DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTERS
Notice of Privacy Practices
Effective January 1, 2005
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.
The most recent copy of this document will be posted within patient view.
DESERT HAIR INSTITUTE & DESERT PLASTICE SURGERY CENTERS is committed to protecting your personal health information. Protected health information (PHI) includes information that we have created or received regarding your health, your health care, and payment for your health care.
THIS NOTICE COVERS THE FOLLOWING ENTITIES PROVING YOUR CARE:
All employees, physicians, nurses, administrative staff, affiliated physicians and other health care professionals providing you care.
PART 1 – YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
Here is a listing of your rights with respect to your protected health information, along with a description of how you may exercise these rights:
• You must have a right to request limits on the way we use or disclose your health information. You must make the request in writing to our Privacy Office and tell us what information you want to limit and to whom you wan the limits to apply. DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTER INSTITUTE is not required to agree to the restriction.
• You have a right to request how we provide confidential communications to you. For example, we may communicate your test results to you by mail or telephone. You may ask us to share information with you in a certain way or in a certain place. For example, you may ask us to send information to your work address instead of your home address: you may also request that we call you at work instead of at home. You must make this request in writing to our office. We are required to follow your request, if it is reasonable.
• In most cases, you have the right to look at or get copies of your records; you must make the request in writing to our office. We may charge you a reasonable fee based on copying and other costs. In certain situations, we may deny your request and will tell you why we are denying it. In some cases, you may have the right to ask for a review of our denial.
• You have a right to request a correction or an update of your records. You may ask us to amend or add missing information if you think there is a mistake. You must make the request in writing to our office and provide a reason for your request. In certain cases we may deny your request, in writing. You may respond by filing a written statement of disagreement with us and ask that the statement be included in you PHI.
• You have a right to get a list of persons or agencies to which your records were sent. You must make this request in writing to our office. The list will not include the releases of your information made for the purpose of treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your written authorization.
• You have a right to get a paper copy of the most recent version of this notice, if you request it.
• You have the right to withdraw your permission for us to release your information. If you sign an authorization to use or disclose information, you can revoke that authorization at any time. The revocation must be made in writing and given to our Privacy Office. This will not affect information that has already been used or disclosed.
To exercise your rights under the law, call the numbers listed in the document or write our office. Our staff will assist you with your request.
PART 2 – DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTERS RESPONSIBLITIES UNDER THE LAW
This office is required by law to provide you with our Notice of Privacy Practices. This law is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under this law, we must protect the privacy of your “protected health information” or PHI. PHI is information that we have created or received regarding your health or payment for your health care. It includes both your medical records and personal information such as your name, social security number, address, and phone number.
We are required to:
• Keep your protected health information private except as indicated below
• Follow the terms of the Notice currently in effect
• Give you this notice
We have the right to change our practices regarding the protected health information we maintain if we make changes, we will update our Notice and make it available to you. The most recent copy of the Notice will be posted in all offices.
PART 3 - HOW WE MAY USE OR DISCLOSE MEDICAL INFOMRATION ABOUT YOU
DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTERS uses and discloses PHI in a number of ways connected to your treatment, payment for your care, and health care operations. Your PHI may be transmitted by FAX for the purpose of treatment, payment or operations. You have the right to ask that we do not transmit your information by FAX. Here are some examples of how we may use or disclose your personal health information without your authorization.
To provide treatment; for example:
• 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 or other healthcare professionals involved in your care. For example, your doctor will need to know if you are allergic to any medicines. The doctor may share this information with pharmacists and others caring for you.
• We may also disclose information to other professionals providing your health care. For example, we may need to call a specialist about your medical conditions. We may refer you to a specialist, so that you may receive the proper care.
To receive payment for services we provide or to obtain insurance authorization for services we recommend; for example:
• If you have health insurance, we request payment from your health insurance plan for the services we provide. For example, we may need to give your health plan information about your visit, your diagnosis, procedures, and supplies used so that we can be compensated for the treatment provider. However, we will not disclose your health information to a third party payer without your authorization except required by law.
• We may also tell your health plan about your recommended treatment to get their prior authorization, if that is required under your insurance plan. For example, if you need surgery, we will call your health plan to make sure the surgery is covered and will be paid for by the health plan.
To carry out healthcare operations; for example:
• We may use of disclose your health information in order to manage our programs and activities. For example, we may use your health information to review the quality of services you receive or to provide training to our staff.
• We may use and disclose medical information to contact you by telephone or by mail as a reminder that you have an appointment for treatment of to inform you of test results.
For research: We may use and disclose medical information about you for research purposes.
For joint activities: Your health information may be used and shared by the Providers in furtherance of their joint activities and with other individuals or organizations that engage in joint treatment, payment or healthcare operational activities with the Providers.
As required by law: We may use and disclose protected health information when required by federal or state law.
For judicial and administrative proceedings: We may disclose protected health information in response to an order of a court or administrative tribunal; in response to a subpoena, discovery request or other lawful process.
For law enforcement purposes: We may disclose protected health information to a law enforcement official.
For abuse reports and investigations: DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTERS may use and disclose information regarding suspected cases of abuse, neglect, or domestic violence, when the law so requires.
To medical examiners/coroners or funeral directors: We may use and disclose protested health information consistent with applicable laws to allow them to carry out their duties.
To comply with workers’ compensation laws: We may disclose protected health information as authorized by laws relating to workers compensation or other programs that provide benefits for work-related injuries or illness without regard to fault.
For organ, eye, or tissue donation purposes: We may disclose protected health care information to organ procurement organizations or entities.
For specialized government functions: We may use and disclose information to agencies administering programs that provide public benefits. For example, Public Health may disclose information for the determination of Supplemental Security Income (SSI) benefits. We also may provide information to government officials for specifically identified government functions such as national security or military activities: or law enforcement custodial situations, such as correctional institutions.
To avoid serious threat to health or safety: DESERT HAIR INSTITUTE & DESERT PLASTIC SURGERY CENTERS may use and disclose protected health information when we believe it necessary to avoid a serious threat to the health or safety of a person or the general public.
For public health and safety purposes as allowed or required by law: We may disclose protected health information to health care oversight agencies for oversight activities authorized by law.
Disaster relief: We may use and disclose information about you to assist in disaster relief efforts.
OTHER USES AND DISCLOSURES REQUIRE YOUR WRITTEN AUTHORIZATION:
Uses and disclosures not described in this Notice will be made only as allowed by law or with your written authorization. You may revoke your authorization to use or disclose protected health information at any time; the revocation must be in writing. The revocation will not affect uses or disclosures that have already been made.
PART 4 – HOW YOU MAY ASK FOR HELP OR COMPLAIN
If you believe your privacy rights have been violated, you may file a complaint with the Medical Director. You may also complain to the Secretary of the U.S. Department of Health and Human Services, at the address below. You will nu be retaliated against for filing a complaint.
Office of Civil Rights: U.S. Department of Health and Human Services
200 Independence Avenue, SW, HHH Building, Room 509H
Washington, D.C., 20201
Phone: 866-627-7748 TTY:886-788-4989 Online: www.hhs.gov/ocr