inspect and obtain a copy of any IDCC HEALTH SERVICES records, including those kept in written and/or electronic format, that are used to make decisions about your care and treatment, and any billing records.  To inspect or obtain a copy of any of these records, your request must be in writing.  IDCC HEALTH SERVICES may charge a fee for the costs of copying, mailing, or any other supplies used to fulfill your request.

IDCC HEALTH SERVICES will respond to your request for inspection of records within ten (10) days.  If IDCC HEALTH SERVICES needs more time to respond to a request for copies, we will notify you in writing within ten (10) days with an explanation or reason for the delay and the expected duration of the delay.

In certain, limited circumstances, IDCC HEALTH SERVICES may deny your request to inspect or obtain a copy of your record.  If your request is denied, we may provide you with a summary of the information.  If part of your request is denied, IDCC HEALTH SERVICES will provide you access or copies of the other parts of the record.  We will provide you with written notice that explains the reason for denial, a summary, or limited portions of your record.  Additionally, this notice will include the process by which you may have the determination reviewed.  The notice will include information on how to file a complaint with IDCC HEALTH SERVICES or with the Secretary of the U.S. Department of Health and Human Services.

2. Right to amend records.
   You have the right to ask IDCC HEALTH SERVICES to amend health information you believe is incorrect or incomplete.  You have the right to request an amendment if the information is kept in IDCC HEALTH SERVICES’s records.  A request for an amendment must be made in writing.

If your request to amend information is denied, IDCC HEALTH SERVICES will provide written notice with the reasons for denial.  Additionally, if you disagree with the denial, you may submit a statement explaining your disagreement, which will be placed in your records.  The written denial will include information on how to file a complaint with IDCC HEALTH SERVICES or with the Secretary of the U.S. Department of Health and Human Services.

3. Right to an accounting of disclosures.

You have the right to request an “Accounting of Disclosures” made within six (6) years prior to your request.  An account of disclosures will not include:

• Disclosures the provider made to you or your personal representative;
• Disclosures made pursuant to your written authorization;
• Disclosures made from the Patient Directory;
• Disclosures made to your friends and/or family involved in your care or payment for your care;
• Disclosures that were made for treatment, payment, or health care operations; or
• Disclosures that relate to government functions.
4. Right to request restrictions.

You have the right to request restrictions or limitations on the use or disclosure of your PHI for treatment, payment, or health care operations.  You may also request restrictions or limitations on the disclosure of your PHI to family members, personal representatives, or close personal friends.

Requests to restrict restrictions must be made in writing to our Privacy Officer.  This written request should include: (1) the information you would like to limit; (2) how you would like to limit the use of the information; and (3) to whom you would like the limits to apply.

IDCC HEALTH SERVICES is not required to agree to your request for a restriction, unless the request for restriction is for payment purposes and you have paid the provided services out of pocket, unless the disclosure is required by law.  If IDCC HEALTH SERVICES agrees to your request to restrict disclosure, we will be bound by the agreement, unless the information is necessary to provide you with emergency treatment or comply with the law.  You may revoke this restriction at any time.  Additionally, in certain circumstances, IDCC HEALTH SERVICES may revoke the restriction if we notify you before doing so.

5. Right to request confidential communications.

You have the right to request that you receive PHI by alternate means of communication or at alternate locations.  This request must be made in writing to the Privacy Officer.  IDCC HEALTH SERVICES will try to accommodate all reasonable requests.

6. Request a paper copy of this Notice of Privacy Practices.
   You have the right to request a paper copy of this notice.  To receive a paper copy, please contact our Privacy Officer.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, please contact:

Angella Matatov
Privacy Officer, IDCC HEALTH SERVICES
Tel: (718) 621-1811
201 Kings Highway
Brooklyn, NY 11223

Changes to this Notice of Privacy Practices


IDCC HEALTH SERVICES reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment.  Until such amendment is made, IDCC HEALTH SERVICES is required by law to comply with this Notice.  All changes of this Notice will be posted on IDCC HEALTH SERVICES’ website and at physical locations.

Complaints

You are free to make complaints about this Notice and our compliance with its terms. If you choose to do so, IDCC HEALTH SERVICES will not retaliate against you for filing a complaint. Complaints about this Notice of Privacy Practices or how IDCC HEALTH SERVICES handles your health information should be directed to:

Angella Matatov
Privacy Officer, IDCC HEALTH SERVICES
Tel: (718) 621-1811
201 Kings Highway
Brooklyn, NY 11223

If you are not satisfied with the way this office handles a complaint, you may submit a formal complaint to:

U.S. Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC  20201

You may also address your compliant to one of the regional Offices for Civil Rights.  A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.