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Effective Date: September 08, 2008




If you have any questions about this notice, please contact:


Janie Zeitlin, RDN, CDN      Email:       Phone: (917) 664-4509





I, Janie Zeitlin, understand that your PHI is personal.  I am committed to protecting your health information. This Notice applies to all records of your care generated by my office, my staff or by your personal doctor.  This Notice will tell you about the ways in which I may use and disclose your PHI and will clearly describe your rights.  


The law requires us to:


•  make sure that your PHI is kept private;

•  notify you about how I protect your PHI;

•  explain how, when and why I use and disclose PHI;

•  follow the terms of the Notice that is currently in effect.


I am required to follow the procedures in this Notice. I reserve the right to change the terms of this Notice and to make new notice provisions effective for all PHI that we maintain by:


•  posting the revised Notice in my offices

•  making copies of the revised Notice available upon request;

•  posting the revised Notice on my Website.





The following categories describe different ways that I use and disclose PHI without your written authorization.


For Treatment. My staff and I may use your PHI to provide you with, coordinate or manage your medical treatment or services. I may disclose your PHI to doctors, nurses, technicians, medical students or other personnel working for me, Janie Zeitlin, who are involved in your care.  My staff and I may share your PHI with others outside the office as well, to gather prescriptions, lab work and radiology reports or additional inquiries pertaining to your care.


I may use and disclose PHI to contact you as a reminder that you have an appointment for treatment or medical care with Janie Zeitlin.  I may use and disclose PHI to tell you about or recommend possible treatment options or alternatives or health-related benefits or services that may be of interest to you.


I, Janie Zeitlin may use and disclose your PMI with others involved in your care:

For Payment for Services.  To an insurance company or third party for billing and reimbursement purposes and to obtain prior approval of nutritional services.


For Health Care Operations.  For quality assessment and improvement activities, educational purposes, fundraising efforts, to reduce health care costs and to determine if offered services are effective.


As Required By Law.  To Federal, State and Local law and in limited circumstances, subject to applicable state law, for purposes beyond treatment, payment, and operations:

Research.  For research that has been approved by an Institutional Review Board or Privacy Board with established protocols to ensure privacy of your PHI

Health Risk. To Government authorities if it is suspected that you are a victim of abuse, neglect or domestic violence.  Disclosure of this type of information will occur only to the extend required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent or lessen a serious and imminent threat to you or another person.

Judiciary and Administrative Proceedings.  In response to a court or administrative order, a subpoena, discovery request, or other lawful processes if you are involved in a lawsuit or dispute.  Disclosure will only occur if efforts have been made either by us or by the requesting party to tell you about the request, or to obtain an order protecting the information requested.


Business Associates. To business associates who perform services on our behalf (such as billing companies).  They are required to appropriately safeguard your information. 


Public Health. To public, health or legal authorities charged with preventing/controlling disease, injury or disability as required by law.

To Avert a Serious Threat to Health or Safety.  To prevent a serious threat to your health and safety or the health and safety of the public or another person when necessary.

Health Oversight Activities. To a health oversight agency for activities authorized by law.  These activities include audits, investigations, and inspections as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. 

Organ and Tissue Donation.  To organizations that facilitate organ or tissue donation and transplantation, if you are an organ donor.

For Special Government Functions.  For National Security and Intelligence purposes, protective services for the President, and medical suitability or determinations of the Department of State if you are a member of the armed forces.


Coroners, Medical Examiners, and Funeral Directors. To a coroner, medical examiner or funeral director when applicable by law to enable them to carry out their duties.

Correctional Institutions and Other Law Enforcement Custodial Situations.  To the correctional institution or law enforcement official as necessary for your or another person’s health and safety if you are an inmate of a correctional institution or under the custody of a law enforcement official.

Food and Drug Administration.  To the FDA or persons under the jurisdiction of the FDA, if an adverse reaction occurs in response to drugs, foods, supplements or products or as needed when informing about product defects to enable product recalls, repairs, or replacements.   





Unless you object, or request that only a limited amount or type of information be shared, we may use or disclose your PHI in the following circumstances:


•  We may share with a family member, relative, friend or other person identified by you that is involved in your care or with the payment for your care. We may also share information to notify these individuals of your location, general condition or death.

•  We may share information with a public or private agency (such as the American Red Cross) for disaster relief purposes. Even if you object, we may still share this information if necessary for the emergency circumstances.

If you would like to object to use and disclosure of protected health information in these circumstances, please call or write to our contact person listed on page 1 of this Notice.



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

Right to Inspect and Copy.  You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually, this includes medical and billing records.


To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to Janie Zeitlin, RDN, CDN.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request, and we will respond to your request no later than 30 days after receiving it. There are certain situations in which we are not required to comply with your request. In these circumstances, we will respond to you in writing, stating why we will not grant your request and describe any rights you may have to request a review of our denial.

Right to Amend. If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend or supplement the information.


To request an amendment, your request must be made in writing and submitted to Janie Zeitlin, RDN, CDN.  In addition, you must provide a reason that supports your request. We will act on your request for an amendment no later than 60 days after receiving the request.


We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, and will provide a written denial to you.  In addition, we may deny your request if you ask us to amend information that:


•  Was not created by us, unless the person or entity that created the information is no longer available

   to make the amendment;

•  Is not part of the protected health information kept by; Janie Zeitlin, RDN, CDN

•  Is not part of the information which you would be permitted to inspect and copy; or

•  We believe is accurate and complete.

Right to an Accounting of Disclosures.  You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of protected health information about you.


To request this list or accounting of disclosures, you must submit your request in writing to Janie Zeitlin, RDN, CDN.  You may ask for disclosures made up to six years before your request (not including disclosures made before April 14, 2003). The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We are required to provide a listing of all disclosures except the following:


•  For your treatment

•  For billing and collection of payment for your treatment

•  For health care operations

•  Made to or request by you, or that you authorized

•  Occurring as a byproduct of permitted use and disclosures

•  For national security or intelligence purposes or to correctional institutions or law

   enforcement regarding inmates

•  As part of a limited data set of information that does not contain information identifying you

Right to Request Restrictions.  You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care.


We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment, the disclosure is to the Secretary of the Department of Health and Human Services, or the disclosure is for one of the purposes described on pages 2-3.


To request restrictions, you must make your request in writing to: Janie Zeitlin, RDN, CDN.


Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.


To request confidential communications, you must make your request in writing to Janie Zeitlin, RDN, CDN.  We will accommodate all reasonable requests.


Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice at any time by contacting Janie Zeitlin, RDN, CDN.





We will obtain your written authorization before using or disclosing your PHI for purposes other than those provided above (or as otherwise permitted or required by law). You may revoke this authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your information, except to the extent that we have already taken action in reliance on the authorization.





If you believe your privacy rights have been violated, you may file a complaint with Janie Zeitlin, RDN, CDN or file a written complaint with the Secretary of the Department of Health and Human Services. A complaint to the Secretary should be filed within 180 days of the occurrence of action that is the subject of the complaint.  If you file a complaint, we will not take any action against you or change our treatment of you in any way.

Janie Zeitlin, RDN, CDN



(917) 664-4509





15 N BROADWAY (Floor 2)


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NEW YORK, NY 10003

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