NOTICE OF PATIENT PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided to you, and to enable us to meet our professional and legal obligations to properly operate this medical practice. We are required by law to maintain the privacy of protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information.

This medical practice collects health information about you and stores it in a computer and/or secure electronic medical record. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

1. Treatment. We use medical information about you to provide your medical care. We may disclose medical information to:

• our employees and others who are involved in providing the care you need i.e. other physicians or healthcare providers who may provide services that we do not provide

• pharmacists who need additional information to dispense a prescription to you, or a laboratory that provides testing

• members of your family, whom you designate, who can help you when you are sick or injured

2. Payment. We use and disclose medical information about you to obtain payment for the services we provide. The information may be disclosed to:

• an insurer, employer, governmental authority, contractor, or other entity responsible for paying for healthcare services rendered to the patient, to the extent necessary to allow responsibility for payment to be determined and made

• your health plan to provide the information it requires before it will pay us

• charge your credit card, send a bill to your, require you to pay in advance, and/or send you a receipt of your payment. The information on or accompanying the bill, receipt, or credit card statement will include information that identifies you and your status as a patient. If a charge is disputed, we may need to use medical information to verify services rendered.

3. Health Care Operations. We may use and disclose medical information about you to operate this medical practice. We may use and disclose this information:

• to review and improve the quality of care we provide and the competence of our professional staff

• to get your health plan to authorize services or referrals

• for medical reviews, legal services and audits, including fraud/abuse detection, compliance programs, and business planning and management

• to our “business associates,” such as our phone and billing services that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your protected health information.

• to other health care providers , healthcare clearinghouses, or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, patient-safety activities, population-based efforts to improve health or reduce healthcare costs, protocol development, case management or care-coordination activities, review of competence, training programs, accreditation, certification or licensing activities, or healthcare fraud and abuse detection and compliance efforts.

4. Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not available, we may leave this information on your voicemail or in a message left with the person answering your phone.

5. Appointment Time. We may call out your name in the waiting room when we are ready to see you

6. Communication with Family. We may disclose your health information to notify a family member or another person you’ve designated to be responsible for your care regarding your location, your general condition, or in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may disclose information to someone who is involved with your care or helps pay for your care. We will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgement in communication with your family and others.

7. Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination. Or, we may recommend other treatments, therapies, healthcare providers or settings of care that may be of interest to you.

8. Sale of Health Information: We will not sell your health information or contact information.

9. Required by Law. As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.

10. Public Health. We may be required by law to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child or elder/dependent adult abuse/neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

11. Health Oversight Activities. We may disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure, and other proceedings, subject to the limitations imposed by law. Your medical record may be used in examination, testing, credentialing and/or certifying purposes by The American Board of Plastic Surgery, Inc.

12. Judicial and Administrative Proceedings. We may be required by law to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.

13. Law Enforcement. We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

14. Coroners. We may be required to disclose your health information to coroners in connection with their investigations of deaths

15. Organ or Tissue Donation: We may disclose your health information to organizations involved in procuring, banking, or transplanting organs/tissue.

16. Public Safety. We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

17. Specialized Government Functions: We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

18. Workers’ Compensation. We may disclose your health information as necessary to comply with worker’s compensation laws. For example, to the extent your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.

19. Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information by transferred to another physician or medical group.

20. Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.

21. The American Board of Plastic Surgery, Inc. Your health information may be used in examination, testing, credentialing and/or certifying purposes by The American Board of Plastic Surgery, Inc.

Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

YOUR HEALTH INFORMATION RIGHTS

1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit. We will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject your requests and will notify you of our decision.

2. Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may request that we send information to a particular phone, email, or address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.

3. Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and the preferred form and format. We will also send a copy to any other person you designate in writing. 

4. Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We may deny your request if we did not create the information or if the information is accurate and complete as is.

5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice. This medical practice does not have to account for disclosures as described above, under the following items: 1. Treatment, 2. Payment, 3. Health Care Operations, 6. Communication with Family, and 17. Specialized Government Functions.

6. Right to Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a paper or electronic copy of this notice. 

AMENDMENTS

We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protection will apply to all protected health information that we maintain, regardless of when it was created or received. A copy of the active Notice is posted in our reception area and is available at each appointment.

COMPLAINTS

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information can be made directly with the practice. You will not be penalized in any way for filing a complaint. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint form ( https://www.hhs.gov/hipaa/filing-a-complaint/index.html) to the local Office of Civil Rights (OCRMail@hhs.gov). In the even of any action heron or for the enforcement hereof, the prevailing party shall be entitled to recover reasonable attorney’s fees and costs.