No personal data of yours, including credit card numbers, personal data, medical or psychiatric history, will be stored on my web-site or on the server that hosts my web-site. Your “medical record” will be stored on a separate hard drive that is not connected to the internet, is password protected, and only I have access to it.

My appointments are scheduled through AppointmentQuest LLC. They will ask you for your name, address and contact info. They will also ask for your credit card information so you can pay for your sessions on line. They will not ask for and will not store any of your protected health information such as medical or psychiatric data. The scope of the information that you will need to provide to AppointmentQuest is about the same as you would need to provide for any other on-line purchase transaction. You can verify their security practices at www.appointmentquest.com/privacy.

The security of our on-line sessions is guaranteed by Skype’s encryption technology. You can review Skype's security and safety policies at www.skype.com/security/ .


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.

This notice describes the privacy policies of my practice, and is effective from July 1, 2007.


I am required by law to:

* Maintain the privacy of protected health information * Give you this notice of our legal duties and privacy practices regarding your health information * Follow the terms of the notice currently in effect.

How I may use and disclose your health information

Described as follows are the ways I may use and disclose your health information. Except for the following purposes I will use and disclose your health information only with your written permission. You may revoke such permission at any time in writing.

Treatment. I may use and disclose your health information for your treatment and to provide you with treatment-related health care services. For example, I may disclose

your health information to doctors, nurses, technicians, or other personnel, including people outside my practice, who are involved in your medical care and need the information to provide you with medical care.

Payment. I may use and disclose your health information so that others or I may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, I may give information to your health plan so that they will pay for your treatment.

Health Care Operations. I may use and disclose your health information to evaluate and improve my medical care and to operate and manage my practice. For example, I may use and disclose information to a peer review organization or a health plan that is evaluating my care. I may also share information with others that have a relationship with you for their health care operation activities. I DO NOT DISCLOSE PATIENT NAMES TO ANYONE FOR MARKETING PURPOSES.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. I may use and disclose your health information to contact you and remind you of your appointment, to tell you about treatment alternatives or health-related benefits and services you could use.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, I may share your health information with a person involved in, or paying for, your care (such as your family or a close friend). I may notify your family about your location or condition or disclose such information to an entity assisting in disaster relief.

As Required by Law. I will disclose your health information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety. I may use and disclose your health information when necessary to prevent a serious threat to the health and safety of you, another person, or the public. Disclosures will be made only to someone who can prevent the threat.

Military and Veterans. If you are a member of the armed forces, I may release your health information as required by military command authorities. If you are a member of a foreign military I may release your health information to the foreign military command authority.

Worker's Compensation. I may release your health information for worker's compensation or similar programs that provide benefits for work-related injuries or illness.

Public Health Risks. I may disclose your health information for public health activities to prevent or control disease, injury or disability. I may use your health information in reporting births or deaths, suspected child abuse or neglect, medication reactions or product malfunctions or injuries, and product recall notifications. I may use your health information to notify someone who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. If I am concerned that a patient may have been a victim of abuse, neglect, or domestic violence I may ask your permission to make a disclosure to an appropriate government authority. I will make that disclosure only when you agree or when required or authorized to do so by law.

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

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, I may disclose your health information in response to a court or administrative order. I may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. I may release your health information request by law enforcement official if
1) there is a court order, subpoena, warrant, summons or similar process;
2) if the request is limited to information needed to identify or locate a suspect, fugitive, material witness, or missing person;
3) the information is about the victim of a crime even if, under certain very limited circumstances, I am unable to obtain your agreement;
4) the information is about a death that may be the result of criminal conduct;

5) the information is relevant to criminal conduct on my premises;
6) it is needed in an emergency to report a crime, the location of a crime or victims, or the identity, description, or location of the person who may have committed the crime.

Coroners, Medical Examiners, and Funeral Directors. I may release your health information to a coroner, medical examiner, or funeral director to identify a deceased person or cause of death, or other similar circumstance.

National Security and Intelligence Activities. I may disclose your health information to authorized federal officials for intelligence and other national security activities authorized by law.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or in custody I may disclose your information 1) for the institution to provide you with health care, 2) to protect your health and safety or that of others, and 3) for the safety and security of the institution.


You have the right to inspect and copy your medical and billing records by written request. (Exceptions may include separate psychotherapy notes, information obtained from a non-health care professional under a promise of confidentiality where access would reveal the source; if release is likely to endanger the life or physical safety of, or cause substantial harm to you or another person)

You have the right to request an amendment to your records by written request.

You have a right to an accounting of certain disclosures by written request.

You have the right to request restriction or limitation on your health information used for treatment, payment or health care operations. You may request me to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request. I am not required to agree with your request, but I will try to comply.

You have the right to request that I communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that I contact you only by mail or at work. Your written request must specify how or where you wish to be contacted and be addressed to me. I will accommodate reasonable requests.


I may change this notice and make it effective for medical information I already have about you as well as new information. The current notice will be posted on my web site and available at all times. You have a right to request a paper copy of the current notice in writing.

All written requests should be addressed to:

Suite 1143
New York, NY 10010

MARTA PEK SCOTT, M.D. © 2006 • Tel: 646-775-5765 • Fax: 866-497-1743 • E-mail: info@psychmd.com •
Mailing Address: 303 Park Ave. South, Suite 1143, New York, NY 10010