Notice of Privacy Practice Effective April 14, 2003

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. If you have any questions about this notice, please contact our Privacy Officer, Sandy Iannarone, at 212-535-6340.

Our Pledge Regarding your Protected Health Information (PHI): 
We understand that health information about you is personal and the physicians and staff of Park East Cardiovascular are committed to protecting your health information. This notice explains how we may use and disclose your health information and what your rights are to the health information we keep about you.

We are required by law to: a.) make sure that health information that identifies you is kept private; b.) give you this notice of our legal duties and privacy practices with respect to PHI; and c.)follow the terms of the notice that is currently in effect.

Park East Cardiovascular reserves the right to change the terms of this notice and to make the new notice provisions effective for all the PHI we maintain. In the event of a change, a new notice will be provided to you on your subsequent visit to our office.

The current Notice of Privacy Practice and any subsequent revisions will be available soon on our website at www.pecv.com.

How We May Disclose Your PHI: 
The following categories describe different ways that we may use and disclose health information without asking for written authorization from you. Several examples for each category are described but this list is not meant to be exhaustive.

1.) For Treatment: In order to provide you with the quality of care you require, Park East Cardiovascular may use and disclose your PHI to those healthcare professionals, whether in our practice or not, so that we may provide, coordinate, plan and manage your conditions. For example, we may provide information to the doctor who recommended you see a cardiologist to ensure that the physician has the necessary information to diagnose and treat you.
 2.) For Payment: We may use and disclose PHI so that the services you receive from Park East Cardiovascular may be billed and collected from a third party, typically your insurance company. 
3.) For Operations: We may need to use and disclose PHI to support the business activities of our practice and make sure that all of our patients receive quality care. For example, we may use your health information to review our treatment and services and to evaluate the performance of our staff in caring for you. 
4.) For Communication with Family: We may disclose PHI to a family member, other relative or person you identify if the person, in our provider's best judgment, is involved in your care or payment related to your care. 
5.) To a Business Associate: We may use and disclose PHI to a business associate if Park East Cardiovascular obtains satisfactory written assurance that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists the practice in undertaking some essential functions such as a transcription service that transcribes physician dictation.
 6.) As Required by Law: We will disclose health information about you when required to do so by federal, state or local law. 
7.) To Avert a Serious Threat to Health or Safety: We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. 
8.) For Military Purposes: We may use and disclose PHI to the military command authorities (either local or foreign) or the Department of Veteran Affairs if you are a member of the armed forces or separated/discharged from military service. 
9.) For Worker's Compensation: We may release PHI for work-related illness or injury. 
10.) For Public Health Risks: We may disclose PHI to prevent or control disease, injury or disability, to report births or deaths, to report child abuse or neglect or to notify a person or organization required to receive information of FDA-regulated products. 
11.) For Health Oversight Activities: We may use and disclose PHI for purposes of audits, investigations, inspection and licensure. 
12.) For Lawsuits and Disputes: We may use and disclose PHI in repose of a court or administrative order. 
13.) For Marketing Purposes: We may use and disclose PHI to provide information about treatment alternatives or other health related products or services.

Other uses or disclosures of PHI will be made only with your written authorization. You have the right to revoke any authorization that you give.

Your Rights Regarding Your Protected Health Information 
1.) You have the Right to Inspect and Copy your records. Under very limited circumstance, we may deny your request. You may be charged a fee for the cost of copying and postage. 
2.) You have the Right to Amend your records. Such a request must be made in writing to the attention of the Privacy Officer and must include a reason to support the amendment. Park East Cardiovascular may deny the request if the information to amend: a. was not created by Park East Cardiovascular; b. was not part of the record that you were permitted to inspect and copy; or c. is accurate and complete as determined by the physician of record. 
3.) You have a Right to Obtain a List of Disclosures presuming the disclosures were not made for the purpose of treatment, payment or healthcare operations. 
4.) You have the Right to Request Restrictions on the information we use or disclose about you for treatment, payment of health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care. Park East Cardiovascular may not agree with the restriction if it is deemed unreasonable. 
5.) You have the Right to Request Confidential Communications. Unless specified, Park East Cardiovascular will contact you via telephone and leave messages at the numbers you provide with information pertinent to your care. We will also call you with appointment reminders. Should you prefer another means of communications, it must be delineated in writing to the Privacy Officer of the practice. Unless specified, we will greet you and call you from the waiting room by name. Should you prefer an alternative method, it must be presented in writing to the Privacy Officer. 
6.) You have a Right to a Paper Copy of this Notice.

If you feel that your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

Patient Acknowledgement
By signature below, I acknowledge that I have read and reviewed the above information and agree to the terms.

__________________________                               ____________________________ 
Patient                                                                  Date