Who We Are
This Notice of Privacy Practices ("Notice") is provided by Levesque Plastic Surgery, operated by Dr. Andre Y. Levesque, MD, located at 11851 Jollyville Rd, Suite 203, Austin, TX 78759. We are a covered entity under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and its implementing regulations.
This Notice describes our privacy practices — including how we may use and disclose your protected health information ("PHI"), your rights regarding your PHI, and our obligations to protect it. We are required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
What We Collect
"Protected Health Information" (PHI) means individually identifiable health information that we create, receive, maintain, or transmit — in any form (paper, electronic, oral). We may collect the following categories of information:
- Identifying information — name, address, date of birth, Social Security number, telephone number, email address
- Medical history — past and current health conditions, medications, allergies, surgical history
- Clinical information — consultation notes, photographs (including before-and-after images), treatment plans, operative reports, post-operative notes
- Billing and insurance information — insurance carrier, policy numbers, payment records, explanation of benefits
- Website inquiry data — information submitted through our online consultation request forms, including procedure interests and health notes
- Communications — emails, voicemails, text messages, and notes from phone or in-person conversations
A note about online forms: Our website consultation form collects personal and health-related information. This data is transmitted securely and handled in accordance with this Notice. We do not sell, rent, or share form data with third-party marketers.
How We Use and Disclose Your PHI
HIPAA permits us to use and disclose your PHI without your written authorization for Treatment, Payment, and Health Care Operations ("TPO"). Below are descriptions and examples of each.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example:
- Sharing your medical history with an anesthesiologist who will assist during your procedure
- Sending consultation notes or operative reports to your primary care physician or a specialist
- Providing pre- and post-operative instructions to our clinical staff
- Coordinating care with a hospital or surgery center where your procedure is performed
Payment
We may use and disclose your PHI to obtain payment for your care or to facilitate payment by a third party. For example:
- Submitting claims to your health insurance company, if applicable
- Communicating with a financing partner (such as CareCredit, Alphaeon Credit, Cherry, or PatientFi) in connection with your financing application
- Responding to insurance inquiries or pre-authorization requests
- Collecting past-due balances through a collections agency, if necessary
Health Care Operations
We may use and disclose your PHI for our internal business operations. For example:
- Quality assurance reviews and outcome evaluations
- Staff training and education
- Accreditation, certification, and compliance activities
- Business planning, audits, and practice management
- Contacting you to confirm or reschedule appointments, or to follow up after a procedure
Additional Permitted Uses — Without Authorization
| Purpose | Description |
|---|---|
| Appointment Reminders | We may contact you by phone, text, or email to remind you of upcoming appointments, unless you request a different contact method. |
| Treatment Alternatives | We may use your PHI to tell you about treatment options or health-related services that may be of interest to you. |
| Individuals Involved in Your Care | With your verbal agreement (or when you bring someone to your appointment), we may share relevant information with family members, close friends, or personal representatives directly involved in your care. |
| Required by Law | We will disclose your PHI when required to do so by federal, state, or local law, including court orders and valid subpoenas. |
| Public Health Activities | We may disclose PHI to public health authorities to prevent or control disease, injury, or disability, or to report adverse events related to medications or devices. |
| Health Oversight | We may disclose PHI to government agencies for oversight activities authorized by law, such as audits, investigations, inspections, and licensure. |
| Law Enforcement | Under certain circumstances, we may disclose PHI to law enforcement officials — for example, in response to a court order, warrant, or subpoena, or to report certain types of wounds or injuries as required by law. |
| Serious Threats to Health or Safety | We may disclose PHI to appropriate persons or authorities to prevent or lessen a serious and imminent threat to health or safety. |
| Workers' Compensation | We may disclose PHI as authorized by and to the extent necessary for compliance with workers' compensation laws. |
| Coroners and Medical Examiners | We may disclose PHI to a coroner or medical examiner as necessary to identify a deceased person or determine cause of death. |
| Research | Under certain conditions, and with proper safeguards in place, we may use or disclose your PHI for medical research purposes. |
| Military & National Security | We may disclose PHI to authorized federal officials for intelligence, national security, and protective service activities as required by law. |
Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. The following require your explicit authorization:
- Marketing purposes — using your PHI to communicate marketing messages about products or services (beyond treatment alternatives and health-related services we offer)
- Sale of PHI — we will not sell your PHI without your explicit written authorization
- Psychotherapy notes — if applicable, disclosure of psychotherapy notes requires separate authorization
- Before-and-after photographs — using your photographs for marketing, advertising, educational materials, website content, or social media requires a separate written Photo Release Authorization
- Most other disclosures — any use or disclosure not permitted by law or this Notice requires your written authorization
You have the right to revoke an authorization at any time by submitting a written request to our Privacy Officer. Revocation will not apply to uses or disclosures already made in reliance on your prior authorization.
Business Associates
We may share your PHI with companies or individuals who perform services on our behalf — called "business associates." Examples include our electronic health records platform, billing service, anesthesia provider, and the accredited facility where your procedure is performed. Our business associates are required by law and by contract to protect your PHI and use it only for the purposes for which it was shared.
Business associates we work with may include (but are not limited to):
- Electronic medical records and practice management software vendors
- Medical billing and coding services
- The surgery center or hospital where procedures are performed
- Anesthesia providers
- Information technology and data storage providers
- Patient financing partners (CareCredit, Alphaeon Credit) — only information necessary to process your application
- Attorneys, accountants, and business consultants subject to confidentiality obligations
Your Rights Regarding Your PHI
You have the following rights with respect to your protected health information. To exercise any of these rights, please contact our Privacy Officer in writing (see Contact Information below).
Right to Access
You may request a copy of your medical records and other PHI in our possession. We will respond within 30 days. We may charge a reasonable fee for copying and postage.
Right to Amend
You may request that we correct or add to your records if you believe your PHI is inaccurate or incomplete. We may deny the request if we determine the records are accurate and complete.
Right to an Accounting
You may request a list of certain disclosures of your PHI we have made for purposes other than Treatment, Payment, and Health Care Operations during the past six years.
Right to Request Restrictions
You may ask us to limit how we use or disclose your PHI. We are not required to agree, except in limited circumstances — such as when you pay out-of-pocket in full for a service and ask us not to bill your health insurer.
Right to Confidential Communications
You may request that we contact you about your PHI in a specific way (e.g., only by email, or only at a specific address). We will accommodate reasonable requests.
Right to a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you received it electronically. We will provide a copy at your first visit and upon request.
Right to Opt Out of Fundraising
If we ever contact you for fundraising purposes, you have the right to opt out of receiving such communications at any time.
Right to Electronic Copy
If your PHI is maintained electronically, you have the right to request a copy in an electronic format. We will provide it in the format you request if reasonably producible.
To exercise any of these rights, submit a written request to our Privacy Officer at 11851 Jollyville Rd, Suite 203, Austin, TX 78759 or by email at privacy@levesqueplasticsurgery.com. We will respond to your request within 30 days.
Our Legal Duties
We are required by law to:
- Maintain the privacy and security of your protected health information
- Provide you with this Notice of our legal duties and privacy practices with respect to your PHI
- Follow the terms of this Notice that are currently in effect
- Notify you promptly in the event of a breach of unsecured PHI that may have compromised your privacy
We have the right to change our privacy practices and the terms of this Notice at any time. Changes will apply to all PHI we maintain, including records created before the change. We will post the revised Notice on our website and make copies available at our office. The effective date of the most current version will always be printed at the top of the Notice.
How to File a Complaint
If you believe your privacy rights have been violated, you have the right to file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services. We will not retaliate against you in any way for filing a complaint.
File a Complaint with Our Practice
11851 Jollyville Rd, Suite 203, Austin, TX 78759
File a Complaint with the Federal Government
Contact Our Privacy Officer
For questions, concerns, or to exercise any of your privacy rights, contact our Privacy Officer:
Austin, TX 78759
Effective Date and Revisions
This Notice is effective as of January 1, 2025. We reserve the right to change the terms of this Notice at any time. When we make a material change, we will revise the Notice, update the effective date at the top, post the updated Notice prominently in our office and on our website, and provide a copy to you upon your next visit.
The most current version of this Notice is always available at our office and at levesqueplasticsurgery.com/hipaa-privacy-policy/. You may request a printed copy at any time.
Questions about this Notice or our privacy practices? Please call us at 512-487-5975 or contact our Privacy Officer as described above. We are happy to discuss how we protect your information.