Notice of Privacy Practices

Effective date: July 5, 2026

Bergen Sole Podiatry is required by law to maintain the privacy of your protected health information ("PHI"), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information

For treatment

We use your health information to provide your podiatric care and may share it with other health care providers involved in your care — for example, your primary care physician, a specialist we refer you to, a laboratory, or a pharmacy.

For payment

We may use and disclose your health information to bill and collect payment for services — for example, sending claims to your insurance plan, verifying your benefits, or responding to your insurer's review requests.

For health care operations

We may use and disclose your health information for our practice operations, such as quality assessment, training, licensing, appointment reminders, and telling you about treatment options or health-related services we offer.

Other permitted or required disclosures

We may use or disclose your health information without your authorization when permitted or required by law, including:

• As required by law, including reporting required by federal, state, or local law;
• Public health activities, such as reporting communicable diseases or adverse drug events;
• Reports of abuse, neglect, or domestic violence to authorized authorities;
• Health oversight activities, such as audits, inspections, and licensure actions;
• Judicial and administrative proceedings, in response to a court order, subpoena, or lawful process;
• Law enforcement purposes, within the limits of the law;
• Coroners, medical examiners, and funeral directors, as necessary to carry out their duties;
• Organ and tissue donation organizations, if applicable;
• To avert a serious threat to health or safety;
• Specialized government functions, such as military or national security activities; and
• Workers' compensation programs, as authorized by law.

We may also share information with family members or others involved in your care or payment for your care if you agree, or in an emergency when it is in your best interest. For a patient who is a minor, we may share information with a parent or legal guardian as permitted by law.

Uses and disclosures requiring your written authorization

We will not use or disclose your health information for marketing purposes, sell your health information, or share psychotherapy notes (if any) without your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization, which you may revoke at any time in writing, except to the extent we have already acted on it.

Your rights regarding your health information

• Right to inspect and copy. You may ask to see or receive a copy of your medical and billing records, including an electronic copy. We may charge a reasonable, cost-based fee.
• Right to amend. If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. We may deny the request in certain cases, and you may respond with a statement of disagreement.
• Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your health information in the six years prior to your request.
• Right to request restrictions. You may ask us to limit how we use or share your information. We are not required to agree, except that we must honor your request not to share information with your health plan about a service you (or someone on your behalf) paid for in full out of pocket.
• Right to confidential communications. You may ask us to contact you in a specific way or at a specific location (for example, cell phone only), and we will accommodate reasonable requests.
• Right to a paper copy of this notice. You may request a paper copy at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. We will notify you if a breach occurs that may have compromised the privacy or security of your unsecured health information.

To exercise any of these rights, contact us using the information below.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for health information we already hold as well as information we receive in the future. The current notice is posted in our office and on our website, with its effective date at the top.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/complaints. You will not be penalized or retaliated against for filing a complaint.

Contact / Privacy Officer

Privacy Officer: Dr. Elham (Ellie) Nasab, DPM
Bergen Sole Podiatry
9 S Island Avenue, Ramsey, NJ 07446
(201) 430-5380 · contact@bergensole.com