This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.  A printed copy is available by request.

Leaf Medical’s Privacy Commitment

Thank you for giving us the opportunity to serve you. Leaf Medical creates records about you and the treatment services we provide to you. The information we collect is called Protected Health Information (“PHI”). We take our obligation to keep your PHI secure and confidential very seriously. We are required by federal and state law to protect the privacy of your PHI and to provide you with this Notice about how we safeguard and use it and to notify you following a breach of your unsecured PHI. When we use or give out (“disclose”) your PHI, we are bound by the terms of this Notice. This Notice applies to all electronic or paper records we create, obtain, and/or maintain that contain your PHI, including clinical notes, lab results, X-rays, optometry and pharmacy information (medication history).

How We Protect Your Privacy

We understand the importance of protecting your PHI. We restrict access to your PHI to authorized workforce members who need that information for your treatment, for payment purposes and/or for health care operations. We maintain technical, physical and administrative safeguards to ensure the privacy of your PHI.

How We Use and Disclose Your PHI and Uses of PHI without your authorization

We may disclose your PHI without your written authorization if necessary while providing your health benefits. We may disclose your PHI for the following purposes: • Treatment- As we treat you, we may need to use and disclose your PHI to other health care providers within or outside of Leaf Medical, PLLC. For example, a doctor may use the information in your medical record to find the best treatment option for you or a pharmacist may call your doctor to ask questions about a prescription. In some cases, our staff may use or disclose your health information to help your doctor and our health care team manage your care. • Payment- We may use your PHI and disclose it to insurance companies or employer health plans, and to others in order to receive payment for your bill. For example, we must submit a bill to your insurance company that states your name, what we are treating, how we are treating you, and other information in order for us to receive payment. In certain situations, we may disclose your health information to a collection agency if a bill is not paid. • Health care operations- We may use or disclose, as-needed, your PHI in order to support the business activities of Leaf Medical, PLLC. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your PHI to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when your physician is ready to see you. We may also use your name and exam information for patient flow tracking in the office. We may use or disclose your PHI, as necessary, to contact you. We will share your PHI with third party “business associates” that perform various activities (e.g. billing, transcription services) for the practice. We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI for other educational activities.

We may also disclose your PHI without your written authorization for other purposes, as permitted or required by law. This includes:

Others involved in your health care- Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, general condition or death. Finally, we may disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. • Other Permitted and Required Uses and Disclosures- We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate is in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule. • Cancellation- You may cancel (“revoke”) a written authorization you gave us before. The cancellation, submitted to us in writing, will apply to future uses and disclosures of your PHI. It will not impact disclosures made previously, while your authorization was in effect.

Uses of PHI that require your authorization

Other than for the purposes described above, we must obtain your written authorization to use or disclose certain PHI deemed “Highly Confidential.” For certain kinds of PHI, Federal and state law may require enhanced privacy protection. These would include PHI that is: • Maintained in psychotherapy notes. • About alcohol and drug abuse prevention, treatment and referral. • About HIV/AIDS testing, diagnosis or treatment. • About venereal and/or communicable disease(s). • About genetic testing. We can only disclose this type of specially protected PHI with your prior written authorization except when specifically permitted or required by law. Any other uses and disclosures not described in this Notice will only be made with your prior written authorization.

Your Individual Rights

You have the following rights regarding the PHI that Leaf Medical, PLLC creates, obtains, and/or maintains about you. • Right to inspect and copy your PHI- This means you may inspect and obtain a copy of your PHI, in paper or electronic format, that is contained in a designated record set for as long as we maintain the PHI. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or Federal guidelines. Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. All requests to copy or inspect your PHI must be submitted in writing to Leaf Medical, PLLC. • Right to request restrictions- This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. In certain cases, we may deny your request for a restriction. You will have the right to request that we restrict communication to your health plan regarding specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction. All requests to restrict your PHI must be submitted in writing to Leaf Medical, PLLC. • Right to receive confidential communications- You may ask to receive Leaf Medical, PLLC communications containing PHI by alternative means or at alternative locations. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled. All requests must be submitted in writing to Leaf Medical, PLLC. • Right to amend your records- You have the right to ask us to correct your PHI contained in our electronic or paper records if you believe it is inaccurate. If we determine that the PHI is inaccurate, we will correct it if permitted by law. If a different health care facility or professional created the information that you want to change, you should ask them to amend the information. All requests to amend your PHI must be submitted in writing to Leaf Medical, PLLC with the reason the amendment is being requested. • Right to receive an accounting of disclosures- Upon your request, we will provide a list of the disclosures we have made of your PHI for a specified time period. However, the list will exclude: disclosures you have authorized; disclosures made for treatment, payment, and health care operations purposes except when required by law; and certain other disclosures that are excepted by law. All requests must be submitted in writing to Leaf Medical, PLLC. • Right to name a personal representative- You may name another person to act as your Personal Representative. Your representative will be allowed access to your PHI, to communicate with the health care professionals and facilities providing your care, and to exercise all other HIPAA rights on your behalf. Certain representatives, such as those with a healthcare power of attorney or a legal guardian may also have authority to make health care decisions for you. All requests must be submitted in writing to Leaf Medical, PLLC with your Personal Representative’s information. • Right to receive a paper copy of this Notice- Upon your request, we will provide a paper copy of this Notice, even if you have already received one, as described in the Notice Availability and Duration section later in this Notice.


By utilizing our services or replying to our emails, you acknowledge that you are aware that email is not a secure method of communication, and that you agree to the risks. If you would prefer not to exchange personal health information via email, please notify us by calling P:718.285.3035

Changes to Privacy Practices

Leaf Medical may change the terms of this Notice at any time. The revised Notice would apply to all PHI that we maintain.

Actions You May Take

Contact Leaf Medical, PLLC. If you have questions about your privacy rights, believe that we may have violated your privacy rights, or disagree with a decision that we made about access to your PHI, you may contact us at the following address or telephone number: Leaf Medical, PLLC 18 Adams Street Brooklyn, NY 11201  P:718.285.3035