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Do you have any Federal Rights?
The law entitles you to:
• Inspect and copy certain portions of your health
information.×* This does not include psychotherapy
notes and we may deny your request under limited circumstances.
• Request amendment of your health information
if you feel the health information is incorrect or
incomplete.× (However, under certain circumstances
we may deny your request.)
• Receive an accounting of certain disclosures
of your health information made after April 14, 2003
although this excludes disclosures for treatment,
payment, health care operations.×*
• Request that we restrict how we use or disclose
your health information.× (However, we are not
required to agree with your requests).
• Request that we communicate with you at a specific
telephone number or address.×
• Obtain a paper copy of this notice even if
you receive it electronically.
Requests followed by a diamond (×) must be in writing.
Fees may apply to request followed by a star (*).
Contact the Privacy Officer if you wish to exercise
these rights.
[New York: YOU CANNOT BE DENIED
ACCESS TO YOUR MEDICAL RECORDS SIMPLY BECAUSE YOU
CANNOT PAY THE COSTS OF COPYING OR INSPECTION.]
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