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NY Family Physician PC — Notice of Privacy Practices

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NY Family Physician PC
2020 Cortelyou Road
Brooklyn, NY 11226
Privacy Officer · 718-689-7353
Email: admin@dpmedicalcare.com

Effective Date: October 24, 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.

Contents

Who this notice applies to

This Notice of Privacy Practices (“Notice”) applies to NY Family Physician PC, a New York professional corporation, and the physicians, clinicians, employees, and other personnel who provide care or services for it at the Ditmas Park Medical Care office, 2020 Cortelyou Road, Brooklyn, NY 11226. In this Notice, “we,” “us,” and “our” mean NY Family Physician PC.

New York Interventional Spine & Pain Medicine PC is a separate practice that sees patients at the same office. It is a separate covered entity under HIPAA and has its own Notice of Privacy Practices. This Notice does not apply to that practice, and NY Family Physician PC is not responsible for that practice’s privacy practices. If you receive care from both practices, you may receive a separate Notice from each.

This Notice does not replace our website Privacy Policy at dpmedicalcare.com. The website Privacy Policy explains how we handle information collected through the website. This Notice explains how we handle protected health information (“PHI”) in connection with your care.

Our promise

We are required by law to maintain the privacy and security of your PHI; give you this Notice; follow the terms of the Notice currently in effect; notify you following a breach of unsecured PHI; and not use or disclose your PHI other than as described in this Notice or as you authorize in writing. We will follow the stricter of federal and New York law when both apply.

We do not sell your PHI. We do not use your PHI for marketing. We do not currently use your PHI for fundraising.

How we may use and disclose your PHI

We may use and disclose your PHI for the following purposes without your written authorization, subject to the limits described in this Notice and the law.

1. Treatment

We use your PHI to provide, coordinate, and manage your care. We may share it with doctors, nurses, laboratories, pharmacies, imaging centers, specialists, hospitals, and other providers who are involved in your care. We may also share it with people outside our practice who will provide follow-up care, such as a specialist or home health agency. For example, we may send your history to a specialist you are seeing or send a prescription to your pharmacy.

2. Payment

We use and disclose your PHI to obtain payment for the care we provide. For example, we may share information with your health plan to get prior authorization, confirm coverage, or process a claim. We may also share it with a billing service or another provider involved in your payment.

3. Health care operations

We use and disclose your PHI to run our practice and make sure you receive quality care. This includes quality assessment and improvement, staff training, licensing, accreditation, audits, compliance, business planning, customer service, and resolving complaints. We may share information with our business associates—companies that perform services for us, such as billing, transcription, IT support, or a patient portal vendor. Federal law requires us to have a written agreement with each business associate that protects your PHI.

We may also share your PHI with other health care providers, health plans, or health care clearinghouses that have a relationship with you for their quality assessment and improvement activities, patient safety activities, population-based efforts to improve health or reduce health care costs, protocol development, case management or care coordination, professional competence review, training programs, accreditation, certification, licensing, or fraud and abuse detection, as permitted by HIPAA.

4. Appointment reminders and treatment communications

We may contact you by mail, phone, or the patient portal to remind you of an appointment, confirm a visit, or give you information about your care. If you have agreed, we may contact you by email or text message for appointment reminders or other treatment communications. We may leave a message on your voicemail or with someone who answers your phone, unless you have asked us to use a different method.

You can ask us to contact you in a specific way or at a specific location. For text messages, reply STOP to stop or HELP for help. Message frequency varies, and message and data rates may apply. We do not send marketing texts. If you ask us to stop text reminders, we will honor your request.

5. Treatment alternatives

We may contact you about treatment options and alternatives related to your care. We do not accept payment for these communications. We do not use your PHI for marketing.

6. Sign-in sheet and waiting room

We may ask you to sign in when you arrive, and we may call your name when we are ready to see you. If you prefer a different process, tell the front desk and we will try to accommodate you.

7. Family, friends, and others involved in your care

We may share your PHI with a family member, friend, personal representative, or other person you identify as involved in your care or payment for your care. We may share the information that is directly relevant to that person’s involvement. If you are present and able to object, we will give you the chance to object first. If you are not able to object, we will use our professional judgment to decide what is in your best interest.

We may also share information with a person who has legal authority to act for you, such as a health care proxy or legal guardian, subject to New York law.

8. Disaster relief

We may share your PHI with a disaster relief organization so it can help notify your family about your location and condition.

9. Required by law

We will disclose your PHI when federal, state, or local law requires it, but we will limit the disclosure to what the law requires. For example, we may report suspected child abuse, elder abuse, or neglect; respond to a court order; report certain wounds or injuries; or comply with a public health reporting requirement.

10. Public health

We may disclose your PHI to public health authorities for activities such as preventing or controlling disease, injury, or disability; reporting births, deaths, and certain diseases; reporting adverse reactions to medications or problems with products; notifying people about recalls; and reporting suspected abuse, neglect, or domestic violence.

We may report immunizations to the New York State Immunization Information System as required by New York law, and we may disclose proof of immunization to a school or employer that requires it, if you agree. We may also report controlled substance prescriptions to the New York State Prescription Monitoring Program as required by law.

We may disclose your PHI to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of another person or the public.

11. Health oversight

We may disclose your PHI to a health oversight agency for audits, investigations, inspections, licensure, certification, and other activities authorized by law.

12. Judicial and administrative proceedings

We may disclose your PHI in response to a court or administrative order. We may also disclose it in response to a subpoena, discovery request, or other lawful process if the law’s requirements are met, such as efforts to notify you or a court order protecting the information.

13. Law enforcement

We may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person; complying with a court order, warrant, or grand jury subpoena; reporting a crime in an emergency; or reporting a death. We will follow the limits in HIPAA and New York law.

14. Coroners, medical examiners, and funeral directors

We may disclose your PHI to a coroner or medical examiner to identify a deceased person, determine a cause of death, or carry out other duties authorized by law. We may also disclose it to a funeral director as necessary to carry out their duties.

15. Organ and tissue donation

We may disclose your PHI to organizations that handle organ, eye, or tissue donation and transplantation, as permitted by law.

16. Research

We may use or disclose your PHI for research if a privacy board or institutional review board has reviewed and approved the research and the researcher has agreed to protect your information, or if the information is provided in a limited data set with a data use agreement, or if the information is de-identified. We will follow HIPAA and New York law.

17. Specialized government functions

We may disclose your PHI for military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and correctional institutions or law enforcement custodial situations, as permitted by law.

18. Workers’ compensation

We may disclose your PHI as necessary to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illness.

19. Inmates and persons in custody

If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your PHI to the institution or official for certain purposes, such as providing you with health care, protecting your health and safety or the health and safety of others, or maintaining the security of the institution.

20. Business associates

We may share your PHI with business associates who perform services for us. Federal law requires us to have a written agreement with each business associate that protects your PHI. They may use or disclose your PHI only as permitted by that agreement and the law. Examples include billing companies, IT vendors, shredding companies, patient portal vendors and SMS reminder vendors.

21. Incidental uses and disclosures

We take reasonable safeguards to protect your PHI. Sometimes a disclosure may be incidental to an otherwise permitted use or disclosure, such as a conversation overheard in a waiting room. We work to keep these incidents to a minimum.

22. Deceased individuals

We may disclose PHI about a deceased person to a family member or other person who was involved in the person’s care or payment before death, unless the person had objected. We may also disclose to the personal representative of the estate.

23. Patient portal

We offer a patient portal that lets you view some of your health information and communicate with us. The portal is not for emergencies. If you have a medical emergency, call 911. You are responsible for keeping your login credentials confidential and for using a secure device. We may send you portal notifications. Federal law requires us to have a written agreement with our portal vendor that protects your information. If you have concerns about portal privacy, contact the Privacy Officer.

Uses and disclosures that require your written authorization

We will not use or disclose your PHI for the following purposes without your written authorization, except as permitted by law.

Marketing

We do not use your PHI for marketing. If we ever want to use or disclose your PHI for marketing, we will ask for your written authorization first.

Sale of PHI

We do not sell your PHI. If we ever want to sell your PHI, we will ask for your written authorization first.

Psychotherapy notes

We do not maintain psychotherapy notes as defined by HIPAA. If we receive psychotherapy notes from another provider, we will not use or disclose them without your written authorization, except as permitted by law.

Other uses and disclosures

We will ask for your written authorization before using or disclosing your PHI for a purpose not described in this Notice, unless the law permits us to do so without authorization.

New York-specific protections

New York law gives you additional protections for certain health information, including mental health records, HIV/AIDS-related information, genetic testing information, and substance use disorder records. In some cases, New York law requires your written consent before we disclose this information. We will follow the stricter of federal and New York law. If you have questions about a specific type of information, contact the Privacy Officer.

Substance use disorder records (42 CFR Part 2)

If we create or receive health information that is subject to 42 CFR Part 2, we will protect it as required by that law. Part 2 generally requires your written consent before we disclose substance use disorder treatment information, except in limited circumstances. It also restricts the use of Part 2 records in civil, criminal, administrative, or legislative proceedings. If you revoke consent, we will stop future disclosures, but we cannot retrieve information that has already been disclosed. If you have questions about Part 2, contact the Privacy Officer.

Revoking an authorization

You may revoke a written authorization at any time by contacting the Privacy Officer in writing. If you revoke it, we will stop using or disclosing your PHI for the purpose covered by the authorization, but we cannot take back information that we already used or disclosed in reliance on it.

Your rights

You have the following rights regarding your PHI.

1. Right to inspect and copy

You can ask to see or get a copy of your medical record and other health information we have about you. We will provide copies in the form and format you request if they are readily producible. If we cannot produce the format you request, we will work with you to find an acceptable alternative.

We will respond within 30 days. If we need more time, we will tell you in writing and may take up to 30 more days. We may charge a reasonable, cost-based fee as permitted by federal and New York law.

We may deny your request in limited circumstances. If we do, we will tell you why in writing and explain your appeal rights. You can also ask us to send a copy to another person or organization you designate in writing.

2. Right to amend

You can ask us to correct health information that you believe is wrong or incomplete. Your request must be in writing and explain why. We will respond within 60 days. If we need more time, we will tell you in writing and may take up to 30 more days.

We may deny your request if we did not create the information (unless the person or entity that created it is no longer available to make the amendment), it is not part of the record we maintain, it is not available for you to inspect, or it is already accurate and complete. If we deny your request, we will tell you why in writing.

You may submit a written statement of disagreement, and we will include it in your record and with future disclosures. We may also prepare a written rebuttal.

3. Right to an accounting of disclosures

You can ask for a list of the times we disclosed your PHI during the six years before your request. The list will not include disclosures for treatment, payment, or health care operations; disclosures you authorized in writing; disclosures to you; or certain other disclosures.

We will provide one free accounting every 12 months. We may charge a reasonable, cost-based fee for additional accountings within 12 months. We will respond within 60 days. If we need more time, we will tell you in writing and may take up to 30 more days. The accounting will not include disclosures made before April 14, 2003.

4. Right to request restrictions

You can ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are not required to agree to your request, except that we must agree not to disclose PHI to your health plan for an item or service you paid for in full out of pocket, unless the law requires the disclosure or the information is needed for your treatment.

If we agree to another restriction, we will honor it unless we tell you in writing that we are terminating it, or unless the law requires us to disclose the information. To request a restriction, contact the Privacy Officer in writing.

5. Right to confidential communications

You can ask us to contact you in a specific way or at a specific location. For example, you can ask us to call your cell phone instead of your home phone, or to send mail to a different address. We will accommodate reasonable requests. You do not have to explain why you are making the request. We may ask you to put the request in writing.

6. Right to a paper or electronic copy of this Notice

You can ask for a paper copy of this Notice at any time, even if you received it electronically. We will give you a copy promptly. You can also get a copy on our website. If you need this Notice in another format, call us and we will help.

7. Right to choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm that the person has authority.

8. Right to be notified of a breach

You have the right to be notified if we discover a breach of your unsecured PHI. We will notify you as required by law. We may notify you by first-class mail or, if you have agreed, by email. If we do not have enough contact information, we may use another method permitted by law.

9. Right to file a complaint

If you believe we have violated your privacy rights, you can complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint. See “Complaints” below.

Acknowledgment of receipt

We may ask you to sign a form acknowledging that you received this Notice. Signing is not a condition of treatment. We will not deny you care if you choose not to sign.

How to exercise your rights

Contact the Privacy Officer using the information at the top of this Notice. We will provide forms if you need them. We may ask you to verify your identity and, if you are a personal representative, to provide proof of your authority. We will not deny you your rights because you did not use our form.

Our responsibilities

We are required by law to:

  • maintain the privacy and security of your PHI;
  • give you this Notice of our legal duties and privacy practices;
  • follow the terms of the Notice currently in effect;
  • notify you following a breach of unsecured PHI;
  • not use or disclose your PHI other than as described in this Notice or as you authorize in writing; and
  • provide a paper copy of this Notice on request.

Changes to this Notice

We may change this Notice at any time. The new Notice will be effective for all PHI we maintain, including information created or received before the change. We will post the current Notice on our website and make paper copies available at our office. The effective date is shown at the top of this Notice.

Complaints

If you believe we have violated your privacy rights, you can complain to us by contacting the Privacy Officer at the address, phone number, or email at the top of this Notice.

You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

You may file a complaint at any time. We will not retaliate against you for filing a complaint.

Contact us

If you have questions about this Notice or want more information about our privacy practices, contact:

Privacy Officer
NY Family Physician PC
2020 Cortelyou Road
Brooklyn, NY 11226
Phone: 718-689-7353
Email: admin@dpmedicalcare.com

Effective date: October 24, 2026

This Notice applies to care you receive from NY Family Physician PC. It does not apply to New York Interventional Spine & Pain Medicine PC, which has its own Notice of Privacy Practices.

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