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Your Health Information Rights You have the following rights with respect to PHI about you: *Obtain a paper copy of the Notice upon request. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy.To obtain a paper copy, contact the Privacy Officer at (212) 875-1718 or e-mail request to [email protected] *Request a restriction on certain uses and disclosures of PHI.
For instance, you may request we contact you about medical matters only in writing or at a different residence or post office box. We may refuse to continue to treat a customer that revokes his or her consent.
To request confidential communication of PHI about you, you must submit a request in writing to the Privacy Officer or e-mail it to [email protected] Your request must state how or where you would like to be contacted. Example of How We May Use and Disclose PHI The following categories describe and provide examples of different ways we use and disclose PHI about you. Example: Information obtained by the pharmacist will be used to dispense prescription medications to you.
We will document in your record information related to the medications dispensed to you and services provided to you. Example: We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment.
We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain.
Upon request, we will provide any revised Notice to you.