HIPAA NOTICE OF PRIVACY PRACTICES
Empire Medical Wellness
Effective date: 8/1/26
Notice of Privacy Practices of Empire Medical Wellness LLC doing business as Empire Medical Wellness.
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 describes:
HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED;
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION; AND
HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION.
YOU HAVE A RIGHT TO A COPY OF THIS NOTICE IN PAPER OR ELECTRONIC FORM AND TO DISCUSS IT WITH OUR PRIVACY OFFICER AT 929-930-3636 OR admin@empiremedicalwellness.com IF YOU HAVE ANY QUESTIONS.
WHO THIS NOTICE COVERS
This notice applies to Empire Medical Wellness and the health information maintained by our practice in connection with your care. It covers our clinicians and other workforce members, and the work performed for us by service providers subject to applicable privacy agreements. It applies to information in electronic, paper, oral, and other forms, including information connected with in-person and telemedicine services.
Independent clinicians, pharmacies, laboratories, and other organizations may have their own privacy notices. This notice does not replace those notices.
The additional protections described under “Substance use disorder records” apply to records protected by 42 CFR Part 2. Part 2 program requirements apply to our services to the extent those services qualify as a Part 2 program. Not every reference to alcohol or substance use in a medical record is automatically a Part 2 record.
OUR RESPONSIBILITIES
We are required by law to maintain the privacy of protected health information, provide this notice of our legal duties and privacy practices, and follow the notice currently in effect. We must notify affected individuals following a breach of unsecured protected health information, including unsecured Part 2 records when applicable, as required by law.
We use appropriate safeguards and limit access to information based on job responsibilities. Where the minimum-necessary standard applies, we limit uses and disclosures to the information reasonably needed for the permitted purpose. We follow more protective federal or state requirements when they apply.
YOUR HEALTH INFORMATION RIGHTS
To exercise a right described below, contact our Privacy Officer by telephone, email, or mail using the contact information in this notice. We may ask for a written request and appropriate identity verification. We will help identify the correct process and an appropriate way to transmit sensitive information.
ACCESS YOUR RECORDS
You may inspect or obtain an electronic or paper copy of medical, billing, and other information in the records used to make decisions about you, subject to limited legal exceptions. We will provide access in the requested format when readily producible, or agree on another appropriate format.
We generally act on an access request within 30 days, or sooner when applicable law requires. When a legally permitted extension is necessary, we will explain the reason and completion date in writing. Any copying charge will be reasonable, cost-based, and permitted by law. If access is denied, we will explain the basis and any available review rights.
REQUEST AN AMENDMENT
You may request correction of information you believe is inaccurate or incomplete. Please identify the information and explain the requested change. We generally respond within 60 days, subject to a legally permitted extension with written notice. We may deny a request when the law permits, but we will explain the denial and your right to submit a statement of disagreement. An amendment does not ordinarily erase the original record.
REQUEST CONFIDENTIAL COMMUNICATIONS
You may ask us to contact you in a particular way or at a different location, such as using a specific telephone number or mailing address. We will accommodate reasonable requests. You do not need to explain why you want confidential communications, although we may need a usable alternative contact method and, when appropriate, information about how payment will be handled.
REQUEST LIMITS ON USE OR DISCLOSURE
You may ask us to limit certain uses or disclosures for treatment, payment, or health care operations, or disclosures to people involved in your care. We are not required to agree to every restriction. When we agree, we will comply subject to applicable legal exceptions, including certain emergency-treatment situations.
If you or someone other than your health plan pays us in full for a particular item or service, you may request that we not disclose information relating solely to that item or service to your health plan for payment or health care operations. We must honor that request unless the disclosure is required by law. Make the request before the information is disclosed. Separate providers, laboratories, and pharmacies may need their own restriction requests.
RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES
You may request an accounting of certain disclosures made during the six years before your request, or a shorter period you specify. Under HIPAA, this generally excludes disclosures for treatment, payment, health care operations, disclosures made to you or under your authorization, and other legally excluded disclosures. The first accounting in a 12-month period is free. We may charge a reasonable, cost-based fee for additional requests after telling you the cost and allowing you to change or withdraw the request.
RECEIVE A COPY OF THIS NOTICE AND USE AN AUTHORIZED REPRESENTATIVE
You may obtain a paper copy of this notice at any time, even if you previously agreed to receive it electronically. You may also request an electronic copy and discuss the notice with our Privacy Officer.
A person with legally recognized authority, such as a valid health care representative or guardian, may exercise rights within the scope of that authority. We verify the authority before acting. Special rules may limit parental or representative access, including rules for services a minor may consent to independently and circumstances involving abuse, neglect, or endangerment.
HOW WE ORDINARILY USE AND DISCLOSE INFORMATION
The permissions in this section do not override Part 2 or stricter state law. When additional consent is required, we obtain it before the use or disclosure.
Treatment. We may use and disclose information to evaluate, diagnose, treat, prescribe, order testing, and coordinate care. For example, we may communicate relevant medication information to a treating clinician or pharmacy to support safe treatment.
Payment. We may use and disclose information to collect payment, maintain billing records, and resolve payment issues. For example, we may use appointment and charge information to issue an invoice or process a payment. Empire Medical Wellness is a private-pay practice and does not bill insurance directly. This does not prevent disclosures otherwise permitted by law, and it does not reduce your right to request the self-pay restriction described above.
Health care operations. We may use and disclose information for quality improvement, care coordination, staff training, credentialing, professional review, legal or accounting services, compliance, and practice administration. For example, a clinician may review records to evaluate whether our follow-up procedures support safe care.
Service providers. We may use outside organizations to support these activities. When a provider is a business associate or qualified service organization, we obtain the agreements and assurances required for that role. A service provider does not receive unrestricted permission to use your information for its own purposes.
COMMUNICATIONS AND PEOPLE INVOLVED IN YOUR CARE
We may contact you about appointments, test results, prescriptions, treatment alternatives, or health-related services consistent with applicable law and your communication preferences. Ask us to limit voicemail detail or use a different contact method when needed.
When permitted, we may share information relevant to care or payment with family members, close friends, or others you identify if you agree, have an opportunity to object and do not object, or the law otherwise permits. If you cannot express a preference, we may use professional judgment to make a permitted disclosure in your best interests. Similar rules may allow limited disaster-relief communications. Part 2 records and other specially protected information may require written consent instead.
OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
Subject to applicable conditions and any stricter protections, information may be used or disclosed for the following purposes:
Public health and safety: reporting disease, adverse drug reactions, product problems, recalls, suspected abuse or neglect, and certain domestic-violence situations; or preventing a serious and imminent threat when legally permitted.
Oversight and legal requirements: licensing reviews, audits, authorized health oversight, privacy-compliance investigations, and disclosures required by law. Court orders, subpoenas, and other legal demands must meet the applicable legal requirements before records are released.
Research: legally permitted research with required authorization or an applicable waiver or other lawful basis, together with required safeguards.
Other authorized functions: organ and tissue donation; duties of coroners, medical examiners, and funeral directors; workers’ compensation; certain law-enforcement activities; and authorized military, national-security, protective-service, or correctional functions.
These general HIPAA permissions do not authorize unrestricted release of substance use disorder records. The more specific Part 2 rules below control when applicable.
USES REQUIRING YOUR WRITTEN AUTHORIZATION
We obtain your written authorization for most uses or disclosures of separately maintained psychotherapy notes, for marketing that requires HIPAA authorization, and for a sale of protected health information where authorization is required. Our practice policy is not to sell patient information. Psychotherapy notes have a specific legal meaning and are not the same as all mental health progress notes or medication-management records.
Other uses and disclosures not described in this notice will be made only with your written authorization or consent. You may revoke an authorization by submitting a written request to our Privacy Officer, subject to legally permitted exceptions. Revocation does not undo actions already taken in reliance on the authorization.
SUBSTANCE USE DISORDER RECORDS
Federal law provides additional confidentiality protections for patient records covered by 42 CFR Part 2. These protections can apply to records created by a qualifying substance use disorder program and to protected records received from another program. The following provisions apply when we maintain those records or operate services subject to Part 2.
CONSENT FOR TREATMENT, PAYMENT, AND OPERATIONS
A Part 2 program generally obtains written consent before disclosing identifying substance use disorder records outside the program for treatment, payment, or health care operations, unless a specific Part 2 exception applies. For example, consent may be needed to send your substance use disorder treatment records to another clinician coordinating your care.
You may provide a single consent for future uses and disclosures for treatment, payment, and health care operations. The consent identifies its scope, recipients, and expiration. You may discuss a more limited consent with us. We will explain relevant consequences of refusing a requested consent. You may revoke consent in writing through our Privacy Officer, except to the extent information has already been used or disclosed in reliance on it and subject to any other applicable legal exception.
When a HIPAA covered entity or business associate receives Part 2 records under a consent for treatment, payment, and health care operations, the recipient may redisclose them as HIPAA permits. This does not remove the special restrictions on use in proceedings against you.
LIMITED DISCLOSURES WITHOUT CONSENT
Part 2 permits limited disclosures without written consent when its specific conditions are met. These include necessary communications within the program or with an entity having direct administrative control, and services provided under qualifying service-organization arrangements; bona fide medical emergencies and certain FDA product-safety notifications; properly authorized research; qualifying audits and evaluations; and public-health disclosures that meet the required de-identification standard.
Other narrow exceptions include an initial report of suspected child abuse or neglect; limited reports about a crime or threatened crime on program premises or against program personnel; disclosures authorized by applicable cause-of-death laws; and disclosures under a qualifying Part 2 court order and any required legal mandate. An initial child-abuse report does not, by itself, authorize unrestricted release of the underlying treatment records.
INVESTIGATIONS AND PROCEEDINGS AGAINST YOU
We will not use or disclose protected Part 2 records, or testimony describing their contents, in civil, criminal, administrative, or legislative investigations or proceedings against you unless you provide specific written consent or the requirements for a Part 2 court order are met.
When disclosure is based on a court order, the required notice and opportunity to be heard must be provided to you or the record holder as the law requires. An order authorizing disclosure must be accompanied by a subpoena or comparable legal mandate compelling disclosure before the requested records are disclosed. A general treatment, payment, and operations consent is not consent to use records against you in a legal proceeding.
COUNSELING NOTES AND ADDITIONAL RIGHTS
Separately maintained substance use disorder counseling notes generally require specific consent and are not included in a general treatment, payment, and operations consent. Limited legal exceptions apply. We will not condition treatment on consent to disclose these separately maintained notes.
You may request restrictions on disclosures made under a treatment, payment, and operations consent, including the mandatory self-pay restriction described earlier. When you authorize disclosure through an intermediary using a general designation, you may make a written request to that intermediary for a list of recipients during the preceding three years. Contact our Privacy Officer for assistance identifying the intermediary.
Part 2 also provides additional accounting rights, including certain three-year accountings. Requirements whose federal compliance date has been deferred apply when that compliance date takes effect. This does not limit the HIPAA accounting rights or intermediary-list rights already applicable to your information.
STATE-LAW AND OTHER ADDITIONAL PROTECTIONS
When an applicable law provides greater protection than HIPAA, we follow the more protective requirements. Certain laws restrict disclosure of HIV-related information, genetic testing information, mental health records, and records of services a minor may consent to independently. We obtain the specific consent or authorization those laws require and observe their limits on redisclosure.
For example, when New York Public Health Law Article 27-F applies, we disclose confidential HIV-related information only with a qualifying release or another basis specifically permitted by that law, such as necessary treatment, required public-health reporting, or a qualifying court order. An ordinary request for records does not eliminate those protections.
When New York Civil Rights Law Section 79-l applies, genetic test results are subject to its specific written-consent and confidentiality requirements, except where a statutory exception permits disclosure. For records governed by New Jersey or another state’s more protective law, we apply the corresponding consent, access, and disclosure limitations.
FUNDRAISING CHOICES
If we conduct fundraising using information that the law permits us to use, you may opt out of fundraising communications without affecting your treatment or payment arrangements. Before using Part 2 records for fundraising for our program, we will provide a clear, conspicuous opportunity to choose not to receive those communications. You may contact our Privacy Officer to communicate your preference.
QUESTIONS AND COMPLAINTS
You may ask questions or file a privacy or security complaint with our Privacy Officer by telephone, email, or mail. Describe the concern and provide a way for us to contact you. We can help arrange an appropriate method for submitting confidential information.
Empire Medical Wellness
Attention: Privacy Officer
Telephone: 929-930-3636
Email: admin@empiremedicalwellness.com
Privacy mailing address: 220 5th Ave, 11th Floor, New York, NY 10001
HHS complaint instructions: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), through its online complaint portal, by email to OCRComplaint@hhs.gov, or by mail to Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, D.C. 20201. OCR accepts complaints concerning HIPAA and Part 2. Complaints generally must be filed within 180 days after you knew of the issue, although OCR may extend that period for good cause.
We will not retaliate against you for filing a complaint or exercising your privacy rights. You do not have to complain to us before contacting OCR.
CHANGES TO THIS NOTICE
We reserve the right to change this notice as permitted by law and to make revised practices effective for information we already maintain as well as information received in the future. The revised notice will display its effective date, be posted on our website and at applicable service locations, and be available upon request. We will provide or distribute revised notices when the law requires.
ACKNOWLEDGMENT OF RECEIPT
We may ask you to acknowledge receiving this notice. An acknowledgment confirms receipt only. It is not an authorization to disclose records, a Part 2 consent, an agreement to receive marketing, or a waiver of your rights.