Notice of Privacy Practices

Wasef Health, PC and Participating Providers

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.

Scope of This Notice

This Notice of Privacy Practices ("Notice") applies to Wasef Health, PC, its workforce, and healthcare professionals who participate in its organized healthcare arrangements or otherwise agree to follow this Notice (collectively, "Medical Group," "we," "our," or "us"). Atelier Protocol LLC may provide technology and administrative services to the Medical Group as a business associate or other service provider, as applicable.

Our Duties

• We are required by law to maintain the privacy and security of protected health information ("PHI").
• We are required to provide you with this Notice describing our legal duties and privacy practices.
• We must follow the duties and privacy practices described in the Notice currently in effect.
• We will notify affected individuals following a breach of unsecured PHI when notification is required by law.
• We will not use or disclose PHI except as described in this Notice or as otherwise permitted or required by law.

How We May Use and Disclose PHI

Treatment

We may use and disclose PHI to provide, coordinate, or manage your healthcare and related services. We may share PHI with physicians, nurse practitioners, physician assistants, pharmacists, laboratories, and other persons involved in your care.

Payment

We may use and disclose PHI to bill and collect payment for healthcare services, determine payment responsibility, process self-pay transactions, coordinate pharmacy charges, or conduct other payment activities.

Healthcare Operations

We may use and disclose PHI for quality assessment, patient safety, care coordination, credentialing, training, compliance, auditing, legal services, business planning, and other healthcare operations.

Business Associates

We may disclose PHI to contractors and vendors that perform services for us and are required by contract and law to safeguard PHI.

Appointment Reminders and Treatment Communications

We may contact you regarding appointments, follow-up care, prescription status, treatment alternatives, health-related benefits or services, and other care-related communications.

Individuals Involved in Your Care or Payment

With your agreement, when you do not object, or when otherwise permitted by law, we may share relevant PHI with a family member, personal representative, caregiver, or other person involved in your care or payment.

Required by Law

We may use or disclose PHI when federal, state, or local law requires us to do so.

Public Health and Safety

We may disclose PHI for public health activities, product recalls, adverse event reporting, preventing or controlling disease, reporting abuse or neglect, or preventing a serious and imminent threat to health or safety.

Health Oversight

We may disclose PHI to health oversight agencies for audits, investigations, inspections, licensure, disciplinary proceedings, and other authorized oversight activities.

Judicial and Administrative Proceedings

We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process when legal requirements are satisfied.

Law Enforcement

We may disclose PHI to law enforcement officials for purposes permitted by HIPAA and other applicable law.

Coroners, Medical Examiners, and Funeral Directors

We may disclose PHI as necessary for identification, determining cause of death, or performing other lawful duties.

Organ and Tissue Donation

We may disclose PHI to organizations involved in organ, eye, or tissue donation and transplantation.

Research

We may use or disclose PHI for research when an authorization is obtained or an institutional review board or privacy board approves a waiver, or as otherwise permitted by law.

Workers' Compensation

We may disclose PHI as authorized by and necessary to comply with workers' compensation and similar programs.

Military, Veterans, National Security, and Protective Services

We may disclose PHI for specialized government functions when permitted by law.

Correctional Institutions

If you are an inmate or in lawful custody, we may disclose PHI to the correctional institution or law enforcement official as permitted by law.

Uses and Disclosures Requiring Authorization

Uses and disclosures of PHI for purposes not described in this Notice generally require your written authorization. Most uses and disclosures of psychotherapy notes, most uses and disclosures for marketing, and disclosures that constitute a sale of PHI require authorization, subject to exceptions under law. You may revoke an authorization in writing, except to the extent action has already been taken in reliance on it.

Reproductive Healthcare Privacy

Where required by federal law, we will not use or disclose PHI for the purpose of investigating or imposing liability on a person for seeking, obtaining, providing, or facilitating lawful reproductive healthcare, or for identifying a person for such purposes. We may require an attestation before making certain disclosures potentially related to reproductive healthcare.

Substance Use Disorder Records

To the extent we create, receive, or maintain records protected by 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2, those records may receive additional protections. Such records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the patient unless the patient provides specific written consent or a court order and subpoena satisfy applicable law. A general authorization for future treatment, payment, and healthcare operations may apply only as permitted by Part 2 and HIPAA.

Your Rights

Inspect and Obtain a Copy

You may request to inspect or obtain an electronic or paper copy of PHI maintained in a designated record set. We may charge a reasonable, cost-based fee as permitted by law. Limited grounds for denial may apply.

Request an Amendment

You may ask us to amend PHI that you believe is incorrect or incomplete. We may deny the request in certain circumstances and will provide a written explanation.

Accounting of Disclosures

You may request a list of certain disclosures of PHI made during the applicable period, excluding disclosures for treatment, payment, healthcare operations, and other disclosures excluded by law.

Request Restrictions

You may ask us not to use or disclose certain PHI for treatment, payment, or healthcare operations. We generally are not required to agree, except that we must agree to restrict disclosure to a health plan for payment or healthcare operations when you pay the relevant item or service in full out of pocket and the disclosure is not otherwise required by law.

Confidential Communications

You may request that we communicate with you in a specific manner or at a specific location. We will accommodate reasonable requests.

Paper Copy of This Notice

You may obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Choose a Personal Representative

A legally authorized personal representative may exercise your rights and make choices regarding PHI, subject to verification and applicable law.

File a Complaint

You may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

Your Choices

For certain disclosures, such as sharing information with family and friends involved in your care or for disaster relief, you may tell us your preference. If you are unable to communicate your preference, we may act in your best interest when permitted by law. We will obtain written authorization for uses and disclosures that legally require it.

Changes to This Notice

We may change the terms of this Notice and make the revised Notice effective for all PHI we maintain. The revised Notice will be available through the patient-facing service and upon request. The effective date will appear on the first page.

Questions and Complaints

Privacy Official: [NAME OR TITLE OF PRIVACY OFFICIAL]
Wasef Health, PC
418 Broadway, Ste R, Albany, NY 12207
Email: contact@wasef-health.com
Telephone: (929) 723-3212
You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for exercising your rights or filing a complaint.