This page includes:

1. Notice of Privacy Practices for Ohio

2. Notice of Privacy Practices for All Other States

Notice of Privacy Practices for Ohio

Your Information. Your Rights. Our Responsibilities.

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.

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

• Tell family and friends about your condition
• Provide disaster relief
• 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
• Health Information Exchanges
• Appointment reminders
• Business associates
• Use of unsecure electronic communications
• 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

I. 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 with your rights.

A. 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 by submitting a request to your Cityblock medical team, or by contacting the Privacy Office at privacy@cityblock.com.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

B. Ask us to correct your medical record

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

C. Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests

D. 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. However, we are not required to agree to your request in all situations, and we may say “no” if not sharing the information would affect your care.
• 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.
• If you wish to request additional restrictions, please obtain a request form from our Privacy Office and submit the completed form to the Privacy Office. We will send you a written response.

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

• You can ask for a list (also called an “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 the information was shared.
• 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 may charge a reasonable, cost-based fee if you ask for another one within 12 months.

F. 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 by contacting your Cityblock medical team, or by contacting the Privacy Office at privacy@cityblock.com. We will provide you with a paper copy promptly.

G. Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person is able to make decisions on your behalf under authority that has been legally granted to them.

H. 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 at the end of this Notice.
• You can file a complaint with us. Please send any complaint to Cityblock’s Privacy Officer via email privacy@cityblock.com or by sending a letter to Cityblock Attn: Privacy Officer 495 Flatbush Ave #C5, Brooklyn, NY 11225. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

II. 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.

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
• Share information in a disaster relief situation
• Include your information in a hospital directory

 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 never 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.

Apart from what we say in this Notice, we will not use or share your health information unless we get your written permission (i.e., your authorization). If you authorize us to use or share your information, you have the choice to revoke that authorization later on. You can cancel your authorization at any time by sending a written request to our Privacy Office at privacy@cityblock.com. We are unable to take back any disclosures we have already made with your authorization.

III. 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.

A. 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.

B. 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 can use health information about you to evaluate the quality and competence of our physicians, health care professionals, and community health partners.

C. Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. We may also disclose Protected Health Information to your other health care providers when such Protected Health Information is required for them to receive payment for services they render to you.

 Example: We give information about you to your health insurance plan so it will pay for your services.

D. Health Information Exchanges

We may share information that we obtain or create about you with other health care providers and other health care entities through Health Information Exchanges (HIEs) in which we participate, as permitted by law. HIEs help doctors, hospitals and other healthcare providers provide quality care to you and helps us manage your care when more than one doctor is involved. To the extent permitted by law, your health information may be shared through the HIEs to provide faster access, better coordination of care, and to assist healthcare providers, health plans, and public health officials in making more informed decisions. To opt in or out of the HIEs, you generally must notify the HIE yourself. To obtain information on how to opt out of a HIE, please contact the Privacy Office at the information below.

E. Appointment reminders

We may contact you by phone, email, or text messaging with appointment reminders.

F. Business associates

We may disclose your information to certain third parties that perform services for us, such as management, billing, legal, accounting or consulting services. We require business associates to appropriately protect the privacy of your information.

G. Use of unsecure electronic communications.

If you choose to communicate with us via unsecure electronic communication, such as regular email or text message, we may respond to you in the same manner in which you contacted us. In addition, if you provide your email address or cell phone number, we may send you emails or text messages related to appointment reminders, surveys, or other general informational communications. For your convenience, these messages may be sent unencrypted.

 Before using or agreeing to use of any unsecure electronic communication to communicate with us, note that there are certain risks, such as interception by others, misaddressed/misdirected messages, shared accounts, messages forwarded to others, or messages stored on unsecured, portable electronic devices. By choosing to correspond with us via unsecure electronic communication, you are acknowledging and agreeing to accept these risks.

Additionally, you should understand that use of email or other electronic communications is not intended to be a substitute for professional medical advice, diagnosis or treatment. Email communications should never be used in a medical emergency.

H. 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 have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

I. 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

J. Do research

We can use or share your information for health research.

K. 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 it wants to see that we’re complying with federal privacy law.

L. Respond to organ and tissue donation requests

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

M. 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.

N. 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

O. 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.

IV. Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information including information related to reproductive health and other sensitive diagnoses.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We will use certain precautions and safeguards to protect the disclosure of health information related to reproductive health and other sensitive diagnoses.

 For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

V. Other Applicable Laws

Where state law that Cityblock follows and applies to your information is stricter and provides greater privacy protections than HIPAA, Cityblock will follow the stricter applicable state law. We will never share any substance abuse treatment records protected by 42 CFR Part 2 without your written permission.

VI. Affiliated Covered Entity

An affiliated covered entity is a group of organizations under common ownership or control who designate themselves as a single affiliated covered entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The following Affiliated Entities are covered by and bound by the terms of this Notice:

• Oluwatoyin Ajayi Medical Practice, P.C.
• Cityblock Medical Practice MA, P.C.
• Cityblock Medical Practice NC, P.C.
• Cityblock Medical Practice CT, P.C.
• Cityblock Medical Practice, P.A.
• Cityblock Medical Practice VC, P.A.
• Cityblock Medical Practice DC, P.C.

References to “we” “our” and “us” in this Notice includes all the above entities.

VII. 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, in our offices, and on our web site.

VIII. Effective Date of This Notice

The effective date of this Notice is May 30, 2024.

IX. Contacting the Privacy Office

If you desire further information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your Protected Health Information, you may contact the Privacy Office at:

Privacy Office

Cityblock Health

495 Flatbush Avenue, Suite C5

Brooklyn, NY 11225

Telephone Number: (833) 904-2273

Email: privacy@cityblock.com

X. Language Assistance Services

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 347-770-1024 (TTY: 711)

注意：如果您使⽤繁體中⽂，您可以免費獲得語⾔援助服務。請致電  347-770-1024  (TTY:  711).

 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 347-770-1024 (TTY: 711).

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 347-770-1024 (TTY: 711).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 347-770-1024 (TTY: 711) )번으로 전화해 주십시오.

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 347-770-1024 (TTY: 711).

אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון

347-770-1024 אפצאל. רופט (TTY: 711)

ল ক নঃ িযদ আপিন বাংলা, কথা বেলত  পারন, তােহল ি◌নঃখরচায় ভাষা সহায়তা িপেরষবা উপল  আেছ।  েফান

১-347-770-1024 (TTY: 711).

 UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 347-770-1024 (TTY: 711).

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 347-770-1024 (TTY: 711).

 PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 347-770-1024 (TTY: 711).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 347-770-1024 (TTY: 711)

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 347-770-1024 (TTY: 711).

Notice of Privacy Practices for Florida, Illinois, Indiana, Massachusetts, New York, and North Carolina

Your Information. Your Rights. Our Responsibilities.

 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.

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
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.

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
• Share information in a disaster relief situation
• Include your information in a hospital directory

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 never 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.

Apart from what we say in this Notice, we will not use or share your health information unless we get your written permission (i.e., your authorization). If you authorize us to use or share your information, you have the choice to revoke that authorization later on. You can cancel your authorization at any time by sending a written request to our Privacy Office at privacy@cityblock.com. We are unable to take back any disclosures we have already made with your authorization.

Our Uses and Disclosures
We may use and share your information as we:

• Treat you
• Run our organization
• Bill for your services
• Health Information Exchanges
• Appointment reminders
• Business associates
• Use of unsecure electronic communications
• 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

I. 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 with your rights.

A. 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 by submitting a request to your Cityblock medical team, or by contacting the Privacy Office at privacy@cityblock.com.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

B. Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• If you desire to correct your records, please obtain an amendment request form from the Privacy Office at privacy@cityblock.com and submit the completed form to the Privacy Office.

C. Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests. 

D. 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. However, we are not required to agree to your request in all situations, and we may say “no” if not sharing the information would affect your care.
• 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.
• If you wish to request additional restrictions, please obtain a request form from our Privacy Office and submit the completed form to the Privacy Office. We will send you a written response.

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

• You can ask for a list (also called an “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 the information was shared.
• 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 may charge a reasonable, cost-based fee if you ask for another one within 12 months.

F. 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 by contacting your Cityblock medical team, or by contacting the Privacy Office at privacy@cityblock.com. We will provide you with a paper copy promptly.

G. Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person is able to make decisions on your behalf under authority that has been legally granted to them.

H. 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 at the end of this Notice.
• You can file a complaint with us. Please send any complaint to Cityblock’s Privacy Officer via email privacy@cityblock.com or by sending a letter to Cityblock Attn: Privacy Officer 495 Flatbush Ave #C5, Brooklyn, NY 11225. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

II. 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.

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
• Share information in a disaster relief situation
• Include your information in a hospital directory

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 never 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.

Apart from what we say in this Notice, we will not use or share your health information unless we get your written permission (i.e., your authorization). If you authorize us to use or share your information, you have the choice to revoke that authorization later on. You can cancel your authorization at any time by sending a written request to our Privacy Office at privacy@cityblock.com. We are unable to take back any disclosures we have already made with your authorization.

III. 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.

A. 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.

B. 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 can use health information about you to evaluate the quality and competence of our physicians, health care professionals, and community health partners.

C. Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. We may also disclose Protected Health Information to your other health care providers when such Protected Health Information is required for them to receive payment for services they render to you.

Example: We give information about you to your health insurance plan so it will pay for your services.

D. Health Information Exchanges

We may share information that we obtain or create about you with other health care providers and other health care entities through Health Information Exchanges (HIEs) in which we participate, as permitted by law. HIEs help doctors, hospitals and other healthcare providers provide quality care to you and helps us manage your care when more than one doctor is involved. To the extent permitted by law, your health information may be shared through the HIEs to provide faster access, better coordination of care, and to assist healthcare providers, health plans, and public health officials in making more informed decisions. To opt in or out of the HIEs, you generally must notify the HIE yourself. To obtain information on how to opt out of a HIE, please contact the Privacy Office at the information below.

E. Appointment reminders

We may contact you by phone, email, or text messaging with appointment reminders.

F. Business associates

We may disclose your information to certain third parties that perform services for us, such as management, billing, legal, accounting or consulting services. We require business associates to appropriately protect the privacy of your information.

G. Use of unsecure electronic communications.

If you choose to communicate with us via unsecure electronic communication, such as regular email or text message, we may respond to you in the same manner in which you contacted us. In addition, if you provide your email address or cell phone number, we may send you emails or text messages related to appointment reminders, surveys, or other general informational communications. For your convenience, these messages may be sent unencrypted.

Before using or agreeing to use of any unsecure electronic communication to communicate with us, note that there are certain risks, such as interception by others, misaddressed/misdirected messages, shared accounts, messages forwarded to others, or messages stored on unsecured, portable electronic devices. By choosing to correspond with us via unsecure electronic communication, you are acknowledging and agreeing to accept these risks.

Additionally, you should understand that use of email or other electronic communications is not intended to be a substitute for professional medical advice, diagnosis or treatment. Email communications should never be used in a medical emergency.

H. 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 have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

I. Help with public health and safety issues

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

• 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
  

J. Do research

We can use or share your information for health research.

K. 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 it wants to see that we’re complying with federal privacy law.

L. Respond to organ and tissue donation requests

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

M. 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.

N. 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

O. 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.

IV. Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information including information related to reproductive health and other sensitive diagnoses.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We will use certain precautions and safeguards to protect the disclosure of health information related to reproductive health and other sensitive diagnoses.

 For more information see:www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

V. Other Applicable Laws

Where state law that Cityblock follows and applies to your information is stricter and provides greater privacy protections than HIPAA, Cityblock will follow the stricter applicable state law. We will never share any substance abuse treatment records protected by 42 CFR Part 2 without your written permission.

VI. Affiliated Covered Entity

An affiliated covered entity is a group of organizations under common ownership or control who designate themselves as a single affiliated covered entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The following Affiliated Entities are covered by and bound by the terms of this Notice:

• Oluwatoyin Ajayi Medical Practice, P.C.
• Cityblock Medical Practice MA, P.C.
• Cityblock Medical Practice NC, P.C.
• Cityblock Medical Practice CT, P.C.
• Cityblock Medical Practice, P.A.
• Cityblock Medical Practice VC, P.A.
• Cityblock Medical Practice DC, P.C.

References to “we” “our” and “us” in this Notice includes all the above entities.

VII. 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, in our offices, and on our web site.

VIII. Effective Date of This Notice

The effective date of this Notice is May 30, 2024.

IX. Contacting the Privacy Office

If you desire further information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your Protected Health Information, you may contact the Privacy Office at:

 Privacy Office

Cityblock Health

495 Flatbush Avenue, Suite C5

Brooklyn, NY 11225

Telephone Number: (833) 904-2273

 Email: privacy@cityblock.com

X. Language Assistance Services

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 347-770-1024 (TTY: 711)

注意：如果您使⽤繁體中⽂，您可以免費獲得語⾔援助服務。請致電  347-770-1024  (TTY:  711).

 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 347-770-1024 (TTY: 711).

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 347-770-1024 (TTY: 711).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 347-770-1024 (TTY: 711) )번으로 전화해 주십시오.

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 347-770-1024 (TTY: 711).

אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון

347-770-1024 אפצאל. רופט (TTY: 711)

ল ক নঃ িযদ আপিন বাংলা, কথা বেলত  পারন, তােহল ি◌নঃখরচায় ভাষা সহায়তা িপেরষবা উপল  আেছ।  েফান

১-347-770-1024 (TTY: 711).

 UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 347-770-1024 (TTY: 711).

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 347-770-1024 (TTY: 711).

 PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 347-770-1024 (TTY: 711).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 347-770-1024 (TTY: 711)

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 347-770-1024 (TTY: 711).