Last modified: May 12, 2020

Notice of Privacy Practice

The following categories describe different ways that Manhattan Gastroenterology may use and disclose medical information without your specific consent or authorization. We provided examples for each category of uses or disclosures. Not all possible uses or disclosures are listed
For Treatment: We may use and disclose medical information about you to provide you with medical treatment or services. Example: In treating you for a specific condition, we may need to know if you are allergic to specific drugs that could influence which medications we prescribe for the treatment purpose.

For Payment: We may use and disclose medical information about you to bill treatment and services you receive from us, and we may collect payment from your insurance, third party, or you. Example: We may need to send your protected health information, such as your name, address, office visit date, and codes identifying your diagnosis and treatment, to your insurance company for payment.

Health Care Operations: We may use and disclose medical information about you for health care operations to assure that you receive quality care. Example: We may use medical information to review our treatment and services and evaluate the performance of our staff in caring for you.

Other Uses or Disclosures that Can Be Made Without Consent or Authorization

  1. As required during an investigation by Law enforcement agencies.
  2. To avert a serious threat to public health safety.
  3. As required by military command authorities for their medical records.
  4. Compensation to workers or similar programs for processing of claims..
  5. In response to a legal proceeding.
  6. To a coroner or medical examiner for identification of a body.
  7. If an inmate, to the correctional institution or law enforcement official.
  8. As required by the US Food and Drug Administration (FDA).
  9. Other healthcare providers’ treatment activities.
  10. Other covered entities’ healthcare operations activities (to the extent permitted under HIPPA).
  11. Uses and disclosures required by law.
  12. Uses and disclosures in domestic violence or neglect situations.
  13. Health oversight activities. 14.Other public activities.

We May Contact You

We may contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may interest you.

Protected Health Information (PHI)

I understand that, under The Health Insurance Portability Accountability Act of 1996, I have certain rights to privacy regarding my protected health information (PHI). I have received, read, and understood The Notice of Privacy Practices.

I understand that I am formally giving consent

to the practice to receive pharmacy and medication information that I will receive from any and all outside pharmacies, hospitals, or other healthcare institutions. You may receive this information electronically via an electronic medical record or in writing.

Our practice reserves the right to change the terms of the Notice of Privacy Practices. I understand the Practice will provide me with a copy of its Notice of Privacy Practices on request.

I give the physician and their staff permission to leave a message on my automated answering device or to a family member regarding the results of any test or appointments done in this office or referred by this office.

Updated on Oct 19, 2023 by Dr. Shawn Khodadadian (Gastroenterologist) of Manhattan Gastroenterology