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.

This notice applies to all of the records of your care generated by
the practice, whether made by the practice or an associated facility.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" 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 the terms of your notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
The practice provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

OUR THOUGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION:

We understand that your medical information is personal to you, and we are committed to protecting the information about you. As our patient, we create electronic and paper medical records about your health, our care for you, and the services and/or items we provide to you as our patient. We need this record to provide for your care and to comply with certain legal requirements. We are required by law to:

• Make sure that the protected health information about you is kept private
• Provide you with a Notice of our Privacy Practices and your legal rights with respect to protected health information about you; and
• Follow the conditions of the Notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose protected health information that we have and share with others. Each category of uses or disclosures provides a general explanation and provides some examples of uses. Not every use or disclosure in a category is either listed or actually in place. The explanation is provided for your general information only.

• Medical Treatment. We use previously given medical information about you to provide you with current or prospective medical treatment or services. Therefore we may, and most likely will, disclose medical information about you to doctors, nurses, technicians, medical students, or hospital personnel who are involved in taking care of you. This includes sharing information with medical labs and testing facilities. For example, a doctor to whom we refer you for ongoing or further care may need your medical record. Different areas of the Practice also may share medical information about you including your record(s), prescriptions, requests of lab work and x-rays. We may also discuss your medical information with you to recommend possible treatment options or alternatives that may be of interest to you. We also may disclose medical information about you to people outside the Practice who may be involved in your medical care after you leave the Practice; this may include your family members, or other personal representatives authorized by you or by a legal mandate (a guardian or other person who has been named to handle your medical decisions, should you become incompetent).
• Payment. We may use and disclose medical information about you for services and procedures so they may be billed and collected from you, an insurance company, or any other third party. For example, we may need to give your health care information, about treatment you received at the Practice, to obtain payment or reimbursement for the care. We may also tell your health plan and/or referring physician about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment, to facilitate payment of a referring physician, or the like.
• Health-Care Operations. We may use and disclose medical information about you so that we can run our Practice more efficiently and make sure that all of our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performance of our staff, deciding what additional services to offer and where, deciding what services are not needed, and whether certain new treatments are effective. We may also use and disclose information about you for internal and external utilization review and/or quality assurance, to business associates for purposes of helping us to comply with our legal requirements, to auditors to verify records, to billing companies to aid us in this process and the like. We shall endeavor, at all times when business associates are used, to advise them of their continued obligation to maintain the privacy of your medical records.
• Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for medical care with the Practice. This contact my be by phone, in writing, e-mail, a message on an answering machine, or otherwise which could potentially be received or intercepted by others.
• Marketing. In our effort to market the Practice and its services, mailings addressed to you could identify you as a patient. These marketing materials may be intercepted by others.
• Emergency Situations. In addition, we may disclose medical information about you to an organization assisting in a disaster relief effort or in an emergency situation 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 regarding medications, efficiency of treatment protocols and the like. All research projects are subject to an approval process, which evaluates a proposed research project and its use of medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We will obtain an Authorization from you before using or disclosing your individually identifiable health information unless the authorization requirement has been waived. If possible, we will make the information non-identifiable to a specific patient. If the information has been sufficiently de-identified, an authorization for the use and disclosure is not required.
• Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
• To Advert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat either to your specific health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• Workers Compensation. We may release medical information about you for worker's compensation or similar programs. These programs provide benefits for work-related injuries or illness.
• Public Health Risks. Law or public policy may require us to disclose medical information about you for public health activities. These activities generally include the following:

  To prevent or control diseases, injury or disability;

• To report child abuse or neglect;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• To notify a person who may have been exposed to a disease or my be at risk for contracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure If you agree or when required or authorized by law.
  
  

• Investigation and Government Activities. We may disclose medical information to a local, state or federal agency for activities authorized by law. These oversight activities include, for example, audits, investigations, and licensure. These activities are necessary for the payor, the government and other regulatory agencies to monitor the health care system, government programs, and compliance with civil rights laws.
• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. This is particularly true if you make your health an issue. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We shall attempt in these cases to tell you about the request so that you may obtain an order protecting the information requested if you so desire. We may also use such information to defend ourselves, or any member of our practice in any actual or threatened action.
• Law Enforcement. We may release medical information if asked to do so by a law enforcement official.
  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the Practice; and In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Practice to funeral directors as necessary to carry out their duties.
    
  • Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
    
    

  
  OFFICE POLICIES
  
  We ask all patients to read our financial policy. If you have any questions or concerns about our payment policies, please do not hesitate to contact our office manager Joslyn at Tel: 212 949 0393; Fax: 212 949 0396

  Managed care plans (HMO's and some PPO's) require referral authorization for each visit or service in writing from the Primary Care Physician.
  Patients and parents and guardians of the patient are required to sign a waiver if the referral is not received at the time of the patient's visit. Claims rejected by the insurer are the financial responsibility of the patient or the parent/guardian of the patient.If the correct insurance is provided to Andrea N. Persaud, M.D., P.C or its Afflitaes at the time of service, we will submit all claims to the insurance carrier. Payment for services is due at the time when services are rendered including co-payments, outstanding balances, cosmetic procedures, or products. We accept cash, personal checks, money orders, cashier's checks, Visa, or MasterCard.

  Your insurance policy is a contract between you, your employer, and the insurance company. All charges are your responsibility, whether your insurance company pays or not. Not all services are covered benefits in all contracts. You should check directly with your insurance company for the extent of your coverage.

  CANCELLATION POLICY

  Please call well in advance to cancel or reschedule appointments. We reserve the right to charge for missed appointments in the range of $100 to $200 per visit when not cancelled 24 hours in advance.

  MANAGING YOUR ACCOUNT

  We understand that temporary financial problems may affect timely payment of your balance. We encourage you to communicate such problems so that we can assist you in the management of your account. We appreciate your trust and we appreciate the opportunity to serve you.

  CHANGES TO THIS NOTICE

  We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. We will post a copy of the current notice in the Practice. The notice will contain on the first page, in the lower right hand corner, the date of the last revision and effective date. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect.

  COMPLAINTS
  
  If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact our office Manager Joslyn, who will direct you on how to file an office complaint. All complaints must be submitted in writing, and all complaints shall be investigated, without repercussion to you. Joslyn can be reached at this number Tel: 212 949 0393; Fax: 212 949 0396.

  You will not be penalized for filing a complaint.

  OTHER USES OF MEDICAL INFORMATION

  Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with written permission, unless those uses can be reasonably inferred from the intended uses above. If you have provided us with your permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

  PATIENT RIGHTS

  This section describes your rights and the obligations of this practice regarding the use and disclosure of your medical information.

  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. This includes your own medical and billing records, but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed.
    • To inspect and copy your medical record, you must submit your request in writing to our Compliance Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies (tapes, disks, etc.) associated with your request.
    • We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that an outside committee review the denial. Another licensed health care professional chosen by the Practice will review you request and the denial. The person conducting the review will no be the person who denied your request. We will comply with the outcome and recommendations from that review.
      
      
  • Right to Amend. If you feel that the medical information we have about you in your record is incorrect or incomplete, then you may ask us to amend the information, following the procedure below. You have the right to request and amendment for as long as the Practice maintains your medical record.
    • To request an amendment, your request must be submitted in writing, along with your intended amendment and a reason that supports your request to amend. The amendment must be dated and signed by you and notarized.
    • We may deny you 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: 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 medical information kept by or for the Practice; Is not part of the information which you would be permitted to inspect and copy is inaccurate and incomplete.
      
      
  • Right to an Accounting of Disclosures. You have the right to request and "accounting of disclosures." This is a list of the disclosures we made of medical information about you, to others.
    • To request this list, you must submit your request in writing. Your request must state a time period no longer than six (6) years back may not include dates before April 14, 2003 (or the actual implementation date of the HIPAA Privacy Regulations).
    • Your request should indicate in what form you want the list (for example, on paper, electronically). We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any cost are incurred.
  • 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 health care operations. You may 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 (a family member or friend). For example, you could ask that we not use or disclose information about a particular treatment you received.
    • We are not required to agree to your request and we may not be able to comply with your request. If we do agree, we will comply with your request except that we shall not comply, even with a written request, if the information is exempted from the consent requirement or we are otherwise required to disclose the information by law.
    • To request restrictions, you make your request in writing. In your request, you indicate: What information you want to limit; Whether you want to limit our use, disclosure or both; and To whom you want to the limits to apply (e.g., disclosures to your children, parents, spouse, etc.)
  • 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, that we not leave voice mail or e-mail, or the like.
    • To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.
  • Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice