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THIS IS A SUMMARY NOTICE WHICH DESCRIBES HOW MEDICAL INFORMATION ABOUT OUR PATIENTS MAY BE USED AND DISCLOSED AND HOW PATIENTS CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS SUMMARY AND THE FULL NOTICE (ATTACHED) CAREFULLY.

Uses and Disclosures

1. Our practice is permitted to use and disclosure information for the purposes of patient treatment, payment of services, and our health care operations.
2. Our practice is permitted or required to use and/or disclose confidential information without your written authorization for the following purposes:

a) General public health activities to agencies with public health issues as part of their official mandate;
b) Health and safety issues subject to FDA jurisdiction;
c) Reporting about victims of child abuse or neglect;
d) To avert serious threats communicable diseases;
e) Uses and disclosures to employers and workers compensation insurers for workplace medical surveillance and evaluation of work-related illness and injuries;
f) Disclosures for judicial and administrative proceedings as directed by court order;
g) Disclosures for law enforcement purposes as directed by court order;
h) Uses and disclosures about decedents;
i) Uses and disclosures for cadaveric organ, eye or tissue donation purposes;
j) Disclosures to avert a serious threat to health or safety; and
k) Disclosures of information pertinent to ascertaining compliance to the Secretary of the Department of Health and Human Services for investigational purposes.

3. Other uses and disclosures will be made only with your written authorization and you may revoke such authorization.

Separate Statements for Certain Uses or Disclosures

1. Our practice may contact you or leave you voice messages to provide appointment reminders, test results, or information about treatment alternatives or other heath-related benefits and services that may be of interest.
2. Our practice will call you to the exam/treatment area by either last name or first name only or as we are directed by the individual.
3. Our practice may disclose information to your emergency contact in the event of an emergency.
4. Our practice may disclose information in order to communicate with you should there be communication barriers.
5. Our practice may disclose information to a personal representative you formally designate or to persons involved in your health care but are not expressly authorized to act on your behalf.

Individual Rights: as a patient of our practice, you have:

1. The right to request restrictions on certain uses and disclosures, although the practice is not required to agree to a requested restriction;
2. The right to receive confidential communications;
3. The right to inspect and copy protected health information;
4. The right to amend protected health information;
5. The right to receive an accounting of disclosures of protected health information; and
6. The right of an individual to obtain a paper copy of the notice from the practice upon request.

Medical Practice's Duties

1. Our practice is required by law to maintain the privacy of confidential information and to provide individuals with notice of its legal duties and privacy practices with respect to such information;
2. Our practice is required to abide by the terms of the notice currently in effect; and
3. Our practice reserves the right to change the terms of its notice and to make the new notice provisions effective for all confidential information that we maintain. We will provide written revised notice.

Complaints

Individuals may complain in writing to the practice and to the Secretary of the DHHS if they believe their privacy rights have been violated without retaliation.

Contact: Privacy Officer, New York Physicians LLP 635 Madison Avenue New York , New York 10022

Effective Date: April 14, 2003

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