Web Privacy Policy
and Notice of Privacy Practices for Protected Health
Information
Simon W. Rosenberg, D.M.D.
399 E 72nd
Street #1A
New York, NY 10021
Voice 212 988-8822 Fax: 212 988-8858
Email: HIPAA@DrSimonRosenberg.com
Notice of Privacy Practices for Protected Health
Information
This notice describes how health information about you may be
used and disclosed and how you can get access to this
information.
Please review it carefully!
The Privacy of your Health Information is important to
us.
With your consent, the practice is permitted by federal privacy
laws to make uses and disclosures of your health information
for purposes of treatment, payment, and health care operations.
Protected health information is the information we create and
obtain in providing our services to you. Such information may
include documenting your symptoms, examination and test
results, diagnoses, treatment, and applying for future care or
treatment. It also includes billing documents for those
services.
Example of uses of your health information for treatment
purposes:
A nurse obtains treatment information about you and records it
in a health record. During the course of your treatment, the
doctor determines a need to consult with another specialist in
the area. The doctor will share the information with such
specialist and obtain input.
Example of use of your health information for payment
purposes:
We submit a request for payment to your health insurance
company. The health insurance company requests information from
us regarding health care given. We will provide information to
them about you and the care given.
Example of Use of Your Information for Health Care
Operations:
We obtain services from our insurers or other business
associates such as quality assessment, quality improvement,
outcome evaluation, protocol and clinical guidelines
development, training programs, credentialing, health review,
legal services, and insurance. We will share information about
you with such insurers or other business associates as
necessary to obtain these services.
Your Health Information Rights
The health record we maintain and billing records are the
physical property of the practice. The information in it,
however, belongs to you. You have a right to:
- ·
Request a restriction on certain uses and disclosures of
your health information by delivering the request in
writing to our office. We are not required to grant the
request but we will comply with any request
granted;
- ·
Request that you be allowed to inspect and copy your health
record and billing record — you may exercise this right by
delivering the request in writing to our
office;
- ·
Appeal a denial of access to your protected health
information except in certain
circumstances;
- ·
Request that your health care record be amended to correct
incomplete or incorrect information by delivering a written
request to our office;
- ·
File a statement of disagreement if your amendment is
denied, and require that the request for amendment and any
denial be attached in all future disclosures of your
protected health information;
- ·
Obtain an accounting of disclosures of your health
information as required to be maintained by law by
delivering a written request to our office. An accounting
will not
include internal uses of information for treatment,
payment, or operations, disclosures made to you or made at
your request, or disclosures made to family members or
friends in the course of providing
care;
- ·
Request that communication of your health information be
made by alternative means or at an alternative location by
delivering the request in writing to our office;
and,
- ·
Revoke authorizations that you made previously to use or
disclose information except to the extent information or
action has already been taken by delivering a written
revocation to our office.
-
If you want to exercise any of the above rights, please
contact Elina Solomon (our
hygienist) or Dr. Simon W. Rosenberg,
D.M.D.,
in person or in writing, during normal
hours.
S[he]
will provide you with assistance on the steps to take to
exercise your rights.
Our Responsibilities
The practice is required to:
- ·
Maintain the privacy of your health information as required
by law;
- ·
Provide you with a notice of our duties and privacy
practices as to the information we collect and maintain
about you;
- ·
Abide by the terms of this Notice;
- ·
Notify you if we cannot accommodate a requested restriction
or request; and
- ·
Accommodate your reasonable requests regarding methods to
communicate health information with
you.
-
We reserve the right to amend, change, or eliminate
provisions in our privacy practices and access practices
and to enact new provisions regarding the protected health
information we maintain. If our information practices
change, we will amend our Notice. You are entitled to
receive a revised copy of the Notice by calling and
requesting a copy of our "Notice" or by visiting our office
and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or
want to report a problem regarding the handling of your
information, you may contact
Elina Solomon (our hygienist) or Dr. Simon W. Rosenberg,
D.M.D.
Additionally, if you believe your privacy rights have been
violated, you may file a written complaint at our office by
delivering the written complaint to
Elina Solomon (our hygienist)
or to
Dr. Rosenberg.
You may also file a complaint by mailing it or e-mailing it to
the Secretary of Health and Human Services whose street address
and e-mail address will be provided on request.
- ·
We cannot, and will not, require you to waive the right to
file a complaint with the Secretary of Health and Human
Services (HHS) as a condition of receiving treatment from
the practice.
- ·
We cannot, and will not, retaliate against you for filing a
complaint with the Secretary.
-
Other Disclosures and Uses
Notification
Unless you object, we may use or disclose your protected health
information to notify, or assist in notifying, a family member,
personal representative, or other person responsible for your
care, about your location, and about your general condition, or
your death.
Communication with Family
Using our best judgment, we may disclose to a family member,
other relative, close personal friend, or any other person you
identify, health information relevant to that person's
involvement in your care or in payment for such care if you do
not object or in an emergency.
Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information
relating to adverse events with respect to products and product
defects, or post-marketing surveillance information to enable
product recalls, repairs, or replacements.
Workers Compensation
If you are seeking compensation through Workers Compensation,
we may disclose your protected health information to the extent
necessary to comply with laws relating to Workers
Compensation.
Public Health
As required by law, we may disclose your protected health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or
disability.
Abuse & Neglect
We may disclose your protected health information to public
authorities as allowed by law to report abuse or
neglect.
Disaster Relief
We may use and disclose your protected health information to
assist in disaster relief efforts.
Correctional Institutions
If you are an inmate of a correctional institution, we may
disclose to the institution, or its agents, your protected
health information necessary for your health and the health and
safety of other individuals.
Law Enforcement
We may disclose your protected health information for law
enforcement purposes as required by law, such as when required
by a court order, or in cases involving felony prosecutions, or
to the extent an individual is in the custody of law
enforcement.
Health Oversight
Federal law allows us to release your protected health
information to appropriate health oversight agencies or for
health oversight activities.
Judicial/Administrative Proceedings
We may disclose your protected health information in the course
of any judicial or administrative proceeding as allowed or
required by law, with your consent, or as directed by a proper
court order.
Other Uses
Other uses and disclosures besides those identified in this
Notice will be made only as otherwise authorized by law or with
your written authorization and you may revoke the authorization
as previously provided.
Web site
If we maintain a website that provides information about our
entity, this Notice will be on the website.
Effective Date: April 14, 2003
You will be given the opportunity when you come into the
office to confirm that you have read this by signing the
declaration that follows:
I, (Name inserted), hereby acknowledge that I have received a
copy of this practice’s Notice of Privacy Practices. I have
been given the opportunity to ask any questions I may have
regarding this Notice.
Website
Privacy Policy
We have created this privacy statement in order
to demonstrate our firm and continuing commitment to the
privacy of personal information provided by those
visiting and interacting with this web site. We hold the
privacy of your personal information in the highest
regard. The following discloses our information gathering
and dissemination practices for this
website.
We recognize the
importance of protecting your
privacy and our policy is
designed to assist you in understanding how we collect, use and
safeguard the personal information you provide to us and to
assist you in making informed decisions when using our site.
This policy will be continuously assessed against new
technologies, business practices and our customers'
needs.
Sharing and Selling
Information
We do not share,
sell, lend or lease any of the information that uniquely
identify a subscriber or patient (such as email addresses
or personal details) with anyone except to the extent it is
necessary to process transactions or provide services that you
have requested.
What Information Do We
Collect?
When you visit this web site you
may provide us with two types of information: personal
information you knowingly choose to disclose that is collected
on an individual basis and Web site use information collected
on an aggregate basis as you and others browse our Web
site.
1. Personal Information You Choose to
Provide
Registration
Information
When you
register for any of our products, services or newsletters you
will provide us information about yourself.
Credit Card
Information
If you choose to avail of our
services, you may need to give personal information and
authorization to obtain information from various credit
services. For example, you may need to provide the following
information:
-Name
-Mailing address
-Email address
-Credit card number
-Name on credit card
-Credit card billing address
-Business and home phone number
Email
Information
If you choose to correspond with
us through email, we may retain the content of your email
messages together with your email address and our responses. We
provide the same protections for these electronic
communications that we employ in the maintenance of information
received by mail and telephone.
2. Web Site Use
Information
Similar to other commercial Web sites, our Web site utilizes a
standard technology called "cookies" (see explanation below,
"What Are Cookies?") and web server log files to collect
information about how our Web site is used. Information
gathered through cookies and Web server logs may include the
date and time of visits, the pages viewed, time spent at our
Web site, and the Web sites visited just before and just after
our Web site.
How Do We Use the Information That You
Provide to Us?
Broadly speaking, we use
personal information for purposes of administering our business
activities, providing the products and services you requested,
to process your payment, ,
to
monitor the use of the service, our marketing and
promotional efforts and
improve
our content and service offerings, and customize our
site's content, layout, services and for other
lawful purposes. These uses improve
our site and better tailor it to meet your
needs.
Furthermore, such information may be shared with others on an
aggregate basis. Personally identifiable information or
business information will not be shared with parties except as
required by law.
Occasionally, we may also use the information we collect to
notify you about important changes to our Website, new
services, and special offers we think you will find valuable.
You may notify us at any time if you do not wish to receive
these offers by emailing us at the link provided on the
newsletter.
What Are
Cookies?
A cookie is a very small text
document, which often includes an anonymous unique identifier.
When you visit a Web site, that site's computer asks your
computer for permission to store this file in a part of your
hard drive specifically designated for cookies. Each Web site
can send its own cookie to your browser if your browser's
preferences allow it, but (to protect your privacy) your
browser only permits a Web site to access the cookies it has
already sent to you, not the cookies sent to you by other
sites. Browsers are usually set to accept cookies. However, if
you would prefer not to receive cookies, you may alter the
configuration of your browser to refuse cookies. If you choose
to have your browser refuse cookies, it is possible that some
areas of our site will not function as effectively when viewed
by the users.A cookie cannot retrieve
any other data from your hard drive or pass on computer
viruses.
How Do We Use Information We Collect from
Cookies?
As you visit and browse our Web
site, the site uses cookies to differentiate you from other
users. In some cases, we also use cookies to prevent you from
having to log in more than is necessary for security. Cookies,
in conjunction with our Web server's log files, allow us to
calculate the aggregate number of people visiting our Web site
and which parts of the site are most popular. This helps us
gather feedback to constantly improve our Web site and better
serve our clients. Cookies do not allow us to gather any
personal information about you and we do not intentionally
store any personal information that your browser provided to us
in your cookies.
IP
Addresses
IP addresses are used by your
computer every time you are connected to the Internet. Your IP
address is a number that is used by computers on the network to
identify your computer. IP addresses are automatically
collected by our web server as part of demographic and profile
data known as traffic data so that data (such as the Web pages
you request) can be sent to you.
Sharing and Selling
Information
We do not share,
sell, lend or lease any of the information that uniquely
identify a subscriber (such as email addresses or personal
details) with anyone except to the extent it is necessary to
process transactions or provide services that you have
requested.
How Can You Access and Correct Your
Information?
You may request access to all
your personally identifiable information that we collect online
and maintain in our database by emailing us at the usual
address.
What About Legally
Compelled Disclosure of
Information?
We may disclose information when legally compelled to do so, in
other words, when we, in good faith, believe that the law
requires it or for the protection of our legal
rights. We may also disclose
account information when we have reason to believe that
disclosing this information is necessary to identify, contact
or bring legal action against someone who may be violating our
Terms of Service or to protect the safety of our users and the
Public.
What About Other Web Sites Linked to Our
Web Site?
We are not responsible for the
practices employed by Web sites linked to or from our Web site
or the information or content contained therein. Often links to
other Web sites are provided solely as pointers to information
on topics that may be useful to the users of our Web
site.
Please remember that when you use a link to go from our Website
to another web site, our Privacy Policy is no longer in effect.
Your browsing and interaction on any other web site, including
web sites, which have a link on our Website, is subject to that
Web site's own rules and policies. Please read over those rules
and policies before proceeding.
Your
Consent
By using our Web site you
consent to our collection and use of your personal information
as described in this Privacy Policy. We reserve the right to
amend this privacy policy at any time with or without
notice.
Our Commitment To Data Security:
Please note that your
information will be stored and processed on our computers in
the United States. The laws on holding personal data in the
United States may be less stringent than the laws of your
Country of residence or
citizenship. To prevent
unauthorized access, maintain data accuracy, and ensure
the correct use of information, we have put in place
appropriate physical, electronic, and managerial
procedures to safeguard and secure the information we
collect online.
Choice/Opt-In/Opt-Out
This site allows visitors to unsubscribe so that they will not
receive future messages. After unsubscribing we will
discontinue sending the particular messages as soon as
technically feasible.
Surveys &
Contests
From time-to-time our site requests information from users via
surveys or contests. Participation in these surveys or contests
is completely voluntary and the user therefore has a choice
whether or not to disclose this information. Information
requested may include contact information (such as name and
shipping address), and demographic information (such as zip
code, age level). Contact information will be used to notify
the winners and award prizes. Survey information will be used
for purposes of monitoring or improving the use and
satisfaction of this site.
A Special Note About
Children
Children are not eligible
to use our services unsupervised
and we ask that children (under the age of
14) do not submit any personal information to us. If you
are a minor, you can use this service only in conjunction
with permission and guidance from your parents or
guardians.
Acquisition or Changes in
Ownership
In the event that the web site (or a substantial portion of its
assets) is acquired, your information would be considered part
of those assets, and may be part of those assets that are
transferred.
Policy
Modifications
We may change this
Privacy Policy from time to time. If/when changes are made to
this privacy policy, we will email users who have given us
permission to do so. We will post any changes here, so be sure
to check back periodically. However, please be assured that if
the Privacy Policy changes in the future, we will not use the
personal information you have submitted to us under this
Privacy Policy in a manner that is materially inconsistent with
this Privacy Policy, without your prior
consent.
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