New York City · Plastic Surgery

Central Park Plastic Surgery^{SM .} New York ^. New York City ^. Manhattan ^. E-mail ^. 212.496.6600

SCOTT J. ZEVON MD, PC
NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. This notice takes effect on November 18, 2004 and remains in effect until we replace it.

1. OUR PLEDGE REGARDING MEDICAL INFORMATION

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive from Dr. Zevon and his staff. We need this record to provide you with quality care and to comply with applicable laws. This notice tells you about the ways we may use and share medical information about you. It also describes your rights and our duties regarding the use and disclosure of medical information.

2. OUR LEGAL DUTIES

Law requires us to:

1. Keep your medical information private.
2. Give you notice describing Dr. Zevon's duties, privacy practices, and rights regarding your medical information.
3. Follow the terms of the current notice.

We have the right to:
Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.

Notice of change to privacy practices:
Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

3. USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION

This section describes different ways that we use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked by you at any time by writing to us at the address provided at the end of this notice.

FOR TREATMENT: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other people who are taking care of you. We may also share medical information about you with your other health care providers to assist them in treating you.

FOR PAYMENT: We may use and disclose your medical information for payment purposes. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include your medical information.

FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information for our health care operations. This might include assuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

ADDITIONAL USES AND DISCLOSURES: Notification: We may use or disclose your medical information to notify a family member, your personal representative or another person responsible for your care. We will share information about your location, general condition or death. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, prescriptions, medical supplies, x-rays or medical information for you.

Disaster Relief: We may share medical information with an organization or person who can legally assist in disaster relief efforts.

Funeral Director, Coroner, and Medical Examiner: To help them carry out their duties, we may share the medical information of a person who has died with a coroner, medical examiner, funeral director or an organ procurement organization.

Special Government Functions: We may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.

Court Orders and Judicial and Administrative Proceedings: We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

Public Health Activities: As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs, or replacements, to track products, or to conduct activities required by the Food and Drug Administration. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a diseases or condition.

Victims of Abuse, Neglect or Domestic Violence: We may use and disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if necessary to prevent a serious threat to your health or safety or the health or safety of others. We may share medical information when necessary to help law enforcement officials capture a person who admitted committing a crime or has escaped from legal custody.

Worker's Compensation: We may disclose health information when authorized or necessary to comply with laws relating to workers' compensation or other similar programs.

Health Oversight Activities: We may disclose medical information to an agency providing health oversight for activities authorized by law, including audits, civil, administrative or criminal investigations or proceedings, inspections, licensure or disciplinary actions, or other authorized activities.

Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises and crimes in emergencies.

Appointment Reminders: We may use and disclose medical information for purposes of sending you appointment postcards or otherwise reminding you of your appointments. We may contact you by mail or phone at your residence to remind you of appointments, to ask you to contact us to re-schedule an appointment, or to send you information about plastic surgery. Unless you instruct us otherwise in writing, we may leave a brief message for you on a telephone-answering device or with any person who answers the telephone at your residence. You can make reasonable requests, in writing, for us to use alternative methods of communicating with you in a confidential manner. Other uses or disclosures of your medical information will be made only with your written authorization. You have the right to revoke any written authorization that you give.

YOUR INDIVIDUAL RIGHTS

You have a right to:

1. Look at or get copies of certain parts of your medical information. You must make your request in writing. You may request access by sending a letter to the contact person identified at the end of this notice. If you request copies, we will charge you for copies, and also for postage if you want the copies mailed. Contact us using the information at the end of this notice for a full explanation of our fees for this.
2. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency.)
3. Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means or at different locations must be made in writing to the contact person named at the end of this notice.
4. Request that we change certain parts of your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you want changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the change in any future sharing of this information.
5. If you have received this notice electronically, and wish a paper copy, you can obtain a paper copy by making a request in writing to the contact person named at the end of this notice.

OUR OBLIGATIONS CONCERNING PROTECTED HEALTH INFORMATION

If you have questions about this notice or think that we may have violated your privacy rights, please contact us. You may submit a written complaint to the US Department of Health and Human Services. You may contact us to submit a complaint or submit requests involving any of your rights in this notice by writing to the following address: Mary Monahan, Office Manager, Scott J. Zevon, MD PC, 75 Central Park West, New York, NY 10023. Contact her if you desire further information or have questions or concerns. No retaliatory action will be taken against you for complaints.

© 2004 Scott J. Zevon MD, PC
    All rights reserved.

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The shape of THINGS to come^SM - Dr. Zevon is a board certified plastic surgeon practicing in New York City. At his plastic surgery office in Manhattan, he performs cosmetic surgery procedures such as liposuction, tummy tuck, face lift, and eyelid surgery. Dr. Zevon also specializes in breast surgery procedures such as breast augmentation, breast implants and breast lift. Visit Dr. Zevon's extensive archive of plastic surgery before and after photographs.

New York City · Plastic Surgery: Board-certified plastic surgeon Scott J. Zevon MD maintains this website to provide general health information to the public, not medical advice to individuals. If you are interested in a cosmetic surgery procedure, please contact us at our Manhattan plastic surgery office to schedule a consultation with Dr. Zevon.