95-25 Queens Blvd., Third Floor, 
Rego Park, NY 11374

(718) 406-8000

                                    PATIENT NOTICE OF PRIVACY PRACTICES


Patient 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 read it carefully.

  • Your rights regarding medical information about you.
    Your health record is the physical property of the QUEENS BOULEVARD ENDOSCOPY Center.  The information contained in the record however belongs to you. You have the right to:

  • Request a restriction or limitation on the medical information we use or disclose about you for your treatment, payment or health care operations.You also have the right to request a limit on the medical information 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 requested restrictions. If we do not agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

  • Obtain a copy of this notice by requesting it from the Administrator of the Center.

  • Inspect and obtain a copy of your health care record by submitting a request in writing to the Medical Record Department of the Center.

  • Amend your healthcare record if you feel that medical information that we have about you is incorrect or incomplete by requesting in writing that the amendment be made. You must provide a reason that supports your request.

  • Obtain a report of all the disclosures of your health information that we have made.

  • Request that we communicate with you about your medical information in a certain way or at a certain location.

  • Revoke our authorization to use and disclose medial information about you, except to the extent that we have already used or disclosed your medical information.

  • Our responsibilities regarding your medical information.

    We are required by law to:

  • Maintain the privacy of your health information.

  • Provide you with this notice, which describes our legal duties and privacy practices with respect to information we collect about you.

  • Abide by the terms of this notice.

  • Notify you if we are unable to agree to a requested restriction.

  • Accommodate reasonable requests that you have made to have us communicate your health information to you in a certain way or a certain location.

We reserve the right to change this notice. We reserve the right to make the revised and changed notice effective for medical information that we already have about you, as well as any information that we receive in the future.  We will post a copy of the current notice in the Center.  The notice will contain the effective date on the first page. Each time that you register at the Center, we will offer you a copy of the current notice in effect.


  • How we may use and disclose medical information about you.

Each time that you visit us a record of your visit is made. We may use or disclose the health information contained in this record.  The following categories describe the different ways that we may use and disclose your medical information.

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    Health care operations.

    We may use and disclose medical information about you for the operations of the Center.

    For example, members of the medical staff, the risk or quality management committee may use information in your health record to assess the care and outcomes in your case and others like it.  This information will be used in a way to improve the quality and effectiveness of the healthcare and the services that we provide.

  • Appointment reminders.

    We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the Center.

  • Treatment alternatives.

    We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

  • Individuals involved in your care or payment of your care.

    We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care.

  • As required by law.

    We will disclose medical information about you when required to do so by federal, state or local law.

  • Health related benefits and services.

We may use and disclose medical information to inform you about health related benefits or services that may be of interest to you.

  • Emergency.

    We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. The Center would only disclose the information to someone able to help prevent the threat.

  • Business associates.

    Some of the services provided at the Center are provided by business associates. For example, we contract with certain laboratories to perform lab tests.  When we contract for these services, we may disclose your health information to our business associates so that they can perform the job we have hired them to do.  To protect your health information, we require our business associates to appropriately safeguard your information.

  • Worker’s compensation.

    We may release medical information about you to the extent authorized by and to the extent necessary to comply with the laws relating to workers compensation or other similar programs established by law.

  • Public health risks.

    As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

  • Health oversight activities.

    We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include for example audits investigations inspections and licensure.  These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

  • Lawsuits and disputes.

    If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or an administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in a dispute but only if efforts have been made to tell you about the request or to obtain an order protecting the information required.

  • Law enforcement.

    We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

  • Coroners, medical examiners and funeral directors.

    We may release medical information to a coroner or medical examiner. We may also disclose health information to a funeral directors consistent with applicable law to carry out the duties.

  • Food and Drug Administration (“FDA”).

    We may disclose to the FDA health information related to adverse events with respect to food, supplements, products and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

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    Marketing Purposes

    As required by law, the Center will not disclose medical information for marketing purposes that constitute the sale of PHI without an authorization from the patient(s).

  • Other uses of medical information.

    Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only upon written authorization you provide to us.  If you provide us authorization to use or disclose medical information about you, you may revoke that authorization in writing at any time.  If you revoke your authorization we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  The revocation however will not have any effect on any action the Center took before it received the revocation.

  • Questions or complaints.

    If you have any questions and would like additional information, you may contact the Chief Privacy Officer at the QUEENS BOULEVARD ENDOSCOPY Center.

    If you believe that your privacy rights have been violated, you can submit a written complaint describing the circumstances surrounding the violation Attn: Medical director at the facility or to the Secretary of Health and Human Services, State of NY.  You will not be penalized for filing any complaint.


Questions or Comments?
We encourage you to contact us whenever you have an interest about our services.

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Gastroenterologist Rego Park, NY
Queens Boulevard ASC
95-25 Queens Blvd Ste 3
Rego Park, NY 11374
(718) 406-8000