HIPAA NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES

Jaclyn Benzoni OD, PC
2126 Merrick Mall Merrick, NY 11566
(516) 546-3227

Effective Date: January 1, 2026

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.

OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that medical and billing information about you and your health is personal. We are committed to protecting your health information. We create a record of the care and services you receive at this practice to provide you with quality care and to comply with certain legal requirements. This Notice applies to all records of your care generated or maintained by this practice.

I. PERMITTED USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Federal and New York State laws allow us to use and disclose your Protected Health Information (PHI) for the purposes of Treatment, Payment, and Healthcare Operations (TPO) without obtaining your prior written authorization in most circumstances:

1. For Treatment: We may use your PHI to provide, coordinate, or manage your medical care and any related services. For example, we may disclose information to doctors, nurses, technicians, or other healthcare personnel who are involved in taking care of you, or to an outside specialist to whom you have been referred.
2. For Payment: We may use and disclose your PHI so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about a treatment you received so they will pay us or reimburse you.
3. For Healthcare Operations: We may use and disclose your PHI to run our practice, improve your care, and contact you when necessary. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff.

II. SPECIAL PROTECTIONS UNDER NEW YORK STATE LAW & FEDERAL UPDATE RULES
New York State statutes and specific federal updates provide heightened confidentiality protections that override general HIPAA baseline permissions. We will strictly adhere to the following exceptions:

1. HIV-Related Information: Under New York Public Health Law Article 27-F, confidential HIV-related information (including HIV test results, exposure history, status, or treatment) cannot be disclosed without your highly specific written consent. A general authorization for the release of medical records is NOT sufficient.
2. Mental Health Records: In accordance with New York Mental Hygiene Law Section 33.13, clinical records maintained by licensed mental health providers are subject to strict limits. We will not disclose mental health clinical records to a third party without your specific authorization or a formal order signed by a court judge. A standard law enforcement administrative subpoena is not sufficient.
3. Genetic Testing Information: Pursuant to New York Civil Rights Law Section 79-l, all records, findings, and results of genetic tests are strictly confidential. We will not perform genetic tests or disclose genetic test results without obtaining your specific written informed consent.
4. Substance Use Disorder (SUD) Treatment Records: If your records are protected by federal substance use disorder regulations (42 CFR Part 2), we will restrict uses and disclosures of these records. While a single consent may cover Treatment, Payment, and Healthcare Operations, these records may never be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your distinct written consent or a specialized court order accompanied by a subpoena.
5. Minors and Reproductive Care: Under New York law, minors who are legally authorized to consent to their own treatment (such as reproductive health, prenatal care, and STI care) retain sole control over the privacy of those specific medical records, and parents or guardians may not have automatic access to them.

III. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION
For purposes outside of standard treatment, payment, or operations, or where not specifically carved out by New York law, we must obtain your written authorization. You may revoke this authorization at any time in writing.

• Marketing & Sale of PHI: We will never sell your PHI or use your PHI for marketing communications without your explicit written authorization.
• Psychotherapy Notes: Most uses and disclosures of psychotherapy notes require your prior written authorization.

IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding the PHI we maintain about you:

1. Right to Inspect and Copy: You have the right to inspect and obtain a paper or electronic copy of your medical and billing records. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Under New York law, you cannot be denied access to your records solely due to an inability to pay.
2. Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You must submit your request in writing and provide a reason. We may say "no" to your request, but we will tell you why in writing within 60 days.
3. Right to an Accounting of Disclosures: You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you ask, who we shared it with, and why. This includes disclosures made electronically for treatment, payment, and healthcare operations if applicable to updated federal systems.
4. Right to Request Restrictions: You have the right to ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care. However, if you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or operations, and we will honor that request unless a law requires us to share it.
5. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a specific address. We will accommodate all reasonable requests.
6. Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.

V. OUR LEGAL RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.
• We must give you this Notice of our legal duties and privacy practices concerning your PHI.
• We must follow the terms of the Notice currently in effect.
• Breach Notification: We are required by law to notify you promptly following a breach of your unsecured Protected Health Information or your 42 CFR Part 2 protected records.

We reserve the right to change our privacy practices and the terms of this Notice at any time. Any changes will apply to all information we maintain. If we make a material change, an updated Notice will be posted in our office, available on our website, and provided to you upon request.

VI. COMPLAINTS AND CONTACT INFORMATION
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the federal government. You will not be penalized or retaliated against for filing a complaint.

• To file a complaint with our practice, contact our Privacy Officer:
  Privacy & Compliance Department
  2126 Merrick Mall Merrick, NY 11566
  (516) 546-3227
• To file a complaint with the federal government, contact:
  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
  Toll Free: 1-877-696-6775 / www.hhs.gov/ocr/privacy/hipaa/complaints/