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.
If you have any questions about this notice,
please contact the Privacy Contact
for the practice:
Privacy Contact
954-981-FACE
info@cosmeticsurgery2.com
This notice was published and becomes
effective on April 14, 2003.
Our Pledge Regarding Medical
Information
We understand that medical information about
you and your health is personal and we are
committed to maintaining the confidentiality
of your medical information. We create and
maintain a record of the care and services
that you receive at our practice. We need
this record to treat you and to comply with
certain legal requirements. This notice
applies to all of the records of your care
generated by our practice, whether made by
your personal doctor or by other personnel
within our practice.
This notice advises you about the ways in
which we may use and disclose medical
information about you. It also describes
your rights to access and control your
medical information. .Medical information.
is information about you, including
demographic information, that may identify
you and that relates to your past, present
or future physical or mental health or
condition and related health care services.
This notice also describes your rights and
explains certain obligations we have
regarding the use and disclosure of medical
information.
We are required by law to:
-
Make sure that medical information that
identifies you is kept private.
-
Provide you with this notice of our
legal duties and privacy practices with
respect to medical information about
you.
-
Follow the terms described in this
notice
We may change the terms of this notice at
any time. The new notice will be effective
for all protected health information that we
maintain at that time. Upon your request, we
will provide you with any revised Notice of
Privacy Practices by calling our office and
requesting that a revised copy be sent to
you in the mail, by asking for one at the
time of your next office visit, or by
accessing our website.
How We May Use and Disclose Medical
Information About You
The following categories describe different
ways that we may use and disclose medical
information. For each category of uses or
disclosures, we will explain what we mean
and provide examples. Not every use or
disclosure in a category will necessarily be
listed below. However, all of the ways which
we are permitted to use and disclose
information will fall within one of the
categories.
Treatment
- We may use
medical information about you to provide you
with medical treatment or services. We may
disclose medical information about you to
doctors, nurses, technicians, medical
students, or other practice personnel who
are involved in your medical care and
treatment. For example, a doctor treating
you for a broken leg may need to know if you
have diabetes because diabetes may slow the
healing process. In addition, the doctor may
need to inform the dietitian if you have
diabetes so that we can arrange for you to
receive information regarding appropriate
meals. Different areas of the practice also
may share medical information about you in
order to coordinate the different things you
need, such as prescriptions, lab work and
x-rays. We also may disclose medical
information about you to people outside the
practice who may be involved in your medical
care after you leave our office, such as
family members, clergy or others we may rely
upon or ask to assist us in caring for you.
Payment - We may use and
disclose medical information about you so
that the treatment and services which we
provide to you at our practice, or at a
hospital, ambulatory surgery center, nursing
home or other site may be billed to and
payment may be collected from you and/or
your insurance company or other responsible
third party. For example, we may need to
provide to your health insurance plan
information about the services which we
provided to you at our practice, hospital or
ambulatory surgery center, so that your
health plan will pay us or reimburse you for
the services. We may also advise your health
insurance plan about a treatment you are
going to receive in order to obtain prior
approval or to determine whether your plan
will cover the treatment.
Health Care Operations
- We
may use and disclose medical information
about you for our practice operations. These
uses and disclosures are necessary to
operate our practice and make sure that all
of our patients receive quality care. For
example, we may use medical information to
review our treatment and services and to
evaluate the performance of our staff in
caring for you. We may also combine medical
information about many practice patients to
decide what additional services the practice
should offer, what services are not needed,
and whether certain new treatments are
effective. We may also disclose information
to doctors, nurses, technicians, medical
students, and other practice personnel for
review and learning purposes. We may also
combine the medical information we have with
medical information from other practices to
compare how we are doing and see where we
can make improvements in the care and
services that we offer. We may remove
information that identifies you from this
set of medical information so others may use
it to study health care and health care
delivery without learning who the specific
patients are.
Appointment Reminders
- We
may use and disclose medical information in
connection with our efforts to remind you
that you have an appointment.
Treatment Alternatives - We
may use and disclose medical information to
tell you about or recommend possible
treatment options or alternatives that may
be of interest to you. For example, we may
use your information to determine whether
you qualify for a nutritional counseling
program.
Health-Related Benefits and Services
- We may use and disclose medical
information to tell you about health-related
benefits or services that may be of interest
to you.
Fundraising Activities
- We
may use or disclose your demographic
information and the dates that you received
treatment from your doctor, as necessary, in
order to contact you for fundraising
activities supported by our practice. If you
do not want to receive these materials,
please contact our Privacy Contact and
request that these fundraising materials not
be sent to you.
Ambulatory Surgery Center Registry
- If your care or services are
performed at an ambulatory surgery center
that is part of our practice, we may include
certain limited information about you in the
ambulatory surgery registry while you are a
patient at the ambulatory surgery center.
This information may include your name,
location within the ambulatory surgery
center, the facility directory, your general
condition (e.g., fair, stable, etc.) and
your religious affiliation. The registry
information, except for your religious
affiliation, may also be released to people
who ask for you by name. Your religious
affiliation may be given to a member of the
clergy, even if they don.t ask for you by
name. This is so your family, friends and
clergy can visit you in the ambulatory
surgery center and generally be advised of
how you are doing.
Individuals Involved in Your Care or
Payment for Your Care - We may
release medical information about you to a
friend or family member who is involved in
your medical care. We may also give
information to someone who helps pay for
your care. For example, a babysitter
responsible for the care of a child may be
provided with certain information about the
treatment which we provided to the child. We
may also advise your family or friends about
your condition and that you are in a
hospital, ambulatory surgery center or at
our office. In addition, we may disclose
medical information about you to an entity
assisting in a disaster relief effort so
that your family can be notified about your
condition, status and location.
Research - Under certain
circumstances, we may use and disclose
medical information about you for research
purposes. For example, a research project
may involve comparing the health and
recovery of all patients who received one
medication to those who received another,
for the same condition. All research
projects, however, are subject to a special
approval process. This process evaluates a
proposed research project and its use of
medical information, trying to balance the
research needs with patients. need for
privacy of their medical information. Before
we use or disclose medical information for
research, the project will have been
approved through this research approval
process. We may, however, disclose medical
information about you to people preparing to
conduct a research project, for example, to
help them look for patients with specific
medical needs, so long as the medical
information they review does not leave the
practice. We will almost always ask for your
specific permission if the researcher will
have access to your name, address or other
information that reveals who you are, or
will be involved in your care at the
practice.
SPECIAL SITUATIONS
- Other
Permitted and Required Uses and Disclosures
That May Be Made Without Your Consent,
Authorization or Opportunity to Object:
Emergencies - We may use or
disclose your medical information in an
emergency treatment situation. If this
happens, your doctor shall try to obtain
your consent as soon as reasonably
practicable after the delivery of treatment.
If your doctor or another doctor in the
practice is required by law to treat you and
the doctor has attempted to obtain your
consent but is unable to obtain your
consent, he or she may still use or disclose
your medical information in order to treat
you.
Communication Barriers
- We
may use and disclose your medical
information if your doctor or another doctor
in the practice attempts to obtain consent
from you but is unable to do so due to
substantial communication barriers and the
doctor determines, using professional
judgment, that you intend to consent to use
or disclosure under the circumstances.
Coroners, Medical Examiners and
Funeral Directors - We may release
medical information to a coroner or to a
medical examiner. This may be necessary, for
example, to identify a deceased person or to
determine the cause of death. We may also
release medical information about patients
to funeral directors as necessary to carry
out their duties.
Organ and Tissue Donation
-
If you are an organ donor we may release
medical information to organizations that
handle organ procurement or organ, eye or
tissue transplantation or to an organ
donation bank, as necessary to facilitate
organ or tissue donation and
transplantation.
As Required By Law
- We
will disclose your medical information when
required to do so by federal, state or local
law. The use or disclosure will be made in
compliance with the law and will be limited
to the relevant requirements of the law.
Legal Proceedings - If you
are involved in a lawsuit or a dispute, we
may disclose medical information about you
in response to a court or administrative
order. We may also disclose medical
information about you in response to a
subpoena, discovery request, or other lawful
process by someone else involved in the
dispute, but only if required by law or if
efforts have been made to tell you about the
request or to obtain an order protecting the
information requested.
Public Health
- We may
disclose medical information about you for
public health activities. These activities
generally include the following:
-
To prevent or control disease, injury or
disability.
-
To report births and deaths.
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To report child abuse or neglect.
-
To report reactions to medications or
problems with products.
-
To notify people of recalls of products
they may be using.
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To notify a person who may have been
exposed to a disease or may be at risk
for contracting or spreading a disease
or condition.
-
To notify the appropriate government
authority if we believe a patient has
been the victim of abuse, neglect or
domestic violence. In this case, the
disclosure will be made consistent with
the requirements of applicable federal
and state laws.
To Avert a Serious Threat to Health
or Safety - We may use and disclose
medical information about you when necessary
to prevent a serious threat to your health
and safety or the health and safety of the
public or another person. Any disclosure,
however, would only be to someone able to
help prevent the threat.
Law Enforcement
- We will
disclose medical information when required
to do so for law enforcement purposes. These
law enforcement purposes include (1) legal
processes and otherwise required by law, (2)
limited information requests for
identification and location purposes, (3)
pertaining to victims of a crime, (4)
suspicion that death has occurred as a
result of criminal conduct, (5) in the event
that a crime occurs on the premises of the
practice, and (6) medical emergency (not on
the practice.s premises) and it is likely
that a crime has occurred.
Criminal Activity
-
Consistent with applicable federal and state
laws, we may disclose your medical
information, if we believe that the use or
disclosure is necessary to prevent or lessen
a serious and imminent threat to the health
or safety of a person or the public. We may
also disclose medical information if it is
necessary for law enforcement authorities to
identify or apprehend an individual.
Inmates - If you are an
inmate of a correctional facility or under
the custody of a law enforcement official,
we may release medical information about you
to the correctional facility or law
enforcement official. This release would be
necessary (1) for the institution to provide
you with health care; (2) to protect your
health and safety or the health and safety
of others; or (3) for the safety and
security of the correctional institution.
National Security and Intelligence
Activities - We may release medical
information about you to authorized federal
officials for intelligence,
counterintelligence, protection of the
President, other authorized persons or
foreign heads of state, for purpose of
determining your own security clearance and
other national security activities
authorized by law.
Military and Veterans
- If
you are a member of the armed forces, we may
release medical information about you as
required by military command authorities. We
may also release medical information about
foreign military personnel to the
appropriate foreign military authority. If
you are a member of the Armed Forces, we may
disclose medical information about you to
the Department of Veterans Affairs upon your
separation or discharge from military
services. This disclosure is necessary for
the Department of Veterans Affairs to
determine whether you are eligible for
certain benefits.
Workers. Compensation
- We
may release medical information about you to
comply with worker.s compensation laws or
similar programs. These programs provide
benefits for work-related injuries or
illness.
Health Oversight Activities
- We may disclose medical information to a
health oversight agency for activities
authorized by law. These oversight
activities include, for example, audits,
investigations, inspections, and licensure.
These activities are necessary for the
government to monitor the health care
system, government programs, and compliance
with civil rights laws. Under the law, we
must make disclosures to you and when
required by the Secretary of the Department
of Health and Human Services to investigate
or determine our compliance with the
requirements of Section 164.500 et. seq.
Your Rights Regarding Medical
Information About You
You have the following rights regarding
medical information we maintain about you:
Right to Inspect and Copy
-
You have the right to inspect and copy
medical information that may be used to make
decisions about your care. Usually, this
includes medical and billing records and any
other records that your doctor and the
practice use for making decisions about you.
We may deny your request to inspect and copy
in certain limited circumstances. Under
federal law, you may not inspect or copy (1)
psychotherapy notes; (2) information
compiled in reasonable anticipation of, or
use in, a civil, criminal, or administrative
action or proceeding; (3) medical
information that is subject to law that
prohibits access to medical information. If
you are denied access to medical
information, you may request that the denial
be reviewed. Another licensed health care
professional chosen by the practice will
review your request and the denial. The
person conducting the review will not be the
person who denied your request. We will
comply with the outcome of the review.
To inspect and copy medical information that
may be used to make decisions about you, you
must submit your request in writing to our
Privacy Contact . If you
request a copy of the information, we may
charge a fee as permitted by state law for
the costs of copying, mailing or other
supplies associated with your request.
Right to Amend - If you
feel that medical information we have about
you is incorrect or incomplete you have the
right to request an amendment for as long as
the information is maintained by the
practice. Your request must be made in
writing to our Privacy Contact
and you must provide a reason that
supports your 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. 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 medical information
maintained by the practice.
-
Is not part of the information which you
would be permitted to inspect and copy.
-
Is accurate and complete.
Right to Request Confidential
Communications - You have the right
to request that we communicate with you
about medical matters in an alternative way
or at an alternative location. For example,
you can ask that we only contact you at work
or by mail. We will accommodate reasonable
requests and we will not request an
explanation for your request. Please make
this request in writing to our Privacy
Contact.
Right to Request Restrictions
- You have the right to request a
restriction or limitation on the medical
information we use or disclose about you for
treatment, payment or health care
operations. You also have the right to
request a limit on the medical information
we disclose about you to someone who is
involved in your care or the payment for
your care, like a family member or friend.
For example, you could ask that we not use
or disclose information about a surgery that
you had. Your request must be made in
writing to our Privacy Contact and you must
tell us (1) what information you want to
limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you
want the limits to apply, for example,
disclosures to your spouse.
The practice is not required to
agree to your request . If your
doctor believes it is in your best interest
to permit the use and disclosure of your
medical information, then your medical
information will not be restricted. If we do
agree, we will comply with your request
unless the information is needed to provide
you with emergency treatment. With this in
mind, please discuss any restriction you
wish to request with your doctor.
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
medical information about you. This right
applies to disclosures other than purposes
of treatment, payment or health care
operations as described in this Notice of
Privacy Practices. It excludes disclosures
we may have made to you, for a facility
directory, to family members or friends
involved in your care, or for notification
purposes. Your request must be made in
writing to our Privacy Contact
and must indicate a time-period
that may not be longer than six years and
may not include dates prior to April 14,
2003. Your request should indicate in what
form you want the list (for example, on
paper, electronically). The first list you
request within a 12-month period will be
provided at no cost to you. For additional
lists, we may charge you for the costs of
providing the list. We will notify you of
the cost involved and you may choose to
withdraw or modify your request at that time
before any costs are incurred.
Right to a Paper Copy of This Notice
- You have the right to a paper
copy of this notice, even if you have agreed
to receive this notice electronically. You
may ask us to provide you with a copy of
this notice at any time.
Complaints
If you believe your privacy rights have been
violated, you may file a complaint with the
practice or with the Secretary of the
Department of Health and Human Services. All
complaints must be made in writing. You will not be penalized for filing a
complaint .
To file a complaint with the practice
contact our Privacy Contact .
Other Uses of Medical Information
Other uses and disclosures of medical
information not covered by this notice or
the laws that apply to us will be made only
with your written permission. If you provide
us permission to use or disclose medical
information about you, you may revoke that
permission, in writing, at any time. If you
revoke your permission, we will no longer
use or disclose medical information about
you for the reasons covered by your written
authorization. You understand that we are
unable to take back any disclosures we have
already made with your permission, and that
we are required to retain our records of the
care that we provided to you. |
