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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.

 

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Middletown Medical P.C is dedicated to protecting the privacy of our patients.

 

Our Obligation to You

We are required to maintain the privacy of your “Protected Health Information” (“PHI”) consistent with federal and state law, use and disclose your PHI only as permitted or required by federal and state law, notify you of our legal duties and your legal rights, and follow the privacy policies described in this notice, and PHIe terms of this Notice of Privacy Practices.

“Protected health information” means any information, whether written, electronic, or oral, including demographic data, that relates to:

• Your past, present or future physical or mental health or condition;
• The provision of health care to you; or
• The past, present, or future payment for the provision of health care services to you;

And that identifies you or for which there is a reasonable basis to believe it can be used to identify you.

We are required to provide you with a copy of this notice.   

Use and Disclosure of Information about You   

Middletown Medical P.C. may use and disclose your PHI, without your authorization, for purposes of treatment, payment, and health care operations (TPO).

Treatment: We will use your PHI and disclose it to others as necessary to provide treatment to you, such as in the following examples:

• It may be necessary to send blood or tissue samples to a laboratory for analysis to help us evaluate your medical condition.  
• We may provide information to your health plan or another treatment provider in order to arrange for a referral or clinical consultation.  
• We will contact you to remind you of appointments, treatment alternatives, and other health related benefits and services.  
• We may contact you to tell you about treatment services that we offer that might be of benefit to you.
• Various members of our staff may see your clinical record in the course of our care for you. This includes physicians, nurses, medical assistants and other providers.  

Payment: We will use or your PHI as needed to arrange for payment for service that you receive from us and other health care providers. For example, information about your diagnosis and the service we render is included in the bills that we submit to your health insurance plan. We may provide your health plan with health information in order to confirm that the service we rendered is covered by your benefit program and medically necessary. We may submit information about you to another health care provider that delivers services to you, such as a clinical laboratory, in order to allow them to seek payment from you or your health plan for their services.

Health Care Operations: It may also be necessary to use or disclose your PHI for our health care operations or those of another organization that has a relationship with you. For example, our quality assurance staff reviews records to be sure that we deliver appropriate treatment of high quality. Your health plan may wish to review your records to be sure that we meet national standards for quality of care.

Other Uses and Disclosures that do not require your authorization

Emergencies. We may disclose your PHI in emergency situations or to avert serious health and safety situations.

Disclosure to your family and friends. If you are an adult, and in the case of certain minors, you have the right to control disclosure of PHI about you to any other person, including family members or friends. If you ask us to keep your information confidential, we will respect your wishes. But, when consistent with your wishes,, we will share your PHI with family members or friends involved in your care as needed to enable them to help you.

Legally Required. We will disclose your PHI when we are legally required to do so by any federal, state or local law including in judicial settings and to health oversight regulatory agencies and law enforcement.

Abuse or Neglect. We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. Your PHI will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others, and as permitted by applicable law.

Public Health Responsibilities. We will disclose your PHI to the extent required by law to report problems with products, reactions to medications, product recalls, and disease/infection exposure and to prevent and control disease, injury and/or disability.

Coroners, Medical Examiners, Funeral Directors. We will disclose your PHI to a coroner or medical examiner. For example, this will be necessary to identify a deceased person or to determine a cause of death. We may also disclose your PHI to funeral directors as necessary to carry out their duties.

Organ Procurement. We will disclose your PHI, if appropriate, to an organ procurement organization or entity for organ, eye, or tissue donation purposes.
Appointment Reminders. We may use your PHI to remind you of recommended services, treatment or scheduled appointments.

Medical Research. We may use or disclose your PHI for research when the use or disclosure for medical research has been approved by an Institutional Review Board or privacy board.
Specified Government Functions. In certain circumstances, federal regulations authorize us to use or disclose your PHI to facilitate specified government functions relating to military and veterans’ affairs, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions and law enforcement custodial situations.

Workers Compensation. We may release your PHI to comply with workers compensation laws or similar programs.

Fundraising. We may also use or disclose your PHI to contact you about fundraising for ourselves or to market our services and products. Our fundraising and marketing communications with you will let you know how you can opt-out of receiving similar communications in the future. If you do not wish to be contacted on marketing and fundraising activities, please notify our Contact Person.

Uses or Disclosures that do require your authorization:

We are required to obtain your written authorization prior to the use or disclosure of your PHI in the following cases:

• Psychotherapy Notes: We will obtain your written authorization before using or disclosing psychotherapy notes, unless such notes are required for purposes as stated above, or are otherwise allowed by law to be used or disclosed.
• Marketing: We are required to obtain your written authorization prior to the use or disclosure of your PHI for marketing activities in which we are paid by others to encourage you to use a services or product.
• Sale of PHI: We are required to obtain your written authorization to sell your PHI. We, however, will never seek to sell your PHI to anyone.
• Research: Certain laws require your written authorization to use or disclose your PHI for research purposes in cases where the research has not been approved by an Institutional Review Board or privacy board.
• Other Uses and Disclosures: We will obtain your written authorization before using or disclosing your PHI for any purpose that is not referenced in this Notice of Privacy Practices.

You may revoke any prior written authorization you have previously provided to us, but please know that your revocation will not apply to any uses or disclosures that occur prior to your revocation.

We follow special privacy protections that are required by New York law or other federal laws if they are more protective than HIPAA. This includes laws that apply to HIV-related information, substance use disorder (“SUD”) treatment information, and genetic information. For example, under New York law, confidential HIV-related information can only be shared with persons allowed to have it by law, or persons you have allowed to have it by signing a specific authorization form. We follow these state law requirements for HIV-related information because they are more protective than the requirements under HIPAA.

It is important to know that another federal law referred to as Part 2 protects the privacy of SUD treatment information more stringently than HIPAA. We maintain a separate notice that describes how your SUD treatment information may be used and disclosed, your rights with respect to your SUD treatment information and how to file a complaint concerning a violation of the privacy or security of your SUD treatment information, and your rights concerning your SUD treatment information. Please contact us at [add email] if you would like a copy of our notice concerning how we protect the privacy of SUD treatment information.

You have the following legal rights regarding your PHI:

Right to request confidential communications. You may request that communications to you, such as appointment reminders, bills, or treatment options be made in a confidential manner. We will accommodate any such request, as long as you provide a means for us to process payment transactions for services we provide for you.

Right to request restrictions on use and disclosure of your PHI. You have the right to request restrictions on our use of your PHI for particular purposes, such as treatment, payment or health care operations, or our disclosure of that information to certain third parties, such as family members or friends who may be involved in your care. You have a right to restrict certain disclosures of PHI to a health plan if you are paying out-of-pocket for the healthcare item or service. We are not obligated to agree to a requested restriction, but we will consider your request.

Right to revoke a Consent or Authorization. You may revoke a written Consent or Authorization for us to use or disclose your PHI. The revocation will not affect any previous use or disclosure of your information.

Right to review and copy record. You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the PHI. A designated record set usually contains medical and billing records but it does not include psychotherapy notes, information compiled for use in a civil, criminal or administrative action or proceeding, and any PHI for which access is otherwise prohibited by law.

We may deny your request to inspect or copy your PHI if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have a right to request a review of this decision.

To inspect and copy your PHI, you must submit a written request to the Medical Records Department. We may charge you a reasonable fee to cover copying, mailing or other costs incurred by us in complying with your request.

Right to “amend” record. You have a right to request an amendment of your PHI in a designated record set for as long as we maintain it. If a mistake in your PHI is identified, a note will be entered in your record to correct the error. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal and provide you with a copy. Requests for amendment must be in writing and directed to the Medical Records Department. This information will be included as part of the total record and shared with others if it might affect decisions they make about you.

Right to an accounting. You have the right to an accounting of certain disclosures of your PHI to third parties. This does not include disclosures that you authorize, or disclosures that occur in the context of treatment, payment or health care operations, or disclosures we are permitted to make without your authorization. The request for an accounting of disclosures must be made in writing to the Medical Records Department. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that took place six years prior to the date on which the accounting is requested, unless otherwise required by law.

Right to a paper copy of this Notice. You have the right to a paper copy of our Notice of Privacy Practices, even if you have already received a copy of the Notice or have agreed to accept this Notice electronically.

Right to Communication. You have the right to request that we communicate with you in certain ways, and we will accommodate reasonable requests.

Right to Notification. You have the right to receive notifications of breaches of your unsecured PHI.

Right to choose someone to act on your behalf. If you have given someone healthcare power of attorney or if someone is your legal guardian or healthcare proxy, that person can exercise your rights and make choices about your PHI. We will make sure the person has this authority and can act for you before we disclose any PHI to them or take any action in response to a request the person might have made.

Changes to the Terms of this Notice.
We can change the terms of this notice, and the changes will apply to all PHI we have about you. The new notice will be available upon request, in our office, and on our website.

How to Exercise Your Rights.
Questions about our policies and procedures, requests to exercise individual rights, and complaints should be directed to our Compliance Department at 845-342-2567 or via email at compliance@middletownmedical.com.

Complaints

If you have any complaints or concerns about our privacy policies or practices, please submit a written complaint to our Compliance Officer, and we will consider it promptly. If you wish, our Compliance Officer will give you a form that you can use to submit a complaint.

You can also submit a complaint to the United States Department of Health and Human Services. Send your complaint to:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: 1-800-368-1019

We will never retaliate against you for filing a complaint.

Effective Date

April 14, 2003, and last revised on August 20, 2025.

FOR OUR PATIENT BILL OF RIGHTS > click here