NOTICE OF PRIVACY PRACTICES OF THE OFFICE OF :

   Andrew W. Green, M.D. & Rita R. Sloan. M.D.

   LLP: Adult and Pediatric Allergy 

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. If you have any questions about this Notice please contact Dr. Andrew Green who is our Privacy Contact.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment of health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. "Protected Health Information" (PHI) is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change terms of our notice at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website (www.allergydocswny.com), calling the office to request a revised copy by mail or asking for one at the time of your next appointment.

1. Uses and Disclosures of Protected Health Information (PHI): You will be asked by our office staff to sign a form acknowledging receipt of this Notice. This office then can use and disclose your PHI for treatment, payment and health care operations. The PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.

Treatment:  We will use and disclose your PHI to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with other healthcare professionals who  already have obtained your permission to have access to your PHI. We will also disclose your PHI to other physicians who may be treating you or who become involved in your care.

Payment: Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Healthcare Operations:  We may use or disclose, as needed, your PHI in order to support the business activities of your physician's practice. These include, but are not limited to, quality assessment activities, employee review activities, training of medical personnel, licensing and conducting or arranging for other business activity. We may use a sign-in sheet at the registration desk, call your name in the waiting room or contact you to remind you of an appointment. We will share your PHI with third party "business associates" that perform various activities (e.g. billing, transcription services) for the practice. Such "business associates" will inform us that they will protect the privacy of your PHI. We may provide you with information about treatment alternatives or other health-related benefits and services or send you a newsletter or other information relevant to our practice that we believe may be of interest to you. You may request of us not to send you these materials.

Uses and Disclosures of Protected Health Information (PHI) Based Upon Your Written Authorization:  Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law. You may revoke this authorization at any time in writing except to the extent that your physician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object: We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then your physician, may use professional judgment, determine whether the disclosure is in your interest. In this case, only the PHI that is relevant to your health care will be disclosed. Others Involved in Your Health Care:  Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you
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identify, your PHI that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If a doctor in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to do so, he or she may still use or disclose your PHI. Communication Barriers: We may use or disclose your PHI if a doctor in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the doctor determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object:  We may use or disclose your PHI in the following situations without your consent:  To the extent it is required by law, for public health reporting purposes, for communicable diseases reporting needs, health oversight, compliance with abuse or neglect laws, notifications to the Food and Drug Administration, legal proceedings (to the extent such disclosure is authorized), law enforcement (so long as applicable legal requirements are met), criminal activity reporting (consistent with applicable federal and state laws to prevent or lessen a serious and imminent threat to the health or safety of a person or the public), military activity and national security (when appropriate conditions apply), Worker's Compensation Boards (in compliance with applicable laws).  Also, under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with applicable regulations.

2. Your Rights: Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights. You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain such PHI.  A "designated record set" contains medical and billing records and any other records that the physician and the practice use for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. Please contact our Privacy Contact if you have questions about access to your medical record. You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations or to family or friends who may be involved in your care or for notification purposes as described in this Notice. Your written request must state the specific restriction and to whom you want the restriction to apply. Your physician is not required to agree to a requested restriction and if the doctor believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If the doctor agrees to the restriction, such restriction may be voided by the physician if it is necessary to do so in an emergency treatment situation. You may obtain a restriction by asking the reception area staff for a Protected Health Information Restriction form. You have the right to request in writing to our Privacy Contact to receive confidential communication from us by alternative means or at an alternative location. We will accommodate reasonable requests and may condition agreement to do so by obtaining information as to how payment for services will be handled. You may have the right to have your physician amend your PHI: This means you may request in writing an amendment to your PHI in your "designated record set" for as long as we maintain such records. In certain cases we may deny your request and, if so, you have the right to file a statement of disagreement with us and we may prepare a rebuttal and will provide you with a copy of such rebuttal. Please contact our Privacy Contact if you have questions about amending your PHI. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to exceptions, restrictions and limitations. You have the right to obtain a copy of this notice, upon request, if you have agreed to accept this notice electronically.

3. Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Contact, Dr. Andrew Green at 716-675-2660, of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and became effective on January 6, 2003 and reviewed on September 1, 2009.