Notice of Privacy Practices

Effective Date: October 19, 2026

CUTLER PEDIATRIC MEDICINE, PLLC

P.O. Box 145, Somers, NY 10589 · 914-614-8427 ·

info@cutlerpediatric.com

Privacy Officer/Privacy Contact: Suzanne Cutler, MD

Telephone: (914) 614-8427

Email: info@cutlerpediatric.com

Address: P.O. Box 145, Somers, NY 10589

Your Information. Your Rights. Our Responsibilities.

Our practice is committed to protecting the privacy and security of your health information. We follow federal and New York State privacy laws that are applicable to the services that we provide and have adopted privacy and security practices consistent with HIPAA.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

If you are acting on behalf of a child as the child’s parent, guardian or other authorized representative, the references in this Notice to “you”, “your” or other similar terms refers to the child and the child’s

medical information and rights.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record

  • Correct your paper or electronic medical record

  • Request confidential communication

  • Ask us to limit the information we share

  • Get a list of those with whom we’ve shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you believe your privacy rights have been violated

Your Choices

  • You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition

  • Provide disaster relief

  • Include you in a hospital directory if applicable to the practice

  • Provide mental health care

  • Market our services and sell your information

  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you

  • Run our organization

  • Bill for your services

  • Help with public health and safety issues

  • Do research

  • Comply with the law

  • Respond to organ and tissue donation requests

  • Work with a medical examiner or funeral director

  • Address workers’ compensation, law enforcement, and other government requests

  • Respond to lawsuits and legal actions

To the extent that we have your substance use disorder patient records, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information within the timeframes required by applicable state and federal law. We may charge a reasonable, cost-based fee permitted by law.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within the timeframe required by applicable law.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests when required by applicable law and, as a matter of practice, will make reasonable efforts to accommodate your request.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If someone has authority to act as your personal representative, such as if someone has your medical power of attorney, if someone is your legal guardian, or, if the patient is a minor, the patient's parent or guardian, that person can exercise your rights and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action. We may ask for documents, such as custody orders, to confirm it.

    • If the patient is a minor, a parent or guardian generally exercises the patient's rights as the law permits. New York law allows minors to consent to certain care on their own, and privacy laws may limit a parent's access to information about that care. The Practice will handle a minor's health information as the law requires.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information below:

Privacy Officer/Privacy Contact: Suzanne Cutler, MD

Telephone: (914) 614-8427

Email: info@cutlerpediatric.com

Mailing Address: P.O. Box 145, Somers, NY 10589

  • You may also contact the appropriate state or federal agency or professional licensing authority. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, when applicable, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting the Office for Civil Rights website https://www.hhs.gov/hipaa/filing-a-complaint/index.html.

  • We will not retaliate against you for filing a complaint.

Additional Protections Under New York Law.

Certain health information is subject to heightened confidentiality protections under New York State law. Where New York law is more protective than other applicable law, we comply with the more protective state requirements to the extent applicable to you and required by applicable law. Specifically, the following information may be subject to treatment with heightened care and we may be prohibited from disclosing it without complying with applicable law, which may include requirements for obtaining written authorization or a court order:

  • HIV/AIDS-related information

  • Mental health and psychiatric records

  • Genetic testing results and traits

  • Alcohol and substance use disorder treatment records

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions except to the extent inconsistent with any applicable laws.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care or payment for your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory if applicable

Unless you tell us otherwise, we may share your information in these situations as we think appropriate and as permitted by law.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we do not share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again by contacting the Privacy Officer/Privacy Contact listed in this Notice.

If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

You may access certain health information through our patient portal. Please contact us for information about accessing and using the patient portal. https://app.elationpassport.com

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from you and, if you ask us to and we agree to do so, from health plans or other entities.

Currently, we do not submit claims to health insurance plans on your behalf. Our services are provided on a self-pay basis. If you wish to seek reimbursement from your own insurer, you may request an itemized receipt (superbill) to submit. We release records directly to an insurer only as permitted by law and, where required, with your written authorization.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We may have to meet conditions in the law before we can share your information for these purposes.

In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services, if the applicable government authority wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena or other legal process, as permitted by applicable federal and New York State law.

Our Responsibilities

  • We are committed to maintaining the privacy and security of your health information and follow applicable federal and New York State privacy and security requirements.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.

  • We will follow the privacy practices described in this Notice and provide you with a copy upon request.

  • We will not use or share your information other than as described in this notice, unless the use or disclosure is otherwise permitted or required by applicable law. If you tell us we can share your information, you may change your mind at any time and thereafter we will cease further sharing of such information in that way. Let us know in writing if you change your mind.

  • For more information see the U.S. Department of Health and Human Services Office for Civil Rights website and consult applicable New York State laws.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site and office if applicable.