Call Us Today! 212-767-1100 | info@drbradleywasserman.com

Patient Forms

HIPAA PRIVACY
Bradley R. Wasserman, MD, PLLC
125 East 63rd Street, New York, NY 10065
Phone #: 212‐767­‐1100
HIPAA PRIVACY

Our Duties:

The office is required by law to maintain the privacy of your health information and to provide you with this notice of our duties and privacy practices. We are required to abide by the terms of this notice as may be amended from time to time. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information that we maintain. If the office changes it notice, we will provide a copy of the revised notice by delivering to you a copy of the revised notice via regular mail or in person.

Complaints:

You have the right to express complaints to the office and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the Office by contacting the Office’s Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. The office, all staff members and physicians will not treat you any differently or retaliate in any manner should you file a complaint.

Contact Person:

The office’s contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer. Complaints against the office can be mailed to the Privacy Officer at:

Bradley Wasserman,
125 East 63rd Street, New York, NY 10065

Consent
Participant's Name
Participant's Name
First
Last
Start Over