The privacy of your children's medical information is important to us. You may be aware that the U.S. government has established a privacy rule ("HIPAA") concerning protected health information. This required notice tells you about how it may be used and about certain rights you have.

HIPAA requires the designation of a "privacy officer" who is in charge of privacy matters in our office. Dr. Zurhellen has assumed this role. You can contact him at (845) 528-5222 if you desire further, specific, information, or if you have questions or concerns.

Federal law provides that we may use your child(ren)'s medical information (protected health information) for treatment of your children, without further specific notice to you or written authorization by you. For example, if we refer you to a specialist, we may provide history, laboratory, or test data to that specialist.

Federal law provides that we may use your child(ren)'s medical information to obtain payment for our services without further specific notice to you or written authorization by you. For example under your health plan, we are required to provide them with a diagnosis and a description of services rendered for a visit.

Federal law provides that we may use your child(ren)'s medical information for health care management without further specific notice or written authorization by you. For example, our accountants may see your child(ren)'s name(s), dates of treatment, or procedure codes during an audit of our books. They, in turn, have signed an agreement, under HIPAA regulations, not to further disclose any of the information.

We may use or disclose your child(ren)'s medical information, without further notice to you, or specific authorizations by you, where:

        1. required by law;

        2. required for public health purposes;

        3. required under State education regulations;

        4. required by law to report child abuse;

        5. required by a County, State or Federal health oversight agency (such as the Department of Health, Office of

            Professional Discipline or Professional Medical Conduct) for oversight activities authorized by law;

        6. required by law in judicial or administrative proceedings;

        7. required for law enforcement purposes by a law enforcement official;

        8. required by a medical examiner or coroner;

        9. permitted by law to a funeral director;

        10. permitted by law for organ donation purposes;

        11. permitted by law to avert a serious threat to health or safety;

        12. permitted by law and required by military authorities if you or you children are a member of the armed forces of the

             United States;

        13. approved research purposes as defined by healthcare law;

New York State law provides additional protection for information regarding HIV/AIDS. We will continue to follow New York State law with respect to such information.

We may contact you by mail or phone, at your residence, to remind you of appointments or to provide information about treatment. Unless you instruct us otherwise, we may leave a message for you on an answering device or with any person who answers the phone at your residence.

You can make reasonable requests, in writing, for us to use alternative methods of communication with you, such as email. You may contact the Privacy Officer for instructions on how to do so.

Other uses or disclosures of medical information will be made only with your written authorization. You have the right to revoke any written authorization that you have given, at any time.

You have the right to request restrictions on certain of the uses or disclosures described above. Except as stated below, we are not required to agree to such restrictions.

You have the right to inspect and obtain copies of your child(ren)'s medical information (a reasonable fee may be charged.)

You have the right to request amendments to your child(ren)'s medical information. Such requests must be in writing, and must state the reason for the requested amendment. We will notify you as to whether we agree of disagree with the requested amendment. If we disagree with any requested amendment, we will further notify you of your rights.

You have the right to request an accounting of any disclosures we make of your child(ren)'s medical information, except for disclosures we make to you, or to carry out treatment, payment, or healthcare management. or as requested by your written authorization, or as permitted or required under 45 CFR 164.502, or for emergency or notification purposes, national security and intelligence purposes as permitted by law, or to correctional facilities or law enforcement officials as permitted by law, or for research of public health purposes (after being de-identified or limited by removal of personally identifiable information), or disclosures made prior to the effective date of this notice.

We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices.

We are required to abide by the terms of this notice as long as it is currently in effect.

We reserve the right to revise this notice, and to make a new notice effective for all protected health information we maintain. Any revised notice will be posted in our office, and copies will be available there.

If you wish to complain about violations of privacy regulations in regard to your child(ren)'s health information, you have the right to file a written complaint with the Secretary of the Department of Health and Human Services of the United States. You may also file a complaint with us by writing to the Privacy Officer, Putnam Valley Pediatrics, PO Box 397, Putnam Valley, New York, 10579.

No retaliatory action will be taken against you for any complaint you may make.

William Zurhellen, MD FAAP

Yevgeniya Shurp, MD FAAP