Dear Dr. Christina
PM Pediatrics

Notice of Privacy Practices

Effective Date: September 23, 2013

This Notice describes how protected health information about you may be used and disclosed and how you may obtain access to this information. Please review it carefully.

I. What Is the Notice of Privacy Practices?

This Notice of Privacy Practices (the “Notice”) describes the commitment of PM Pediatrics (collectively referred to as “we,” “us” or “our” in this Notice) to protect the privacy and confidentiality of our patients’ information. For purposes of this Notice, when we refer to “you” or “your,” we mean you as a patient or you as the provider of information about a minor patient. This Notice explains our confidentiality practices, the ways we may use and share patients’ information under the law and your right to access and control this information.

In this Notice, “protected health information” or “PHI” refers to any individually identifiable information that we obtain from you or another person that relates to your past, present or future physical or mental health conditions, the healthcare you have received or the payment for your care. Protected health information includes, but is not limited to:

II. Who Must Follow This Notice of Privacy Practices?

The practices described in this Notice will be followed by all PM Pediatrics employees, healthcare professionals, trainees, students, volunteers, independent contractors and business associates at any PM Pediatrics location (collectively referred to as “Personnel” in this Notice).

III. Overview

This Overview is a summary of the remainder of the Notice. This Overview summarizes the ways PM Pediatrics may use and share your PHI and your rights to access and control this information. For more details, please read sections IV through VII of this Notice or contact the Compliance Committee. For purposes of this Notice, the Compliance Committee may be contacted by phone at 516.869.0650 x276.

IV. Ways PM Pediatrics May Use and Share Your Protected Health Information

PM Pediatrics may use and share your PHI for certain purposes allowed by law. This section describes the purposes for which we may use or disclose your PHI without your prior specific authorization. Not every permissible use or disclosure is listed. However, every permitted use or disclosure will fall within at least one of the following categories:

V. Disclosure of Your Protected Health Information in Special Situations
VI. Uses and Disclosures Requiring Your Written Authorization
VII. Your Rights with Regard to Your Protected Health Information

Region II: New York
Attn: 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

Telephone: 212.264.3313
Fax: 212.264.3039
TDD: 212.264.2355

VIII. Future Changes to the Notice of Privacy Practices

PM Pediatrics reserves the right to change this Notice and its practices without providing you notice. We reserve the right to make a revised Notice effective for the PHI we already have about you and any PHI we receive in the future. You may request a written copy of the current Notice of Privacy Practices at any time from the Compliance Committee at 516.869.0650 x 276.

Return to homepage