Terms & Conditions of HIPAA Authorizations

By accepting the terms or conditions you or your authorized representative, request that health information regarding your care and treatment be released and exchanged as set forth by these terms and conditions in accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), You understand that:

 

This authorization includes the disclosure of your health record including information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION.  You understand that you have the right to request a list of people who may receive or use my HIV-related information without authorization.  If you experience discrimination because of the release or disclosure of HIV-related information, you may contact the New York State Division of Human Rights at 1 (212) 480- 2493 or the New York City Commission of Human Rights at 1 (212) 306-7450.  These agencies are responsible for protecting your rights.  You have the right to revoke this authorization at any time by writing to the East End Mental Health at 332 West Montauk Highway Suite 5 Hampton Bays, New York 11946.  You understand that you may revoke this authorization except to the extent that action has already been taken based on this authorization.  You understand that agreeing to this authorization is voluntary.  Your treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon your authorization of this disclosure.  Information disclosed under this authorization might be redisclosed by the recipient and this redisclosure may no longer be protected by federal or state law (with exception to HIV-related information).  THIS AUTHORIZATION DOES NOT AUTHORIZE EAST END MENTAL HEALTH TO DISCUSS YOUR HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE PARTY EXPRESSLY AGREED UPON.

Contact

332 West Montauk Hwy Suite 5
Hampton Bays,  NY  11946-3551

631-495-3300 Office

631-822-2833 Fax

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M  2-6pm

Tu 11-8pm

W  9-6pm

Th 9-6pm

F   9-6pm

Office Hours

THE CONTENT OF THE SITE IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND IS NOT, AND SHOULD NOT BE CONSIDERED TO BE, MEDICAL ADVICE. THIS INFORMATION IS NOT INTENDED TO CREATE, AND RECEIPT OF IT DOES NOT CONSTITUTE, A PHYSICIAN-PATIENT RELATIONSHIP. THE CONTENT IS NOT INTENDED FOR USE IN THE DIAGNOSIS OR TREATMENT OF ANY INDIVIDUAL CONDITION OR AS A SUBSTITUTE FOR A CONSULTATION WITH A LICENSED MEDICAL PROFESSIONAL. THE CONTENT SHOULD NOT BE CONSIDERED COMPLETE; IS NOT EXHAUSTIVE; AND DOES NOT COVER ALL DISEASES, AILMENTS, PHYSICAL CONDITIONS, OR THEIR DIAGNOSIS OR TREATMENT. THE CONTENT SHOULD NOT BE USED IN PLACE OF A VISIT, CALL OR CONSULTATION WITH, AND THE ADVICE OF, YOUR PHYSICIAN OR OTHER HEALTH CARE PROVIDERS. SHOULD YOU HAVE ANY HEALTH CARE-RELATED QUESTIONS, CALL OR SEE YOUR PHYSICIAN OR OTHER HEALTH CARE PROVIDER PROMPTLY. TALK TO YOUR DOCTOR OR PHARMACIST BEFORE TAKING ANY PRESCRIPTION OR OVER THE COUNTER DRUGS, INCLUDING ANY HERBAL MEDICINES OR SUPPLEMENTS. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY IN SEEKING IT, BECAUSE OF SOMETHING THAT YOU HAVE READ ON THE SITE.

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