GUPTA GASTRO HIPAA Notice of Privacy Practices:

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. 

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out 

treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also 

describes your rights to access and control your protected health information. “Protected health information” is information 

about you, including demographic information, that may identify you and that relates to your past, present or future physical or 

mental health or condition and related health care services. 1. Uses and Disclosures of Protected Health InformationUses 

and Disclosures of Protected Health Information Your protected health information may be used and disclosed by your 

physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of 

providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any 

other use required by law . Treatment: We will use and disclose your protected health information to provide, coordinate, or 

manage your health care and any related services. This includes the coordination or management of your health care with a 

third party. For example, we would disclose your protected health information, as necessary, to a home health agency that 

provides care to you. For example, your protected health information may be provided to a physician to whom you have been 

referred to ensure that the physician has the necessary information to diagnose or treat you. Payment: Your protected health 

information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a 

hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for 

the hospital admission. Healthcare Operations: We may use or disclose, as-needed, your protected health information in 

order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality 

assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other 

business activities. For example, we may disclose your protected health information to medical school students that see 

patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your 

name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you 

and take a picture or record video for identification purposes. We may use or disclose your protected health information, as 

necessary, to contact you to remind you of your appointment. We may use or disclose your protected health information, as 

necessary, while receiving technical support and/or maintenance of Electronic Medical Records system computers/servers. We 

may use or disclose your protected health information in the following situations without your authorization. These situations 

include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or 

Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and 

Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: 

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the 

Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 

164.500. Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or 

Opportunity to Object unless required by law. You may revoke this authorization, at any time, in writing, except to the 

extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the 

authorization. Your Rights Following is a statement of your rights with respect to your protected health information. You 

have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or 

copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, 

criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to 

protected health information. You have the right to request a restriction of your protected health information. This means 

you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or 

healthcare operations. You may also request that any part of your protected health information not be disclosed to family 

members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy 

Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your 

physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit 

use and disclosure of your protected health information, your protected health information will not be restricted. You then have 

the right to use another Healthcare Professional.You have the right to request to receive confidential communications from 

us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, 

upon request, even if you have agreed to accept this notice alternatively i.e. electronically. You may have the right to have 

your physician amend your protected health information. If we deny your request for amendment, you have the right to file 

a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any 

such rebuttal. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected 

health information. We reserve the right to change the terms of this notice and will inform you by mail of any changes. You 

then have the right to object or withdraw as provided in this notice. Complaints: You may complain to Neville Gupta at 130 

Avenue P, Brooklyn, New York, 11204 or to the Secretary of Health and Human Services if you believe your privacy rights 

have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not 

retaliate against you for filing a complaint. This notice was published and becomes effective on/or before April 14, 2003. 

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy 

practices with respect to protected health information. If you have any objections to this form, please ask to speak with our 

HIPAA Compliance Officer in person or by phone at our Main Phone Number (718) 372-7434