Neurology New Patient Welcome Packet - Mount Sinai Hospital

MSSM FPA - Patient Rights Coordinator, Box 1621, One Gustave L. Levy Place,New York, NY 10029MSHQ – Privacy Officer, 25-10 30 th Avenue, Long Island City, NY 11202NSMG – Privacy Officer, 325 Park Avenue, Huntington, NY 11743Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and GeneticInformation. Special privacy protections apply to HIV-related information, alcohol andsubstance abuse treatment information, mental health information, and genetic information.Some parts of this general Notice of Privacy Practices may not apply to these types ofinformation. Notices explaining how these categories of information will be protected by MountSinai are attached as Attachments A-D.YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATIONYou have the following rights regarding your medical information:Right To Inspect and Copy RecordsYou have the right to inspect and obtain a copy of any of your health information that may beused to make decisions about you and your treatment for as long as we maintain this informationin our records. This includes medical and billing records. To inspect or obtain a copy of yourhealth information, please submit your request in writing to:MSH and D&TC - Medical Record Department, Box 1111MSSM FPA - Patient Rights Coordinator, Box 1621MSHQ - Medical Record DepartmentNSMG – Medical Records DepartmentIf you request a copy of the information, we may charge a fee, as permitted by law, for the costsof copying, mailing or other supplies we use to fulfill your request. The fee must generally bepaid before or at the time we give the copies to you.We will respond to your request for inspection of records within 10 days. We ordinarily willrespond to requests for copies within 30 days if the information is located in our facility andwithin 60 days if it is located off-site at another facility. If we need additional time to respond toa request for copies, we will notify you in writing within the time frame above to explain thereason for the delay and when you can expect to have a final answer to your request.Under certain very limited circumstances, we may deny your request to inspect or obtain a copyof your information. If we do, we will provide you with a summary of the information instead.We will also provide a written statement that explains the reasons for providing only a summaryand a complete description of your rights to have that decision reviewed and how you canexercise those rights. The notice will also include information on how to file a complaint aboutthese issues with us or with the Secretary of the Department of Health and Human Services. Ifwe have reason to deny only part of your request, we will provide complete access to theremaining parts after excluding the information we may not let you inspect or copy.MR-250 (Rev 5/04)3