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If )Tj (you wish to revoke your authorization, please )Tj T* (contact the Privacy Office at [Privacy Office phone number] or in writin\ g at [Privacy Office address].)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td ()Tj /Span <>BDC ( )Tj EMC 0.028 Tw 2.571 0 Td [(Activities where we receive money for giving your Health Information to \ a third party)69(.)]TJ /T1_0 1 Tf 0.027 Tw [( F)23(or certain activities in which we would receive remuneration, directly o\ r )]TJ T* [(indirectly)74(, from a third party in exchange for your Health Information, we must ob\ tain your specific written authorization prior to doing)( so. However)93(, we would not require )]TJ T* (your authorization for activities such as for treatment, public health o\ r research purposes. If you do provide us with your wr)Tj (itten authorization, you have a right to revoke )Tj T* (your authorization at any time. 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Requests for restrictions must be in writing. Please )]TJ 0.027 Tw T* (contact the Privacy Office if you wish to request a restriction.)Tj /T1_1 1 Tf 0 Tw -2.057 -1.286 Td (2.)Tj /Span <>BDC ( )Tj EMC 0.035 Tw 2.571 0 Td (Right to Confidential Communications.)Tj /T1_0 1 Tf 0.034 Tw [( )1(Y)93(ou )1(have )1(the )1(right )1(to )1(make )1(a )1(reasonable )1(written )1(request )1(to )1(receive )1(your )1(Health )1(Information )1(by )1(alternative )1(and )1(reasonable )]TJ 0.027 Tw T* (means of communication or at alternative reasonable locations.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (3.)Tj /Span <>BDC ( )Tj EMC 0.07 Tw 2.571 0 Td (Right to Inspect/Copy Health Information,)Tj /T1_0 1 Tf 0.067 Tw [( Y)93(ou have the right to inspect and request copies of your Health Informati\ on that we maintain. F)23(or Health Information )]TJ 0.007 Tw T* (that we maintain in any electronic designated record set, you may reques\ t a copy of such Health Information in a reasonable el)Tj (ectronic format, If readily producible. )Tj -0.029 Tw T* [(However)93(, under limited circumstances, you may be denied access to a portion of \ your records. F)23(or example, if your doctor believes that certain information contained )]TJ 0.026 Tw T* (within your medical record could be harmful to you, we would not release\ that information to you. Please contact [Responsible D)Tj (epartment/Individual\) if you would )Tj 0.005 Tw T* [(like )1(to )1(inspect )1(or )1(request )1(copies )1(of )1(your )1(Health )1(Information )1(from )1(us. )1(W)23(e )1(may )1(charge )1(you )1(a )1(reasonable )1(fee )1(for )1(paper )1(copies )1(of )1(your )1(Health )1(Information )1(or )1(the )1(amount )]TJ 0.027 Tw T* (of our reasonable labor costs for a copy of your Health Information in a\ n electronic format.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (4.)Tj /Span <>BDC ( )Tj EMC 0.039 Tw 2.571 0 Td (Right to Notice of Breach.)Tj /T1_0 1 Tf 0.037 Tw [( W)23(e take very seriously the confidentiality of our patients\222 informatio\ n, and we are required by law to protect the privacy and s)(ecurity of )]TJ 0.088 Tw T* [(your Health Information through appropriate safeguards. W)23(e will notify you in the event a breach occurs involving or potentially \ involving your unsecured Health )]TJ 0.027 Tw T* [(Information and inform you of what steps you may need to take to protect\ yourself)19(.)]TJ /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (5.)Tj /Span <>BDC ( )Tj EMC 0.016 Tw 2.571 0 Td [(Right to P)28(aper Copy of Notice of Privacy Practices.)]TJ /T1_0 1 Tf 0.015 Tw [( Y)93(ou may at any time request a paper copy of this Notice, even if you prev\ iously agreed to receive this Notice )]TJ 0.027 Tw T* (by email or other electronic format. Please contact the Privacy Office t\ o obtain a paper copy of this Notice.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (6.)Tj /Span <>BDC ( )Tj EMC 0.031 Tw 2.571 0 Td (Right to Revoke Authorization.)Tj /T1_0 1 Tf 0.03 Tw [( Y)93(ou may at any time revoke your authorization, )1(whether it was given verbally or in writing. Y)93(ou will generally be required to revoke )]TJ 0.047 Tw T* (your authorization )Tj /T1_1 1 Tf 0.049 Tw (in writing )Tj /T1_0 1 Tf 0.047 Tw (by contacting our Privacy Office. Any revocation will be granted except \ to the extent we may have taken action in reliance upon)Tj ( your )Tj 0 Tw T* (authorization.)Tj /T1_1 1 Tf -0.004 Tc 0.004 Tw -2.571 -1.286 Td (7.)Tj /Span <>BDC ( )Tj EMC 0.135 Tw 2.571 0 Td (Right to Request Amendment.)Tj /T1_0 1 Tf 0.13 Tw [( Y)93(ou may request that we amend, or change, your Health Information that we\ maintain by contacting [Responsible Department/)]TJ 0.027 Tw T* [(Individual]. W)23(e will comply with your request )]TJ 0.004 Tw (unless:)Tj /Span <>BDC 0 Tc 0 Tw 0.553 -1.286 Td ( )Tj EMC /T1_2 1 Tf -0.553 0 Td (\037)Tj /T1_0 1 Tf 0.004 Tc 0.027 Tw 2.571 0 Td [(W)23(e believe the information is accurate and complete;)]TJ /Span <>BDC 0 Tc 0 Tw -2.022 -1.286 Td ( )Tj EMC /T1_2 1 Tf -0.549 0 Td (\037)Tj /T1_0 1 Tf 0.09 Tw 2.571 0 Td [(W)23(e maintain the information you have asked us to change but we did not cr\ eate or author it, for example, your medical records fr)(om another doctor were )]TJ 0.027 Tw T* (brought to us and incorporated into your medical records with our doctor\ s;)Tj /Span <>BDC 0 Tw -2.022 -1.286 Td ( )Tj EMC /T1_2 1 Tf -0.549 0 Td (\037)Tj /T1_0 1 Tf 0.027 Tw 2.571 0 Td (The information is not part of the designated record set or otherwise un\ available for inspection.)Tj /Span <>BDC 0 Tw -2.026 -1.286 Td ( )Tj EMC /T1_2 1 Tf -0.545 0 Td (\037)Tj /T1_0 1 Tf -0.004 Tc 0.027 Tw 2.571 0 Td (Requests for amendments must be in writing.)Tj /T1_1 1 Tf 0.004 Tw -5.143 -1.286 Td (8.)Tj /Span <>BDC ( )Tj EMC 0.028 Tw 2.571 0 Td (Right to an Accounting.)Tj /T1_0 1 Tf 0.027 Tw [( Y)93(ou may request an accounting of certain disclosures we have made of your\ Health Information within the period of six \(6\) years )(from the)-4( )]TJ T* (date of your request for the accounting. The first accounting you reques\ t within a period of twelve \(12\) months is free. Any su)Tj [(bsequently )38(r)38(e)38(q)38(u)38(e)38(s)38(t)38(e)38(d)38( )38(a)38(c)38(c)38(o)38(u)38(n)38(t)38(i)38(n)38(g)38(s)38( )38(m)38(a)38(y)-4( )]TJ -0.042 Tc T* (result in a reasonable charge for the accounting statement. Please conta\ ct the Privacy Office if you wish to request an account)Tj [(ing of disclosures. W)23(e will generally respond to your)-42( )]TJ T* (request in writing within thirty \(30\) days from receipt of the request\ .)Tj /Span <>BDC /T1_1 1 Tf 0 Tc 0 Tw 0.964 -1.286 Td ( )Tj EMC /T1_3 1 Tf -0.964 0 Td (\037)Tj /T1_1 1 Tf -0.036 Tc 0.028 Tw 2.571 0 Td (Right to Request an Accounting of Disclosures.)Tj /T1_0 1 Tf -0.038 Tc 0.027 Tw [( Y)93(ou may request an accounting of certain disclosures we have made of your\ Health Information from a designated record)-38( )]TJ T* (set within the period of )Tj /T1_1 1 Tf -0.036 Tc 0.028 Tw (three \(3\) years )Tj /T1_0 1 Tf -0.038 Tc 0.027 Tw (from the date of your request for the accounting. The first accounting y\ ou request within a period of twelve \(12\) months is fre)Tj [(e. Any)-38( )]TJ T* (subsequent requested accountings may result in a reasonable charge for t\ he accounting statement. Please contact the Privacy Off)Tj [(ice if you wish to request an accounting of)-38( )]TJ T* [(disclosures. W)23(e will generally respond to your request in writing within thirty \(30\)\ days from receipt of the request. ])]TJ /Span <>BDC /T1_1 1 Tf 0 Tc 0 Tw -1.611 -1.286 Td ( )Tj EMC /T1_3 1 Tf -0.96 0 Td (\037)Tj /T1_1 1 Tf -0.04 Tc 0.028 Tw 2.571 0 Td ( Right to Request Access Report.)Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw [( Y)93(ou may request an access report of all accesses to your Health Informati\ on maintained in an electronic designated record set wi)(thin the)-42( )]TJ T* (period of)Tj /T1_1 1 Tf -0.04 Tc 0.028 Tw ( three \(3\) years )Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw [(from the date of your request for the access report. T)-2(h)-2(e)-2( )-2(first access report you request within a period of twelve \(12\) months \ is free. Any subsequent)-42( )]TJ T* (requested accountings may result in a reasonable charge for the access r\ eport. Please contact the Privacy Office if you wish to)Tj [( request an access report. W)23(e will generally)-42( )]TJ T* (respond to your request in writing within thirty \(30\) days from receip\ t of the request.)Tj /T1_1 1 Tf 0.05 Tc -0.05 Tw -7.714 -1.286 Td [(IV)130(.)]TJ /Span <>BDC ( )Tj EMC 0.028 Tw 2.571 0 Td (OUR DUTIES.)Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw T* [(W)23(e are required by law to maintain the privacy of your Health Information\ and to provide you with a copy of this Notice.)]TJ T* [(W)23(e are also required t)-2(o)-2( )-2(abide by the terms of this Notice.)]TJ -0.047 Tc T* [(W)23(e reserve the right to amend this Notice at any time in the future and t\ o make the new Notice provisions applicable to all your)( Health Information \227 even if it was created prior to the change)-47( )]TJ T* (in the Notice.)Tj 0 Tc 0 Tw 5.331 0 Td ( )Tj -0.047 Tc 0.027 Tw -5.331 -1.286 Td [(However)93(, if we do change this Notice, we will only make changes to the extent p\ ermitted by law)65(. W)23(e will also make the revised Notice available to you by posting it in a \ place where all)-47( )]TJ 0.013 Tc T* [(i)60(n)60(d)60(i)60(v)60(i)60(d)60(u)60(a)60(l)60(s)60( )60(s)60(e)60(e)60(k)60(i)60(n)60(g)60( )13(services from us will be able to read the Notice [as well as on our webs\ ite at http://].)]TJ T* [(Y)93(ou may obtain the new Notice in hard copy as well from our Privacy Offic\ e.)]TJ /T1_1 1 Tf -0.04 Tc 0.04 Tw -2.571 -1.286 Td (V.)Tj /Span <>BDC 0.959 0 Td ( )Tj EMC 0.09 Tc 0.028 Tw 1.612 0 Td [(COMPLAINTS TO THE GO)9(VERNMENT)139(.)]TJ /T1_0 1 Tf 0 Tc 0.027 Tw T* [(Y)93(ou may make complaints to the Secretary of the Department of Health and \ Human Services \(\223DHHS\224\) if you believe your rights hav)(e been violated.)]TJ T* [(W)23(e promise not to retaliate against you for any complaint you make to the\ government about our privacy practices.)]TJ /T1_1 1 Tf 0.081 Tc -0.081 Tw -2.571 -1.286 Td (VI.)Tj /Span <>BDC ( )Tj EMC 0.028 Tw 2.571 0 Td [(CONT)37(ACT INFORMA)37(TION.)]TJ /T1_0 1 Tf 0 Tc 0 Tw 14.091 0 Td ( )Tj -14.091 -1.286 Td ( )Tj /T1_1 1 Tf 0.09 Tc -0.09 Tw -2.571 -14.143 Td (VII.)Tj /Span <>BDC ( )Tj EMC 0.028 Tw 2.571 0 Td (ELECTRONIC NOTICE)Tj /T1_0 1 Tf 0.013 Tc 0.027 Tw -2.571 -1.286 Td [(This Notice of Privacy Practices is also available on our web page at ht\ tps://www)65(.trinitashospital.org)]TJ ET q 1 0 0 1 264.96 112.032 cm 0 0 0 1 K /GS1 gs 0 0 m 0 22.248 l S Q q 1 0 0 1 54.72 111.532 cm 0 0 0 1 K /GS1 gs 0 0 m 210.24 0 l S Q q 1 0 0 1 264.96 38.3839 cm 0 0 0 1 K /GS1 gs 0 0 m 0 72.648 l S Q q 1 0 0 1 264.96 111.532 cm 0 0 0 1 K /GS1 gs 0 0 m 95.04 0 l S Q BT /T1_0 1 Tf -0.018 Tc 7 0 0 7 59.22 124.4319 Tm [(Y)93(ou may contact us about our privacy practices by writing or)-18( )]TJ 0 -1.2 TD [(calling the Privacy Officer at:)-18( )]TJ /T1_4 1 Tf 0 Tc 0 Tw 30.034 1.2 Td [(Y)74(ou may contact the DHHS at:)]TJ -30.034 -3.25 Td [(P)19(rivacy Office)]TJ T* [(T)74(rinitas R)19(egional Ji8Ƶ Center)]TJ T* (225 Williamson Street)Tj T* (Elizabeth, New Jersey 07207)Tj T* [(T)93(elephone Number)-19(: \(908\) 994-5317)]TJ 30.034 4.8 Td (Office for Civil Rights)Tj T* [(Depar)-74(tment of HHS)]TJ T* [(Jacob Javits F)23(ederal Building)]TJ T* [(26 F)23(ederal Plaza - Suite 3312)]TJ T* [(New Y)74(ork, NY 10278)]TJ T* [(V)42(oice Phone \(212\) 264-3313)]TJ T* [(F)42(AX \(212\) 264-3039)]TJ T* (TDD \(212\) 264-2355)Tj ET endstream endobj 50 0 obj << /AP << /N 69 0 R >> /Rect [0.00000 0.00000 612.00000 1008.00000 ] /P 48 0 R /Type /Annot /Subtype /PlyBorder /F 68 >> endobj 69 0 obj << /Resources << /ProcSet [/PDF /Text ] >> /FormType 1 /Type /XObject /BBox [0 0 612 1008 ] /Subtype /Form /Length 56 >> stream q 1 w [] 0 d 0 0 0 RG 0 0.001 611.999 1007.999 re h S Q endstream endobj 62 0 obj << /BaseEncoding /WinAnsiEncoding /Type /Encoding /Differences [31 /a173 ] >> endobj 59 0 obj << /FirstChar 32 /Encoding /WinAnsiEncoding /ToUnicode 70 0 R /LastChar 73 /BaseFont /WRTLWB+TimesNewRomanPS-BoldMT /Subtype /TrueType /FontDescriptor 31 0 R /Widths [250 0 0 0 0 0 0 0 0 0 0 0 0 0 250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 389 ] /Type /Font >> endobj 70 0 obj << /Filter /FlateDecode /Length 240 >> stream H\PMk0 Wl V2Cc9OvJzBgSz@~P0&sX 8:/5Xgҭ+t:'Z?OΉV=^wHΏ>u{' *h8W ZXZ#B]fsI8PF̏&̭*.>3~|*Kqcmi[5 ,)1~"*`k s endstream endobj 60 0 obj << /AIS false /ca 1.00000 /SMask /None /CA 1.00000 /op true /OP true /SA false /OPM 1 /BM /Normal /Type /ExtGState >> endobj 58 0 obj << /FirstChar 31 /Encoding 40 0 R /ToUnicode 71 0 R /LastChar 31 /BaseFont /WRTLWB+CommercialPiBT-Regular /Subtype /Type1 /FontDescriptor 42 0 R /Widths [549 ] /Type /Font >> endobj 71 0 obj << /Filter /FlateDecode /Length 235 >> stream H\j0 ~ C]atrX;[I m琷&G'~۷6#GaqK=>F> endobj 72 0 obj << /Filter /FlateDecode /Length 3813 /Subtype /Type1C >> stream HDTkPWf{W#3X 3FT^Z A4Ka0K@D4dV ( f 3;iTFؐdlRhIY /_FҤMJWLQfBY 4Պy*TVM"!^x$& L5VgdiR –$Iَ"< › ?"@DH"D&!&$r qh$d&攈U@qFQPRmI%-1\i-ko[iGE}kO۫7ڗ;qP0qbRc~b]E_cD'? 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Please )]TJ 0.027 Tw T* (contact the Privacy Office if you wish to request a restriction.)Tj /T1_1 1 Tf 0 Tw -2.057 -1.286 Td (2.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.991 -61.728 Td ( )Tj EMC ET BT 0.035 Tw 7 0 0 7 71.977 552.556 Tm (Right to Confidential Communications.)Tj /T1_0 1 Tf 0.034 Tw 7 0 0 7 18 984.652 Tm 26.174 -61.728 Td [( )1 (Y)93 (ou )1 (have )1 (the )1 (right )1 (to )1 (make )1 (a )1 (reasonable )1 (written )1 (request )1 (to )1 (receive )1 (your )1 (Health )1 (Information )1 (by )1 (alternative )1 (and )1 (reasonable)]TJ 0.027 Tw -18.463 -1.286 Td (means of communication or at alternative reasonable locations.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (3.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.991 -64.3 Td ( )Tj EMC ET BT 0.07 Tw 7 0 0 7 71.977 534.552 Tm (Right to Inspect/Copy Health Information,)Tj /T1_0 1 Tf 0.067 Tw 7 0 0 7 18 984.652 Tm 27.698 -64.3 Td [( Y)93 (ou have the right to inspect and request copies of your Health Informati\ on that we maintain. F)23 (or Health Information)]TJ 0.007 Tw -19.987 -1.286 Td (that we maintain in any electronic designated record set, you may reques\ t a copy of such Health Information in a reasonable el)Tj (ectronic format, If readily producible. )Tj -0.029 Tw T* [(However)93 (, under limited circumstances, you may be denied access to a portion of \ your records. F)23 (or example, if your doctor believes that certain information contained )]TJ 0.026 Tw T* (within your medical record could be harmful to you, we would not release\ that information to you. Please contact [Responsible D)Tj (epartment/Individual\) if you would)Tj 0.005 Tw T* [(like )1 (to )1 (inspect )1 (or )1 (request )1 (copies )1 (of )1 (your )1 (Health )1 (Information )1 (from )1 (us. )1 (W)23 (e )1 (may )1 (charge )1 (you )1 (a )1 (reasonable )1 (fee )1 (for )1 (paper )1 (copies )1 (of )1 (your )1 (Health )1 (Information )1 (or )1 (the )1 (amount )]TJ 0.027 Tw T* (of our reasonable labor costs for a copy of your Health Information in a\ n electronic format.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (4.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.991 -72.016 Td ( )Tj EMC ET BT 0.039 Tw 7 0 0 7 71.977 480.54 Tm (Right to Notice of Breach.)Tj /T1_0 1 Tf 0.037 Tw 7 0 0 7 18 984.652 Tm 20.094 -72.016 Td [( W)23 (e take very seriously the confidentiality of our patients\222 informatio\ n, and we are required by law to protect the privacy and s)(ecurity of)]TJ 0.088 Tw -12.383 -1.286 Td [(your Health Information through appropriate safeguards. W)23 (e will notify you in the event a breach occurs involving or potentially \ involving your unsecured Health)]TJ 0.027 Tw T* [(Information and inform you of what steps you may need to take to protect\ yourself)19 (.)]TJ /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (5.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.991 -75.874 Td ( )Tj EMC ET BT 0.016 Tw 7 0 0 7 71.977 453.534 Tm (Right to P)Tj 7 0 0 7 18 984.652 Tm 12.392 -75.874 Td (aper Copy of Notice of Privacy Practices.)Tj /T1_0 1 Tf 0.015 Tw [( Y)93 (ou may at any time request a paper copy of this Notice, even if you prev\ iously agreed to receive this Notice)]TJ 0.027 Tw -4.681 -1.286 Td (by email or other electronic format. Please contact the Privacy Office t\ o obtain a paper copy of this Notice.)Tj /T1_1 1 Tf 0 Tw -2.571 -1.286 Td (6.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.991 -78.446 Td ( )Tj EMC ET BT 0.031 Tw 7 0 0 7 71.977 435.53 Tm (Right to Revoke Authorization.)Tj /T1_0 1 Tf 0.03 Tw 7 0 0 7 18 984.652 Tm 22.258 -78.446 Td [( Y)93 (ou may at any time revoke your authorization, )1 (whether it was given verbally or in writing. Y)93 (ou will generally be required to revoke)]TJ 0.047 Tw -14.547 -1.286 Td (your authorization )Tj /T1_1 1 Tf 0.049 Tw (in writing )Tj /T1_0 1 Tf 0.047 Tw (by contacting our Privacy Office. Any revocation will be granted except \ to the extent we may have taken action in reliance upon)Tj ( your)Tj 0 Tw T* (authorization.)Tj /T1_1 1 Tf -0.004 Tc 0.004 Tw -2.571 -1.286 Td (7.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.983 -82.304 Td ( )Tj EMC ET BT 0.135 Tw 7 0 0 7 71.977 408.524 Tm (Right to Request Amendment.)Tj /T1_0 1 Tf 0.13 Tw 7 0 0 7 18 984.652 Tm 22.221 -82.304 Td [( Y)93 (ou may request that we amend, or change, your Health Information that we\ maintain by contacting [Responsible Department/)]TJ 0.027 Tw -14.51 -1.286 Td [(Individual]. W)23 (e will comply with your request )]TJ 0.004 Tw (unless:)Tj ET BT /Span <>BDC 0 Tc 0 Tw 7 0 0 7 75.848 390.52 Tm ( )Tj EMC ET BT /T1_2 1 Tf 7 0 0 7 71.977 390.52 Tm (\037)Tj /T1_0 1 Tf 0.004 Tc 0.027 Tw 2.571 0 Td (W)Tj 7 0 0 7 18 984.652 Tm 11.167 -84.876 Td (e believe the information is accurate and complete;)Tj ET BT /Span <>BDC 0 Tc 0 Tw 7 0 0 7 75.82 381.518 Tm ( )Tj EMC ET BT /T1_2 1 Tf 7 0 0 7 71.977 381.518 Tm (\037)Tj /T1_0 1 Tf 0.09 Tw 2.571 0 Td (W)Tj 7 0 0 7 18 984.652 Tm 11.163 -86.162 Td (e maintain the information you have asked us to change but we did not cr\ eate or author it, for example, your medical records fr)Tj (om another doctor were )Tj 0.027 Tw -0.881 -1.286 Td (brought to us and incorporated into your medical records with our doctor\ s;)Tj ET BT /Span <>BDC 0 Tw 7 0 0 7 75.82 363.514 Tm ( )Tj EMC ET BT /T1_2 1 Tf 7 0 0 7 71.977 363.514 Tm (\037)Tj /T1_0 1 Tf 0.027 Tw 2.571 0 Td (The information is not part of the designated record set or otherwise un\ available for inspection.)Tj ET BT /Span <>BDC 0 Tw 7 0 0 7 75.792 354.512 Tm ( )Tj EMC ET BT /T1_2 1 Tf 7 0 0 7 71.977 354.512 Tm (\037)Tj /T1_0 1 Tf -0.004 Tc 0.027 Tw 2.571 0 Td (Requests for amendments must be in writing.)Tj /T1_1 1 Tf 0.004 Tw -5.143 -1.286 Td (8.)Tj ET BT /Span <>BDC 7 0 0 7 18 984.652 Tm 5.982 -91.306 Td ( )Tj EMC ET BT 0.028 Tw 7 0 0 7 71.97 345.51 Tm (Right to an Accounting.)Tj /T1_0 1 Tf 0.027 Tw 7 0 0 7 18 984.652 Tm 18.826 -91.306 Td [( Y)93 (ou may request an accounting of certain disclosures we have made of your\ Health Information within the period of six \(6\) years )(from the)]TJ -11.116 -1.286 Td (date of your request for the accounting. The first accounting you reques\ t within a period of twelve \(12\) months is free. Any su)Tj [(bsequently )38 (r)38 (e)38 (q)38 (u)38 (e)38 (s)38 (t)38 (e)38 (d)38 ( )38 (a)38 (c)38 (c)38 (o)38 (u)38 (n)38 (t)38 (i)38 (n)38 (g)38 (s)38 ( )38 (m)38 (a)38 (y)]TJ -0.042 Tc T* (result in a reasonable charge for the accounting statement. Please conta\ ct the Privacy Office if you wish to request an account)Tj [(ing of disclosures. W)23 (e will generally respond to your)-42 ( )]TJ T* (request in writing within thirty \(30\) days from receipt of the request\ .)Tj ET BT /Span <>BDC /T1_1 1 Tf 0 Tc 0 Tw 7 0 0 7 78.718 309.502 Tm ( )Tj EMC ET BT /T1_3 1 Tf 7 0 0 7 71.97 309.502 Tm (\037)Tj /T1_1 1 Tf -0.036 Tc 0.028 Tw 2.571 0 Td (Right to Request an Accounting of Disclosures.)Tj /T1_0 1 Tf -0.038 Tc 0.027 Tw 7 0 0 7 18 984.652 Tm 31.251 -96.45 Td [( Y)93 (ou may request an accounting of certain disclosures we have made of your\ Health Information from a designated record)]TJ -20.97 -1.286 Td (set within the period of )Tj /T1_1 1 Tf -0.036 Tc 0.028 Tw (three \(3\) years )Tj /T1_0 1 Tf -0.038 Tc 0.027 Tw (from the date of your request for the accounting. The first accounting y\ ou request within a period of twelve \(12\) months is fre)Tj [(e. Any)-38 ( )]TJ T* (subsequent requested accountings may result in a reasonable charge for t\ he accounting statement. Please contact the Privacy Off)Tj [(ice if you wish to request an accounting of)-38 ( )]TJ T* [(disclosures. W)23 (e will generally respond to your request in writing within thirty \(30\)\ days from receipt of the request. ])]TJ ET BT /Span <>BDC /T1_1 1 Tf 0 Tc 0 Tw 7 0 0 7 78.69 273.494 Tm ( )Tj EMC ET BT /T1_3 1 Tf 7 0 0 7 71.97 273.494 Tm (\037)Tj /T1_1 1 Tf -0.04 Tc 0.028 Tw 2.571 0 Td ( Right to Request Access Report.)Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw 7 0 0 7 18 984.652 Tm 24.872 -101.594 Td [( Y)93 (ou may request an access report of all accesses to your Health Informati\ on maintained in an electronic designated record set wi)(thin the)-42 ( )]TJ -14.591 -1.286 Td (period of)Tj /T1_1 1 Tf -0.04 Tc 0.028 Tw ( three \(3\) years )Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw [(from the date of your request for the access report. T)-2 (h)-2 (e)-2 ( )-2 (first access report you request within a period of twelve \(12\) months \ is free. Any subsequent)-42 ( )]TJ T* (requested accountings may result in a reasonable charge for the access r\ eport. Please contact the Privacy Office if you wish to)Tj [( request an access report. W)23 (e will generally)-42 ( )]TJ T* (respond to your request in writing within thirty \(30\) days from receip\ t of the request.)Tj /T1_1 1 Tf 0.05 Tc -0.05 Tw -7.714 -1.286 Td [(IV)130 (.)]TJ ET /Span <>BDC EMC BT 0.028 Tw 7 0 0 7 53.966 237.486 Tm (OUR DUTIES.)Tj /T1_0 1 Tf -0.042 Tc 0.027 Tw T* (W)Tj 7 0 0 7 18 984.652 Tm 5.977 -108.024 Td (e are required by law to maintain the privacy of your Health Information\ and to provide you with a copy of this Notice.)Tj -0.839 -1.286 Td [(W)23 (e are also required t)-2 (o)-2 ( )-2 (abide by the terms of this Notice.)]TJ -0.047 Tc T* [(W)23 (e reserve the right to amend this Notice at any time in the future and t\ o make the new Notice provisions applicable to all your)( Health Information \227 even if it was created prior to the change)]TJ T* (in the Notice.)Tj 0 Tc 0 Tw 5.331 0 Td ( )Tj -0.047 Tc 0.027 Tw -5.331 -1.286 Td [(However)93 (, if we do change this Notice, we will only make changes to the extent p\ ermitted by law)65 (. W)23 (e will also make the revised Notice available to you by posting it in a \ place where all)-47 ( )]TJ 0.013 Tc T* [(i)60 (n)60 (d)60 (i)60 (v)60 (i)60 (d)60 (u)60 (a)60 (l)60 (s)60 ( )60 (s)60 (e)60 (e)60 (k)60 (i)60 (n)60 (g)60 ( )13 (services from us will be able to read the Notice [as well as on our webs\ ite at http://].)]TJ T* [(Y)93 (ou may obtain the new Notice in hard copy as well from our Privacy Offic\ e.)]TJ /T1_1 1 Tf -0.04 Tc 0.04 Tw -2.571 -1.286 Td (V.)Tj ET /Span <>BDC EMC BT 0.09 Tc 0.028 Tw 7 0 0 7 53.966 165.47 Tm (COMPLAINTS TO THE GO)Tj 7 0 0 7 18 984.652 Tm 19.451 -117.026 Td [(VERNMENT)139 (.)]TJ /T1_0 1 Tf 0 Tc 0.027 Tw -14.313 -1.286 Td [(Y)93 (ou may make complaints to the Secretary of the Department of Health and \ Human Services \(\223DHHS\224\) if you believe your rights hav)(e been violated.)]TJ T* [(W)23 (e promise not to retaliate against you for any complaint you make to the\ government about our privacy practices.)]TJ /T1_1 1 Tf 0.081 Tc -0.081 Tw -2.571 -1.286 Td (VI.)Tj ET /Span <>BDC EMC BT 0.028 Tw 7 0 0 7 53.966 138.464 Tm (CONT)Tj 7 0 0 7 18 984.652 Tm 8.293 -120.884 Td [(ACT INFORMA)37 (TION.)]TJ ET /Span <>BDC EMC BT /T1_1 7 Tf 0.63 Tc 3.227 Tw 35.969 30.804 Td (V)Tj 1 0 0 1 40.974 30.804 Tm (II.)Tj /C0_0 7 Tf <0001>Tj /T1_1 7 Tf 0.196 Tw 13.622 0 Td (E)Tj 1 0 0 1 59.797 30.804 Tm (L)Tj 1 0 0 1 64.487 30.804 Tm (E)Tj 1 0 0 1 69.688 30.804 Tm (CTRONIC NOTICE)Tj /T1_0 7 Tf 0.091 Tc 0.189 Tw -33.719 -8.554 Td (Th)Tj 1 0 0 1 44.131 22.25 Tm (i)Tj 1 0 0 1 45.776 22.25 Tm (s Notice of Privacy Practices is als)Tj 1 0 0 1 156.485 22.25 Tm (o)Tj 1 0 0 1 160.643 22.25 Tm ( )Tj 1 0 0 1 162.841 22.25 Tm (av)Tj 1 0 0 1 170.191 22.25 Tm (ailable on our web page at )Tj /C0_0 7 Tf <00490055005500510054001B>Tj 1 0 0 1 275.21 22.25 Tm <00100010>Tj 1 0 0 1 280.026 22.25 Tm <00580058>Tj 1 0 0 1 289.798 22.25 Tm <0058000F00350053004A004F004A0055004200540033002E0024000F005000530048000F>Tj ET 1 w /GS1 gs q 1 0 0 1 264.96 112.032 cm 0 0 m 0 22.248 l S Q q 1 0 0 1 54.72 111.532 cm 0 0 m 210.24 0 l S Q q 1 0 0 1 264.96 38.3839 cm 0 0 m 0 72.648 l S Q q 1 0 0 1 264.96 111.532 cm 0 0 m 95.04 0 l S Q BT /GS0 gs /T1_0 1 Tf -0.018 Tc 0.027 Tw 7 0 0 7 59.22 124.4319 Tm [(Y)93 (ou may contact us about our privacy practices by writing or)]TJ 0 -1.2 TD [(calling the Privacy Officer at:)-18 ( )]TJ /T1_4 1 Tf 0 Tc 0 Tw 30.034 1.2 Td [(Y)74 (ou may contact the DHHS at:)]TJ -30.034 -3.25 Td [(P)19 (rivacy Office)]TJ T* [(T)74 (rinitas R)19 (egional Ji8Ƶ Center)]TJ T* (225 Williamson Street)Tj T* (Elizabeth, New Jersey 07207)Tj T* [(T)93 (elephone Number)-19 (: \(908\) 994-5317)]TJ 30.034 4.8 Td (Office for Civil Rights)Tj T* [(Depar)-74 (tment of HHS)]TJ T* [(Jacob Javits F)23 (ederal Building)]TJ T* [(26 F)23 (ederal Plaza - Suite 3312)]TJ T* [(New Y)74 (ork, NY 10278)]TJ T* [(V)42 (oice Phone \(212\) 264-3313)]TJ T* [(F)42 (AX \(212\) 264-3039)]TJ T* (TDD \(212\) 264-2355)Tj ET endstream endobj 76 0 obj [78 0 R] endobj 77 0 obj <>stream H\j0ໞb!xU1Y.88Բ߾LH>~CmчTtjp WcE6jzoBq3Q}q3,vzRD^7 }9= b*؅"*[:i^!èAZWe Sx*VO\vwizqWHJb։Bv4':$Sd<%ֆU kڲ8ٚINdP$^sSrH^(Uܛ'nއà @p￱#np` endstream endobj 78 0 obj <> endobj 79 0 obj <> endobj 80 0 obj <> endobj 81 0 obj <>stream H: $ N@ endstream endobj 82 0 obj <>stream H|UkPY&$PЮ5V舠 cD\Õ>\ML.ʕQyiD& Cȭ>i)DB!2R$gd)f"!) 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