Town Surgery NY PLLC

Notice of Privacy Practices (HIPAA)

Effective Date: October 21, 2025

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.

1. Our duties

Town Surgery NY PLLC (“the Practice”) is committed to protecting the privacy of your health information. We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI)

  • Provide you with this Notice describing our legal duties and privacy practices

  • Notify you if a breach occurs that may have compromised your information

  • Follow the terms of this Notice until it is replaced or updated

2. How we may use and disclose your health information

We may use and share your PHI for the following purposes:

Treatment – To provide, coordinate, or manage your medical care and share information with other providers involved in your treatment.

Payment – To obtain payment from insurance carriers, verify benefits, and bill for services provided.

Healthcare Operations – For quality improvement, auditing, administrative functions, and staff training.

Business Associates – We may share information with approved vendors who help us operate (e.g., billing companies, scheduling services, IT providers). These vendors sign Business Associate Agreements and are bound by HIPAA.

Public Health and Safety – To report certain diseases, adverse reactions, or to prevent or lessen a serious threat to health or safety.

Law Enforcement and Legal Requirements – To comply with court orders, subpoenas, or lawful investigations.

Workers’ Compensation – As authorized by law for work-related injuries or illness claims.

De-Identified or Limited Data Sets – We may use or share information with identifiers removed for research or analytics consistent with HIPAA.

Any other use or disclosure of your PHI will require your written authorization. You may revoke that authorization at any time.

3. Your rights regarding your health information

You have the right to:

  • Access your record – Obtain an electronic or paper copy of your medical record or billing information.

  • Request a correction – Ask us to correct inaccurate or incomplete information.

  • Request confidential communications – Specify how or where we contact you (e.g., different address or phone).

  • Request restrictions – Ask us not to use or disclose certain information for treatment, payment, or operations. We will honor reasonable requests when legally possible.

  • Obtain an accounting of disclosures – Receive a list of certain disclosures made in the past six years.

  • Receive a paper copy of this Notice – Even if you receive it electronically, you may request a paper copy at any time.

  • File a complaint – You may file a complaint if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

To exercise these rights, contact our Privacy Officer listed below.

4. Marketing, fundraising, and other uses

  • We will not sell your PHI or use it for marketing without your explicit written permission.

  • We may contact you for limited purposes, such as appointment reminders or to inform you of treatment options related to your care.

  • You may opt out of any non-treatment communications at any time.

5. Contact for privacy matters

Privacy Officer
Town Surgery NY PLLC
96 Terryville Road
Port Jefferson Station, NY 11776
Phone: (718) 395-5220
Email: privacy@townplasticsurgery.com

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint directly with our Privacy Officer or with:

Office for Civil Rights (OCR)
U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F
Washington, DC 20201
Website: www.hhs.gov/ocr/privacy

You will not be penalized for filing a complaint.

7. Changes to this Notice

We may revise this Notice at any time. The updated Notice will apply to all PHI we maintain and will be posted in our offices and on our website. The effective date above reflects the latest revision.

8. Relationship to administrative affiliates

Town Surgery NY PLLC is an independent professional medical entity. Administrative, scheduling, and marketing functions are provided by Town Group Management LLC, a non-clinical management services organization bound by a HIPAA Business Associate Agreement. Town Group Management LLC does not provide medical care.

Acknowledgment of Receipt
Patients will be asked to sign an acknowledgment confirming receipt of this Notice at their first visit.