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.





Interfaith Medical Center (IMC) is required by law to maintain the privacy of your protected health information (PHI). This Notice of Privacy Practices tells you how your PHI may be used and how the Hospital keeps your information private and confidential. This notice explains the legal duties and practices relating to your PHI. As part of the Hospital’s legal duties this Notice of Privacy Practices must be given to you. IMC is required to follow the terms of the Notice of Privacy Practices currently in effect.

Each time you register at or are admitted to the Hospital for treatment or health care services as an inpatient or outpatient, we will make available copies of the current Notice.

We reserve the right to make changes to this notice. Any revisions to our Notice will be posted on the Interfaith Medical Center website at


PHI includes demographic and medical information that concerns the past, present, or future physical or mental health of an individual. Demographic information could include your name, address, telephone number, social security number and any other means of identifying you as a specific person. PHI contains specific information that identifies a person or can be used to identify a person.

PHI is health information created or received by a health care provider, health plan, employer, or health care clearinghouse. This medical information is used by IMC in many ways while performing normal business activities.

Your PHI may be used or disclosed by for purposes of treatment, payment, and health care operations.  Exceptions to this rule are found in the subsection of this form labeled EXCEPTIONS.

For Treatment: We may use medical information about you to provide you with medical treatment or services you require. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Hospital personnel who are involved in taking care of you. An example would be if your physician discloses your health information to another doctor for the purposes of a consultation. Different departments of the Hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside the Hospital who may be involved in your medical care. Also, we may contact you with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

For Payment: We may use and/or disclose your health information for the purpose of allowing us, as well as other entities, to secure payment for the health care services provided to you. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may also disclose information about you to other healthcare facilities for purposes of payment as permitted by law.

You may request us to withhold medical information from your health plan if the information relates to services you paid for yourself in full.

For Health Care Operations: We may use and/or disclose your information for the purposes of our day-to-day operations and functions. For example, we may compile your health information, along with that of other patients, in order to allow us to review that information and make suggestions concerning how to improve the quality of care. We have agreed, to the extent permitted by law, to share your PHI among ourselves for purposes of treatment, payment or health care operations. This enables us to better address your health care needs. Also, we may contact you as part of our efforts to raise funds for IMC. All fundraising communications will include information about how you may “opt out” of future fundraising communications.


We may also use or disclose health information in connection with your care in the following circumstances.

Inpatient Directory: We may include certain limited information about you in our directory while you are a patient at the Hospital, so that your family, friends and clergy can visit you and generally know how you are doing. This information may include your name and location within the facility, your religious designation, and information about your condition in general terms that will not communicate specific medical information about you. Except for your religion, we may disclose this information to any person who asks for you by name. We may disclose all directory information to members of the clergy.

Notifications: We may disclose to your relatives or close personal friends, health information that is directly related to that person's involvement in the provision of, or payment for, your care. We may also use and disclose your health information for the purpose of locating and notifying your relatives or close personal friends of your location, general condition or death, and to organizations that are involved in those tasks during disaster situations.

The following categories can also be disclosed without your written authorization as allowed by law. Those circumstances include but are not limited to:

Ø  Reporting abuse and neglect of children, adults, or disabled person, or domestic violence;

Ø  Public health purposes including vital statistics, disease reporting, public health surveillance, investigations, interventions and regulation of health professionals;

Ø  For health oversight activities, such as audits or civil, administrative or criminal investigations;

Ø  Court orders, warrants, or subpoenas;

Ø  Research approved by the Hospital;

Ø  Law enforcement purposes, administrative investigations, and judicial and administrative proceedings;

Ø  To assist coroners, medical examiners or funeral directors with their official duties;

Ø  To facilitate organ, eye or tissue donation;

Ø  To avert a serious threat to health or safety;

Ø  For specialized governmental functions, such as military, national security, criminal corrections, or public benefit purposes; and

Ø  For workers' compensation purposes, as permitted by law.

EXCEPTIONS: The following categories of information receive special protection under state law, and will be used and disclosed only as allowed by state law:

Ø  HIV-related information;

Ø  Records of mental health treatment;

Ø  Substance abuse records.

If you are under 18 years of age, your parent or guardian will control access to, and disclosure of, your health information, subject to the provisions of this Notice, with the following exceptions:

1.  Communicable Diseases. If you are being diagnosed or treated for a sexually transmitted disease or any other disease or condition that we are required by law to report to the government or health authorities, you (the minor) will control access to, and disclosure of, your health information that is related to that diagnosis or treatment.

2. Mental Health. If you are over 14 years of age, and you are able to understand the nature of your mental health records and the purpose of releasing them, you will control access to, and disclosure of, the health information related to your mental health treatment.

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will require your written authorization. This authorization will have an expiration date that can be revoked by you in writing. These uses and disclosures may be for marketing, fundraising and for research purposes. Certain uses and disclosure of psychotherapist notes will also require your written authorization.


You have the right to make certain requests of us related to your PHI. For example you have the right:

  • To inspect and copy your medical records
  • To request that we amend health information that you believe is incorrect
  • To request that we communicate with you in a particular way (ex. via e-mail)
  • To an accounting of disclosures
  • To request that we restrict the uses and disclosures of your health information
  • To request confidential communication

Right to Access and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. This right does not include psychotherapy notes, information compiled for use in a legal proceeding, or certain information maintained by laboratories.

In order to inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Hospital’s Health Information Management Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A licensed healthcare professional will conduct the review. The reviewer will not be the person who denied your original request. We will comply with the outcome of the review.

You also have the right to obtain access to your PHI in an electronic format, when requested.  You are also permitted to designate another person or entity to be the recipient of the transmittal of such electronic PHI.

Right to Amend: If you think that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Hospital. To request an amendment, your request must be made in writing and submitted to the Hospital’s Health Information Management Department. You must give a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Ø  was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

Ø  is not part of the medical information kept by or for the Hospital;

Ø  is not part of the information that you would be permitted to inspect and copy; or

Ø  is accurate and complete.

We will provide you with written notice of action we take in response to your request for amendment.

Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of medical information about you. If your PHI is disclosed through an electronic health record (EHR), we are required to provide you with an accounting, when requested, for up to three years prior to the request. Uses and disclosures of PHI through an electronic health record include treatment, payment and healthcare operations.

To request an accounting of disclosures, you must submit your request in writing to Health Information Management Department. Your request must state a time period. We will attempt to honor your request. If you request more than one accounting in any 12-month period, we may charge you for our reasonable retrieval, list preparation and mailing costs for the second and subsequent requests. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend.  We are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you emergency treatment. We are required to agree with requested restrictions if:

Ø  The disclosure is made to a health plan for purposes other than treatments

Ø  If you or someone else pays in full for the care that is the subject of the PHI

Right to Request Confidential Communications: You have the right to receive confidential communications about your own health information by alternative means or at alternative locations. This means that you may, for example, designate that we contact you only via e-mail, or at work rather than home. To request communications via alternative means or at alternative locations, you must submit a written request to Health Information Management Department. All reasonable requests will be granted.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at your first treatment encounter at the Hospital. You may get an additional copy of this Notice at any time by contacting the Admitting Department. You may also obtain a copy of this notice at our website,


If you believe your privacy rights have been violated, you may file a complaint with the Hospital. The complaint must be in writing, describing the acts or omissions that you believe violate your privacy rights. IMC will not retaliate against you for filing a complaint.

All complaints must be submitted in writing to:

Corporate Compliance Officer

Interfaith Medical Center

1545 Atlantic Avenue

Brooklyn, New York 11213


AMENDMENTS/ACCOUNTING & DISCLOSURES:       If you wish to request an amendment or accounting of disclosures please submit your request in writing to:


Health Information Management Department

Interfaith Medical Center

1545 Atlantic Avenue

Brooklyn, New York 11213

Effective and Revised Date

This Notice of Privacy Practices is effective beginning April 1, 2003, and has been revised on February 3, 2010.


This notice is effective as of April 1, 2003. The notice has been revised February 3, 2010