Bronx Kidney Care
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.
Effective date: [Pending — to be set on adoption]
Who we are
This notice applies to Bronx Kidney Care, an outpatient dialysis facility at 4451 Third Avenue, Bronx, NY 10457, and to all staff who care for you here. We are required by law to maintain the privacy of your protected health information ("PHI"), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
For treatment. We use your health information to provide your dialysis care and share it with the physicians, nurses, technicians, dietitians, and social workers involved in that care — for example, sending your treatment records and lab results to your nephrologist, or to a hospital if you are admitted.
For payment. We use and disclose your information to bill and collect payment for your care — for example, submitting claims to Medicare, Medicaid, or your commercial insurer, and verifying your coverage before you start treatment.
For health care operations. We use your information to run the facility and improve care — for example, quality reviews, staff training, accreditation, and required reporting to the ESRD Network and CMS.
Other uses and disclosures permitted or required by law include: when required by federal, state, or local law; for public health activities; to report suspected abuse, neglect, or domestic violence; for health oversight activities; in response to court orders or lawful subpoenas; to law enforcement in limited circumstances; to coroners, medical examiners, and funeral directors; for organ and tissue donation; for certain research approved by a review board; to prevent a serious threat to health or safety; for specialized government functions; and for workers' compensation.
Uses requiring your written authorization. We will not use or disclose your information for marketing, sell your information, or share psychotherapy notes without your written authorization. You may revoke an authorization at any time, in writing, except to the extent we have already acted on it.
Your rights
- Inspect and receive a copy of your health record, in paper or electronic form.
- Request an amendment to your record if you believe it is incorrect or incomplete.
- Receive an accounting of certain disclosures we have made of your information.
- Request restrictions on how we use or disclose your information, including restricting disclosure to your health plan for services you have paid for in full out of pocket.
- Request that we communicate with you in a certain way or at a certain location.
- Receive a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Be notified if a breach of your unsecured health information occurs.
- Choose someone with medical power of attorney or legal guardianship to act on your behalf.
Our duties
We are required to keep your health information private, provide you this notice, follow the terms of the notice currently in effect, and notify you if a breach compromises your information. We will not use or disclose your information other than as described here without your written permission.
Changes to this notice
We may change this notice and the changes will apply to information we already hold. The current notice is posted in our facility and on this page, with its effective date at the top.
Complaints and questions
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, 1-877-696-6775, or online at hhs.gov/ocr. We will not retaliate against you for filing a complaint.
Privacy Officer: [Name pending] · Bronx Kidney Care, 4451 Third Avenue, Bronx, NY 10457 · 718-960-3860