Notice of Privacy Practices

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.

OUR PLEDGE REGARDING MEDICAL INFORMATION

At Millennial Plastic Surgery, we understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This Notice applies to all of the records of your care generated by the practice.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information:

• 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, or other personnel who are involved in taking care of you.
• For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party (such as CareCredit).
• For Health Care Operations: We may use and disclose medical information about you for practice operations. These uses and disclosures are necessary to run the practice and make sure that all of our patients receive quality care (e.g., quality assessment, auditing, or business planning).
• Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
• Treatment Alternatives & Health-Related Benefits: We may use and disclose medical information to tell you about or recommend possible treatment options or health-related benefits that may be of interest to you.

SPECIAL SITUATIONS

We may release medical information about you without your prior authorization in the following specific circumstances:

• As Required By Law: When required to do so by federal, state, or local law.
• Public Health Risks: For public health activities such as preventing or controlling disease, injury, or disability.
• Lawsuits and Disputes: In response to a court or administrative order, or in response to a subpoena.
• Law Enforcement: If asked to do so by a law enforcement official (e.g., in response to a warrant).

Reproductive Health Care: We are prohibited from using or disclosing your medical information to investigate or impose liability on any person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care. We presume that reproductive health care provided by another practitioner was lawful unless we have actual knowledge to the contrary.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding the medical information we maintain about you:

• Right to Inspect and Copy: Under New York State Public Health Law Section 18, you have the right to inspect and obtain a copy of your health information. We will provide an opportunity to inspect your records within 10 days of your written request. We may charge a reasonable, cost-based fee (not to exceed 75 cents per page) for paper copies, though access will not be denied solely due to an inability to pay.
• Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
• Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we made of medical information about you for purposes other than treatment, payment, and health care operations.
• Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.
• Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time.

ADDITIONAL PROTECTIONS FOR SPECIFIC RECORDS

Substance Use Disorder (SUD) Records: If we receive medical records protected by 42 CFR Part 2, we will not use or disclose those records (or testimony relaying their content) in any civil, criminal, administrative, or legislative proceedings against you without your express written consent or a specific court order.

Breach Notification: We are required by law to notify you promptly in the event of a breach that may have compromised the privacy or security of your protected health information.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the practice or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.

To download a full, printable copy of our HIPAA policies and medical records fee schedule, please click here.

NONDISCRIMINATION AND ACCESSIBILITY

Millennial Plastic Surgery complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We do not exclude people or treat them differently because of their race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

Language and Communication Assistance: We provide free auxiliary aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats. We also provide free language services to people whose primary language is not English, such as qualified interpreters. If you need these services, please contact our Privacy Officer at (929) 225-8734.

CONTACT INFORMATION

To exercise any of your rights or to ask questions regarding this notice, please contact our Privacy Officer at: