Medical Records & Privacy Information

Matters relating to HIPAA are collaboratively managed by the Compliance and Information Technology departments. The departments implement policies and procedures to manage the acquisition, use and disclosure of protected health information (PHI;) investigate privacy and security complaints and breaches; and provide regulatory guidance to ACPNY staff to ensure that it complies with federal, state, and local laws and regulations, as well as its own policies.

What is HIPAA? ►

To report a compliance or HIPAA concern, please contact: Compliance Helpline: 844-7-COMPLY (844-726-6759). Available 24 hours a day, 7 days a week.

Click below to access these patient forms:

Notice of Privacy Practices – English

Noticed of Privacy Practices - Spanish

Patient Request for Confidential Communications

Patient Request for Restricted Communications

Request for Amendment of Protected Health Information

HIPAA Representative Form

Health Care Proxy

Request Your Medical Record

At ACPNY, your privacy is our priority. You have a right to access a copy of your medical records and trust that your information is kept secure. Your records are strictly confidential and protected against any unauthorized release of your PHI.

You can obtain a copy of your medical record electronically or by mail:
  • Electronically: The fastest, most convenient way to locate your medical record is to access myACPNY, our free online patient portal.­ Simply sign in with your username and password and click on the medical records tab at the top of the screen. If you do not have a sign-in or a registration code, access myACPNY, click on “I do not have a registration code” and follow the onscreen instructions.
  • By Mail: To make a request by mail please access our Authorization Form, giving our medical staff appropriate permission to release your chart.  Please print out the form, complete it, and provide a copy of a legal identification (passport or driver’s license) with your signature.

Please mail it to the Health Information Management Department at the address below.
             Mailing Address:
            AdvantageCare Physicians
            Attn: Verisma
            55 Water Street, 2nd Floor,
            New York, NY 10041

  • By Fax: (646) 766-9798
* Please Note: A per-record service charge of $6.50 may apply when requesting paper copies of your chart.

For More Information
It is our goal to provide you with excellent customer service. If you have any questions regarding release of PHI, or on completing the required authorization form, please call the Health Information Management Department at (646) 680-1234.