Catholic Health is committed to ensuring that your health and other private information is maintained in a confidential and secure manner. Catholic Health is responsible for, among other things, ensuring the confidentiality and integrity of your health information as well as providing access to your health information in accordance with various federal and state laws including the Health Insurance Portability and Accountability Act of 1996 (HIPAA). By doing so, we also promote trust between our patients and their health care providers.

Notice of Privacy Practices

You are entitled to know how Catholic Health uses and discloses your information. Catholic Health maintains a Notice of Privacy Practices that describes the ways in which we may use and disclose your protected health information as well as how you can obtain access to such. A copy of the Notice of Privacy Practices is available for you to download and view:

Catholic Health Notice of Privacy Practices - English

Catholic Health Notice of Privacy Practices - Spanish

Prohibiting Information Blocking

Catholic Health is obligated under federal law, with limited exception, to provide you with unrestricted access to your health information. Catholic Health is also prohibited from engaging in practices or discriminatory behaviors that forbid, limit or restrict the access, exchange or disclosure of one’s health information; commonly referred to as “Information Blocking.” Get more information on Information Blocking.
 

Accessing Your Health Information/Medical Records

You are entitled to access your health information as well as entitled to request that a copy of your medical record be released to you or a personal representative of yours by downloading, completing and submitting an “Authorization for Release of Health Information Pursuant to HIPAA”. A copy of this form is provided below:

Authorization for Release of Health Information Pursuant to HIPAA

Please visit Catholic Health’s Health Information Management for more information on accessing or requesting your health information electronically or visit Catholic Health MyChart, our secure online patient portal.

Requesting an Amendment to Your Medical Record

You are entitled to request an amendment (often referred to as a correction) be made to your medical record by downloading, completing and submitting a “Patient Request for Amendment/Correction of Protected Health Information”. A copy of this form is provided below:

Patient Request for Amendment of Records

This form must be submitted by mail or in person to the Health Information Management (HIM) Department of the specific Catholic Health facility or practice that treats or has treated you. 

Requesting Confidential Communications or Restrictions of Health Information

You are entitled to request a restriction on the use or disclosure of your health information that Catholic Health routinely uses or discloses for treatment, payment or health care operations (such as payment, billing, quality assurance) purposes. Please note, Catholic Health is under is under no obligation to agree to a request but if we do, we must comply with the restrictions, except for purposes of treating you in an emergency. You may request a restriction by downloading, completing and submitting a “Request for Confidential Communications and/or Restrictions on Access, Use or Disclosure of Protected Health Information.” A copy of this form is provided below:

Request for Confidential Communications and/or Restrictions on Access, Use or Disclosure of Protected Health Information 

This form must be submitted by mail or in person to the Health Information Management (HIM) Department of the specific Catholic Health facility or practice that treats or has treated you. 

Contact Information

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To report a privacy concern, potential violation, or ask a general question, please contact the Privacy Office or the Privacy Officer of the Catholic Health facility or practice directly. Or, you can choose to remain anonymous by using the Privacy Office’s confidential web reporting system at chsli.ethicspoint.com.

  • Catholic Health Chief Privacy Officer: email Lesli Giglio; call 516-705-3704
  • Catholic Health Deputy Privacy Officer: email Frank Caria; call 516-705-1784
  • Good Samaritan University Hospital email Cynthia Vigilante; call 631-376-3582
  • St. Charles Hospital email Lisa Oberting; call 631-474-6759
  • St. Catherine of Siena Hospital email Mariann Carroll; call 631-862-3056
  • Mercy Hospital Rosemarie Povinelli; call 516-705-2375
  • St. Francis Hospital & Heart Center®: email Tiffany Wickes-Demillio; call 516-562-6551
  • St. Joseph Hospital: email Blake Benz; call 516-520-2776
  • Our Lady of Consolation: email Dorothy Scholz; call 631-587-1600 ext. 6538
  • Catholic Health Home Care/Good Shepherd Hospice: email Lucas Magnani; call 631-828-7414
  • Catholic Health Physician Practices email Michael Withus; call 631-465-1507

Good Samaritan University Hospital HIM Department
1000 Montauk Highway, West Islip, NY 11795
631-376-4058

Mercy Hospital HIM Department
1000 North Village Avenue, Rockville Centre, NY 11570
516-570-1173

St. Catherine of Siena Hospital HIM Department
50 Route 25A, Smithtown, NY 11787
631-862-3080

St. Charles Hospital HIM Department
200 Belle Terre Road, Port Jefferson, NY 11777
631-474-6123

St. Francis Hospital & Heart Center® HIM Department
100 Port Washington Boulevard, Roslyn, NY 11576
516-562-6064

St. Joseph Hospital HIM Department
4295 Hempstead Turnpike, Bethpage, NY 11714
516-520-2822

Catholic Health Home Care HIM Department
110 Bi-County Boulevard, Farmingdale, NY 11735
631-828-7674

Good Shepherd Hospice HIM Department
110 Bi-County Boulevard, Farmingdale, NY 11735
631-828-7647

Good Samaritan Nursing & Rehabilitation HIM Department
101 Elm Street, Sayville, NY 11782
631-669-3160

Our Lady of Consolation Nursing & Rehabilitation HIM Department
111 Beach Drive, West Islip, NY 11795
631-587-1600 ext. 6538

St. Catherine of Siena Nursing & Rehabilitation
HIM Department
52 Route 25A Smithtown, NY 11787
631-862-3965

Catholic Health Physician Partners: To obtain your medical record or request an amendment from a Catholic Health physician practice, send the forms form directly to the HIM Department of the physician practice.

For Billing Records Only/Catholic Health Services Patient Accounts
245 Old Country Road, Melville, NY 11747