Privacy Policy | New York Medical Clinic

JERRY UDUEVBO, MD PC, dba New York Medical Clinic

Notice of Privacy Practices

What is the notice of privacy practices?

The Notice explains how we fulfill our commitment to respect the privacy and confidentiality of your protected health information. This Notice explains how we may use and share your protected health information, as well as the legal obligations we have regarding your protected health information, and about your rights under federal and state laws. The Notice applies to all records held by the Jerry Uduevbo, MD, PC, regardless of whether the record is written, computerized or in any other form. We are required by law to make sure that information that identifies you is kept private and to make this Notice available to you. In this Notice, the term “protected health information” refers to individually identifiable information about you, which may include:

Information about your health condition (such as medical conditions and test results you may have).
Information about healthcare services you have received or may receive in the future (such as a surgical procedure).
Information about your healthcare benefits under an insurance plan (such as whether a prescription is covered).
Geographic information (such as where you live or work).
Demographic information (such as your race, gender, ethnicity or marital status) – Unique numbers that may identify you (such as your Social Security number, your phone number or your driver’s license).
Biometric identifiers (such as fingerprints) – Full-face photographs.

Who follows the Jerry Uduevbo, MD, PC Notice of Privacy Practices

This Notice describes the practices of Jerry Uduevbo, MD, PC will be followed by all healthcare professionals, employees, medical staff, trainees, students, volunteers and business associates of Jerry Uduevbo, MD, PC

Overview

The following is a summary of the key provisions in our Notice. This summary is not a complete listing of how we use and disclose your protected health information. If you have any questions about any of the information contained in this summary, please read this full Notice of Privacy Practices or contact a Jerry Uduevbo, MD, PC receptionist for more information.

Jerry Uduevbo, MD, PC may use and disclose your protected health information without your consent to:

Provide you with medical treatment and other services.
Carry out certain operations necessary to the operation of our facilities and programs, such as quality improvement studies and medical education.
Coordinate your care, which may include such things as giving you appointment reminders and telling you about other treatment options available through community medical facilities.
Talk to family or friends involved in your care, unless otherwise indicated by you – Ensure that we follow the rules of regulatory agencies regarding the quality of care we provide.
Comply with all legal requirements, subpoenas and court orders – Engage in certain preapproved research activities.
Request payment from you, your insurance company or some other third-party payer.
Contact you for fundraising activities unless otherwise indicated by you – Meet special situations as described in this Notice, such as public health and safety.

You have a right to:

See and obtain a copy of your medical record in the format of your choosing, with certain restrictions.
Ask us to amend the protected health information we have about you if you feel the information we have is wrong or incomplete.
Ask us to restrict or limit the protected health information we use and share about you.
Ask us to communicate with you about medical matters in a certain way or at a specific location.
Obtain a list of individuals or entities that have received your protected health information from Jerry Uduevbo, MD, PC, subject to limits permitted by law – Be notified if your protected health information is improperly disclosed or accessed – Obtain a paper copy of this Notice.
Submit a complaint.

How we may use and share your protected health information with others

The following categories describe different ways that we may use and disclose your protected health information. Not every use or disclosure will be listed; however, all the ways we are permitted to use and disclose your information will fall within at least one of the following categories:

For treatment: We may use or disclose protected health information about you to provide, coordinate or manage your medical treatment or services. We may disclose protected health information about you to doctors, nurses, technicians, students or other Health personnel involved in taking care of you. We may share protected health information about you with Health providers, agencies or facilities in order to provide or coordinate the different things you need, such as prescriptions, lab work, X-rays, home health agencies and transport companies.

For payment: In order to receive payment for the services we provide to you, we may use and share your protected health information with your insurance company or a third party, such as Medicare and Medicaid. We may also share your protected health information with another doctor, facility or service provider, such as an ambulance company or subcontractor within our facilities that has treated you or has provided services to you, so that they can bill you, your insurance company or a third party. For example, in order for your insurance company to pay for your health-related services, we must submit a bill that identifies you, your diagnosis and the treatment we provided. We may also tell your health plan about a proposed treatment to determine whether your plan will cover the treatment. In addition, insurance companies and other third parties may require that we provide your Social Security number for verification and payment purposes.

For healthcare operations: We may use your protected health information to support our business activities and improve the quality of care. For example, we may use your protected health information to review the treatment and services that we gave you and to see how well our staff cared for you. We may share your information with our students, trainees and staff for review and learning purposes. Your protected health, to handle patients’ grievances or lawsuits and for health care contracting relating to our operations.

Appointment reminders: We may use and share your protected health information to remind you of your appointment for treatment or medical care. For example, if your doctor has sent you for a test, the testing site may call you to remind you of the date you are scheduled.

Business associates: We may share your protected health information with a business associate that we hire to help us, such as a billing or computer company or transcription service. Business associates will have assured us in writing that they will safeguard your protected health information as required by law.

Individuals involved in your care or payment for your care: Unless you decline, we may release protected health information to people such as family members, relatives or close personal friends who are helping to care for you or pay your medical bills. Additionally, we may disclose information to a patient representative. If a person has the authority under the law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your protected health information.. If you do not want protected health information about you released to those involved in your care, please notify us in writing.

As required by law: We will share your protected health information when federal, state or local law requires us to do so.

Special situations

Legal proceedings, lawsuits and other legal actions: We may share your protected health information with courts, attorneys and court employees when we get a court order, subpoena, discovery request, warrant, summons or other lawful instructions from those courts or public bodies, and in the course of certain other lawful, judicial or administrative proceedings, or to defend ourselves against a lawsuit brought against us.

Law enforcement: If asked to do so by law enforcement, and as authorized or required by law, we may release protected health information:

To identify or locate a suspect, fugitive, material witness or missing person – About a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
About a death suspected to be the result of criminal conduct.

To avert a serious threat to health or safety: We may use and disclose your protected health information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to help stop or reduce the threat.

Public health risks: As required by law, we may disclose your protected health information to public health authorities for purposes related to: preventing or controlling disease, injuries or disability, reporting vital events, such as births and deaths, reporting child abuse or neglect, reporting domestic violence, reporting reactions to medications or problems with products; notifying people of recalls, repairs or replacements of products they may be using, notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease and reporting to your employer findings concerning work-related illness or injury so that your workplace may be monitored for safety.

Workers’ compensation: We may share your protected health information for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.

Specialized government functions: If you are a member of the armed forces (of either the United States or of a foreign government), we may share your protected health information with military authorities so they may carry out their duties under the law. We may also disclose your protected health information if it relates to national security and intelligence activities, or to providing protective services for the President or for other important officials, such as foreign heads of state.

Health oversight activities: We may disclose your protected health information to local, state or federal governmental authorities responsible for the oversight of medical matters as authorized by law. This includes licensing, auditing and accrediting agencies and agencies that administer public health programs such as Medicare and Medicaid.

Coroners, medical examiners and funeral directors: We may release your protected health information to a coroner or medical examiner as necessary to identify a deceased person or to determine the cause of death. We also may release protected health information to funeral directors so they can carry out their duties.

Organ, eye and tissue donation: If you are an organ donor, we may release your protected health information to organizations that obtain organs or handle organ, eye or tissue transplantation. We also may release your information to an organ donation bank as necessary to facilitate organ, eye or tissue donation and transplantation.

Inmates: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your protected health information to the correctional institution or law officer as authorized or required by law. This includes sharing information that is necessary to protect the health and safety of other inmates or persons involved in supervising or transporting inmates.

Incidental disclosures: While we will take reasonable steps to safeguard the privacy of your protected health information, certain disclosures of your information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your information. For example, during the course of a treatment session, other patients in the treatment area may see or overhear discussion of your information. These “incidental disclosures” are permissible.

Uses and disclosures requiring your written authorization

Uses and disclosures not covered in this Notice: Other uses and disclosures of your protected health information not described above in this Notice or permitted by law will be made only with your written authorization. In addition, we will obtain your authorization for most uses and disclosures of psychotherapy notes. When consent for disclosure is required by law, your consent will be obtained prior to such disclosure. If you give us authorization to use or share protected health information about you, you may revoke that authorization in writing at any time. Please understand that we are unable to retract any disclosures already made with your authorization.

Stricter state laws: New York has adopted medical privacy laws that are stricter than federal law. For example, New York prohibits the disclosure of HIV-related information and the records of licensed mental health facilities for certain purposes that are permitted by HIPAA. We will follow these stricter state laws, and we will not disclose your protected health information for any purpose prohibited by these laws without your consent.

Your rights concerning your protected health information

Right to ask to see and obtain a copy: You have the right to ask to see and obtain a copy of the protected health information we used to make decisions about your care. This includes medical records (including laboratory testing results) and billing records, but does not include psychotherapy notes. If the record is maintained electronically by Jerry Uduevbo, MD, PC, you have the right to obtain an electronic copy of the record. Your request must be in writing and must be given to the Medical Record Unit. We may charge you a reasonable fee for the costs of copying, mailing or other expenses associated with complying with your request. We may deny access under certain limited circumstances. If we deny your request, we may provide you a written summary of your record or we may provide you with limited portions of your record. If we deny your request, in part or in its entirety, you may request that the denial be reviewed. A description of the process to have a denial reviewed, as well as information on how to file a complaint with the Secretary of the U.S. Department of Health and Human Services, will be included in the correspondence informing you of our decision to deny your request.

Right to ask for an amendment or addendum: If you feel that the protected health information that we have about you is incorrect or incomplete, you may ask us to amend the information. You have a right to request an amendment as long as the information is kept by or for Jerry Uduevbo, MD, PC. You are required to submit this request in writing by completing a Request for Amendment to Health Information form. We may deny your request 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:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment – Is not part of the protected health information kept by or for Jerry Uduevbo, MD, PC.
Is not part of the information you would be permitted to see and copy – Is determined by us to be accurate and complete.

If we deny your request, we will give you a written explanation of why we did not make the amendment. You will have the opportunity to have certain information related to your request included in your medical records, such as your disagreement with our decision. We will also provide you with information on how to file a complaint with Jerry Uduevbo, MD, PC or with the U.S. Department of Health and Human Services.

Right to ask for an accounting of disclosures: You have the right to ask us for a listing of those individuals or entities who have received your protected health information from Jerry Uduevbo, MD, PC in the six years prior to your request. This listing will not cover disclosures made:

To you or your personal representative.
To provide or arrange for your care.
To carry out treatment, payment or healthcare operations.
Incident to a permitted use or disclosure.
To parties you authorize to receive your protected health information – To those who request your information– To your family members, relatives or friends who are involved in your care – For national security or intelligence services.
To correctional institutions or law enforcement officials.
As part of a limited data set for research purposes.

You must submit your request in writing Jerry Uduevbo, MD, PC Medical Record Unit, PO BOX 17, East Norwich, NY 11732. Your request must state the time period for the requested disclosures. The first list requested within a 12-month period will be free. We may charge you for responding to any additional requests in that same period.

Right to request restrictions: You have the right to ask us to restrict or limit the protected health information we use or disclose about you for treatment, payment or healthcare operations. In most cases, we must consider your request, but we are not required to agree to it. However, we must agree to limit disclosures made to your health insurer or other third-party payer about services we provided to you if, prior to receiving the medical services, you pay for the services in full, unless the disclosure of that information is required by law. If multiple medical services are provided to you at one time by Jerry Uduevbo, MD, PC, you will have to pay for all of the services in order to restrict the disclosure of any one of them to your health insurance. If you require follow-up care related to the undisclosed service and you decide you do not want to pay for that follow-up care at the time it is provided to you, it may be necessary for us to tell your health insurer about the previously undisclosed service. This will be done only to the extent necessary to receive payment for subsequent medical treatment. To restrict information provided to your health insurer or to another third- party payer, you must notify Jerry Uduevbo, MD, PC receptionist at the time of registration and fill out a form indicating this preference. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment of your care, such as a family member or a friend. For example, you could ask that we not disclose information to a family member about a treatment you had. Your request for any restriction must be made in writing and given to the Office of Jerry Uduevbo, MD, PC, 2503 church Ave, Brooklyn, NY 11226.

Email, Text Messages, and Voicemail. It is important for Jerry Uduevbo, MD PC to be able to communicate with you about your healthcare. By providing an email address or phone numbers, the Clinic may use those means of communication, including autodialed phone calls, autodialed text messages, and voicemails, for purposes of communicating about your healthcare, including appointment related information, health reminders, identity authentication, prescription information, test results, and information about billing and payment for the medical services you receive. Message and data rates may apply to text messages, and not all carriers are covered. You can always text STOP to stop (a confirmation message will be sent) or HELP for help. Messages sent through email or SMS text will be limited in the information they contain to protect your privacy. These text messages and emails are not encrypted in transit and may be accessed by others while in transit or upon receipt. To reduce the chance that your information is seen by the wrong recipient, we suggest you enable the highest security measures on your personal devices (passcodes, strong passwords, two step authentication, etc.). Please do not sign our electronic consent if you DO NOT want the Clinic to communicate with you via the email or phone number that you provided. If at any point you change or obtain a new phone number, or if you no longer maintain the phone number you originally provided to us, you agree that it is your responsibility to notify the Clinic immediately of such change. No mobile or messaging consent information will be shared with third parties/affiliates for marketing/promotional purposes.

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 contact you only at home or only by mail. If you want us to communicate with you in a special way, you will need to give us details about how to contact you, including a valid alternate address. You will also need to give us information about where your bills may be sent. Your request must be made in writing by filling out a Jerry Uduevbo, MD, PC form requesting confidential communications. As indicated on the form, this request must be sent via certified mail to the Compliance Unit at PO BOX 17, EAST NORWICH, NY 11732. You do not need to provide a reason for your request. We will comply with all reasonable requests. However, if we are unable to contact you using the requested means or locations, we may contact you using whatever information we have.

Right to receive notice of a breach: You have a right to be notified in the event of a breach of the privacy of your unsecured protected health information by Jerry Uduevbo, MD, PC or its business associates. You will be notified as soon as reasonably possible, but no later than 60 days following our discovery of the breach. The notice will provide you with the date we discovered the breach, a brief description of the type of information that was involved and the steps we are taking to investigate and mitigate the situation, as well as contact information for you to ask questions and obtain additional information.

Future changes to Jerry Uduevbo, MD, PC privacy practices and this Notice

We reserve the right to change this Notice and the privacy practices of our office without first notifying you. We reserve the right to make the revised or changed Notice effective for protected health information we already have about you as well as any information we receive in the future. To request a copy of the most recent Notice, please contact Record Unit at (718)928-7575 or ask the receptionist for one at the time of your next visit. The current Notice will also be posted at our front desk. At any time, you may request a copy of the Notice currently in effect.

How to file a privacy complaint: If you believe that your privacy rights have not been followed as directed by federal regulations and state law or as explained in this Notice, you may contact us by telephone, submit a written complaint through our web-based reporting, or file a written complaint with us at the address below:

Compliance Privacy Officer, Jerry Uduevbo, MD, PC, PO BOX 17, East Norwich, NY 11732

Compliance line: (718) 928-7575

You will not be retaliated against or denied any health services if you file a complaint: If you are not satisfied with our response to your privacy complaint or you otherwise wish to file a complaint, you may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. The complaint must be in writing, it must describe the subject matter of the complaint and the individuals or organization that you believe violated your privacy and it must be filed within 180 days of when you knew or should have known that the violation occurred. The complaint should then be sent to:

Region II: New York Att:

Regional Manager

Office for Civil Rights

U.S. Department of Health and Human Services

Jacob Javits Federal Building

26 Federal Plaza, Suite 3312 New York, NY 10278

Phone: (800) 368-1019 | Fax: (202) 619-3818 | TDD: (800) 537-7697

Updated 12/25/2022