This draft must be checked against the practice’s actual procedures. It is not an adopted patient notice or an acknowledgment of receipt.
Practice And Notice Scope
This draft is for Abramov Medical Services in Adult Health, NP, P.C., 73-12 170th Street, Ground Floor, Fresh Meadows, NY 11366. It describes clinical health information, separately from the Website Privacy Policy.
Review required: Designate the privacy official and contact method, confirm the legal entity and covered locations, add applicable New York protections, and approve an effective date before use.
Your Rights
- Request to inspect or obtain an electronic or paper copy of your health records. Ask the office how to submit a request. Applicable legal timelines, exceptions, and reasonable permitted fees apply.
- Ask to amend information you believe is incomplete or incorrect. If a request is denied, the practice provides the explanation and applicable review or disagreement options.
- Request reasonable confidential communications, such as a different telephone number or mailing address.
- Ask for limits on use or disclosure. The practice is not required to accept every restriction. When you pay in full out of pocket, you may request that information about that service not be disclosed to your health plan for payment or operations, unless disclosure is required by law.
- Request an accounting of qualifying disclosures and a paper copy of the adopted notice.
- Have an authorized personal representative act for you after the practice verifies that authority.
Care, Payment, And Practice Operations
Health information may be used or disclosed as permitted by law to provide and coordinate treatment, obtain payment, and operate the practice. Examples include sharing relevant records with a treating clinician, sending a claim to an insurer, reviewing quality of care, and communicating about your care.
Vendors handling protected health information on the practice’s behalf must meet applicable privacy and contractual requirements. Website hosting or a scheduling link alone does not establish those arrangements.
Your Choices And Written Authorization
You may express preferences about sharing relevant information with people involved in your care or disaster relief. If you cannot express a preference, limited sharing may be permitted in your best interests or to address a serious threat.
Uses and disclosures requiring written authorization, including most uses of psychotherapy notes and certain marketing or sales of protected health information, will not occur without that authorization. You may revoke an authorization in writing for future activity, subject to legal exceptions. You may opt out of fundraising communications.
Other Permitted Or Required Disclosures
Subject to legal conditions, information may be disclosed for public health and safety, reporting abuse or neglect, health oversight, workers’ compensation, legally authorized research, organ donation, medical examiners, certain government functions, and valid legal proceedings. A request from another person does not by itself authorize release.
Federal and New York protections may impose additional restrictions on sensitive records. The practice must identify those protections in the adopted notice.
Substance Use Disorder Records
If the practice receives records protected by 42 CFR part 2, it must follow the applicable additional protections. Those records cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without the required written consent or a qualifying court order and subpoena. Applicable advance notice and choice must be provided before Part 2 information is used for fundraising.
Practice Responsibilities And Changes
The practice must safeguard protected health information, provide legally required breach notifications, make its adopted notice available, and follow its stated privacy practices. Uses beyond those described require authorization unless otherwise permitted or required by law.
If the adopted notice changes, the revised notice will identify its effective date and be available through the office and practice website. Changes may apply to information already held as permitted by law.
Questions And Complaints
Call the office at (718) 689-7355 to request the designated privacy contact or instructions for a privacy request. Do not include medical records in ordinary email.
You may also complain to the U.S. Department of Health and Human Services Office for Civil Rights. The practice will not retaliate for a complaint.
Before This Notice Is Adopted
Confirm the privacy official; legal identity; effective date; records-request, amendment, accounting and complaint procedures; patient-portal link; vendor arrangements; any research, fundraising or joint arrangements; and applicable New York rules. Use the current HHS model notices to complete the practice-specific review, including the February 2026 Part 2 provisions.