Notice of Privacy Practices

Introduction: Faisal Rafiq MD. PC. (the “Practice”) is dedicated to safeguarding the privacy of your health information as mandated by federal law. This Notice of Privacy Practices (the “Notice”) outlines our commitment to maintaining the confidentiality of Protected Health Information (PHI), which includes data that could identify you. Please review this Notice carefully to understand your rights and our obligations concerning the collection and maintenance of PHI.

Your Rights: You have certain rights regarding your PHI, as detailed below. To exercise these rights, please submit a written request to the Practice at the address provided.

  1. Right to Inspect and Copy PHI:

    • You may request electronic or paper copies of your PHI, subject to a reasonable fee.

    • The Practice reserves the right to deny requests if disclosure poses a threat to your or another person's life.

  2. Right to Amend PHI:

    • You can request corrections to any inaccurate or incomplete PHI.

    • The Practice may deny requests but will provide a written explanation and allow for a statement of disagreement.

  3. Right to Request Confidential Communications:

    • You can specify preferred communication methods, which the Practice will accommodate whenever feasible.

  4. Right to Limit Use or Disclosure of PHI:

    • You may request restrictions on how your PHI is used or shared, though the Practice is not obligated to comply if it impacts your care.

    • Out-of-pocket payments grant you the option to withhold PHI from your health insurer.

    • You can request non-disclosure of PHI to specific individuals by specifying the restriction and recipients.

  5. Right to Receive an Accounting of PHI Disclosures:

    • You are entitled to a yearly accounting of PHI disclosures at no cost, with additional requests incurring a reasonable fee.

  6. Right to Obtain a Copy of this Notice:

    • You can request a paper copy of this Notice, even if you initially received it electronically.

  7. Right to Designate a Representative:

    • Individuals with medical power of attorney or legal guardianship may act on your behalf.

  8. Right to File a Complaint:

    • You may file complaints with the Practice or the U.S. Department of Health and Human Services Office for Civil Rights without fear of retaliation.

  9. Right to Opt Out of Fundraising Communications:

    • While the Practice may engage in fundraising efforts, you can request to be excluded from future communications.

Our Uses and Disclosures: The Practice may use or disclose PHI for various purposes without requiring your authorization, including:

  • Treatment, payment, and health care operations.

  • Public health, safety, and law enforcement requirements.

  • Compliance with legal, judicial, or administrative requests.

  • Coroners, funeral directors, and organ donation purposes.

  • Research, business associates, and inmate care.

  • Disclosure to family or friends involved in your care or in your best interest.

Authorization Requirement: Certain uses and disclosures of PHI require your written authorization, such as marketing, sale of PHI, and psychotherapy notes. You have the right to revoke authorization at any time.

Our Responsibilities:

  • The Practice is obligated to uphold the privacy and security of PHI.

  • We adhere to the terms outlined in this Notice and will notify you of any amendments.

  • In the event of a breach compromising PHI, the Practice will inform affected individuals promptly.

Effective Date: This Notice is effective as of 11/21/2021.

For questions or concerns regarding privacy practices, please contact:

Faisal Rafiq MD. PC. 120 Broadway Amityville NY 11701 Suite D Faisal Rafiq MD. Phone: 631-440-1010

You may also file complaints with the U.S. Department of Health and Human Services Office for Civil Rights.

Revision: 4/14/24 Faisal Rafiq MD.