Effective Date: January 1, 2025
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.
We are required by law to:
We will use and disclose your health information to provide, coordinate, or manage your aesthetic treatments. This includes consultation between providers, referrals, and coordination with our Medical Director.
Example: We may share information about your medical history and current medications with our supervising physician to ensure safe treatment.
We may use and disclose your health information to bill and collect payment for services. This may include submitting claims to your insurance company or health plan.
Example: We may disclose information about the treatment you received so your insurance company will pay us or reimburse you.
We may use and disclose your health information for our healthcare operations, including quality assessment, training, and business management.
Example: We may review your treatment records to assess the quality of care provided and identify areas for improvement.
We may also use or disclose your health information without your authorization in these situations:
To remind you about appointments
To inform you about treatment options
To tell you about health services
When required by federal or state law
To prevent or control disease
To authorized health oversight agencies
In response to court orders
For limited law enforcement purposes
You have the right to inspect and obtain a copy of your health records. We may charge a reasonable fee for copying and mailing costs. We may deny your request in certain limited circumstances.
If you believe your health information is incorrect or incomplete, you may request an amendment. We may deny your request if the information was not created by us, is not part of our records, or is accurate and complete.
You have the right to request a list of certain disclosures we made of your health information for up to six years prior to your request. This does not include disclosures for treatment, payment, or healthcare operations.
You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request, but if we do, we will comply with your request unless the information is needed for emergency treatment.
You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
You have the right to obtain a paper copy of this notice, even if you have agreed to receive it electronically. You may request a copy at any time.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.
Contact our Privacy Officer:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against for filing a complaint.
We reserve the right to change this notice and make the new notice effective for all health information we maintain. We will post the current notice in our office and on our website with its effective date. You may request a copy of the current notice at any time.
You will be asked to sign an acknowledgment form indicating that you have received a copy of this notice. This is not a consent for use of your information; it simply acknowledges that you have been provided with this notice.
If you have questions about this notice, please contact our office at (260) 229-3255