Privacy Policy
Nova Cosmetic
Center
Vein Centers of America
NOTICE OF PRIVACY PRACTICES
Date of last revision:
01/08/2009
Effective: Immediately
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
The Practice (the "Practice"), in accordance with the federal Privacy
Rule, 45 CFR parts 160 and 164 (the "Privacy Rule") and applicable state
law, is committed to maintaining the privacy of your protested health
information ("PHI"). PHI includes information about your health
condition and the care and treatment you receive from the Practice and
is often referred to as your health care or medical record. This Notice
explains how your PHI may be used and disclosed to third parties. This
Notice also explains your rights regarding your PHI.
HOW THE PRACTICE MAY USE AND
DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The Practice, in accordance with this
Notice and without asking for your express consent or authorization, may
use and disclose you PHI for the purposes of:
(a) Treatment - To provide you with the health care you require,
the Practice may use and disclose your PHI to those health care
professionals, whether on the Practice's staff or not, so that it may
provide, coordinate, plan and manage your health care. For example,
before starting on anti-aging therapy the physician may need to know the
results of your latest physical examination.
(b) Payment - To get paid for services provided to you, the
Practice may provide your PHI, directly or through a billing service, to
a third party who may be responsible for your care, including insurance
companies and health plans. If necessary, the Practice may use your PHI
in other collection efforts with respect to all persons who may be
liable to the Practice for bills related to your care. For example, the
Practice may need to provide your insurance plan with information about
health care services that you received from the Practice so that the
Practice can be reimbursed. The Practice may also need to tell your
insurance plan about treatment you are going to receive so that it can
determine whether or not it will cover the treatment expense.
(c) Health Care Operations - To operate in accordance with
applicable law and insurance requirements, and to provide quality and
efficient care, the Practice may need to compile, use and disclose your
PHI. For example, the Practice may use your PHI to evaluate the
performance of the Practice's personnel in providing care to you.
OTHER EXAMPLES OF HOW THE PRACTICE MAY
USE YOUR
PROTECTED HEALTH INFORMATION
(a) Advice of Appointment and Services
-The Practice may, from time to time, contact you to provide appointment
reminders or information about treatment alternatives or other
health-related benefits and services that may be of interest to you. We
may use and disclose medical information to contact you. This contact
may be by phone, in writing, e-mail, or otherwise, and may involve the
leaving of an e-mail, a message on an answering machines, or otherwise
which could (potentially) be received or intercepted by others.
(b) Directory/Sign-In Log - The Practice may, from time to time,
maintain a sign-in log at its reception desk for individuals seeking
care and treatment in the office. The sign-in log is located in a
position where staff can readily see who is seeking care in the office,
as well as the individual's location within the Practice's office suite.
This information may be seen by, and is accessible to, others who are
seeking care or services in the Practice's offices.
(c) Family/Friends - The Practice may disclose to a family
member, other relative, a close personal friend, or any other person
identified by you, your PHI directly relevant to such person's
involvement with your care or the payment of your care. The Practice may
also use or disclose your PHI to notify or assist in the notification
(including identifying or locating) a family member, a personal
representative, or another person responsible for your care, of your
location, general condition or death. However, in both cases, the
following conditions will apply:
(i) If you are present at or prior to the use or disclosure of your PHI,
the Practice may use or disclose your PHI if you agree, or if the
Practice can reasonably infer from the circumstances, based on the
exercise of its professional judgment, that you do not object to the
disclosure.
(ii) If you are not present, the Practice will, in the exercise of
professional judgment, determine whether the use or disclosure is in
your best interests and, if so, disclose only the PHI that is directly
relevant to the person's involvement with your care.
OTHER USE & DISCLOSURES WHICH MAY BE
PERMITTED OR REQUIRED BY LAW
The Practice may also use and disclose
your PHI without your consent or authorization in the following
instances:
(a) De-identified Information - The Practice may use and disclose
health information that may be related to your care but does not
identify you and cannot be used to identify you.
(b) Business Associate - The Practice may use and disclose PHI to
one or more of its business associates if the Practice obtains
satisfactory written assurance, in accordance with applicable law, that
the business associate will appropriately safeguard your PHI. A business
associate is an entity that assists the Practice in undertaking some
essential function, such as a billing company that assists the office in
submitting claims for payment to insurance companies.
(c) Personal Representative - The Practice may use and disclose
PHI to a person who, under applicable law, has the authority to
represent you in making decisions related to your health care.
(d) Emergency Situations - The Practice may use and disclose PHI
for the purpose of obtaining or rendering emergency treatment to you
provided that the Practice attempts to obtain your Consent as soon as
possible: The Practice may also use and disclose PHI to a public or
private entity authorized by law or by its charter to assist in disaster
relief efforts, for the purpose of coordinating your care with such
entities in an emergency situation.
(e) Public Health Activities - The Practice may use and disclose
PHI when required by law to provide information to a public health
authority to prevent or control disease.
(f) Abuse, Neglect or Domestic Violence - The Practice may use
and disclose PHI when authorized by law to provide information if it
believes that the disclosure is necessary to prevent serious harm.
(g) Health Oversight Activities - The Practice may use and
disclose PHI when required by law to provide information in criminal
investigations, disciplinary actions, or other activities related to the
community's health care system.
(h) Judicial and Administrative Proceeding - The Practice may use
and disclose PHI in response to a court order or a lawfully issued
subpoena.
(i) Law Enforcement Purposes - The Practice may use and disclose
PHI, when authorized, to a law enforcement official. For example, your
PHI may be the subject of a grand jury subpoena, or if the Practice
believes that your death was the result of criminal conduct.
(j) Coroner or Medical Examiner - The Practice may use and
disclose PHI to a coroner or medical examiner for the purpose of
identifying you or determining your cause of death.
(k) Organ, Eye or Tissue Donation - The Practice may use and
disclose PHI if you are an organ donor to the entity to whom you have
agreed to donate your organs.
(l) Research - The Practice may use and disclose PHI subject to
applicable legal requirements if the Practice is involved in research
activities.
(m) Avert a Threat to Health or Safety - The Practice may use and
disclose PHI if it believes that such disclosure is necessary to prevent
or lessen a serious and imminent threat to the health and safety of a
person or the public and the disclosure is to an individual who is
reasonably able to prevent or lessen the threat.
(n) Specialized Government Functions - The Practice may use and
disclose PHI when authorized by law with regard to certain military and
veteran activity.
(o) Worker's Compensation - The Practice may use and disclose PHI
if you are involved in a Worker's Compensation claim to an individual or
entity that is part of the Worker's Compensation system.
(p) National Security and Intelligence Activities - The Practice
may use and disclose PHI to authorized governmental officials with
necessary intelligence information for national security activities.
(q) Military and Veterans - The Practice may use and disclose PHI
if you are a member of the armed forces, as required by the military
command authorities.
AUTHORIZATION
Uses and/or disclosures, other than those
described above, will be made only with your written Authorization.
YOUR RIGHTS
You have the right to:
(a) Revoke any Authorization or consent you have given to the Practice,
at any time. To request a revocation, you must submit a written request
to the Practice's Privacy Officer.
(b) Request special restrictions on certain uses and disclosures of your
PHI as authorized by the law. In general, this relates to your right to
request special restrictions concerning disclosures of your PHI
regarding uses for treatment, payment and operational purposes under the
Privacy Rule, Section 164.522(a) and restrictions related to disclosure
to your family and other individuals involved in your care under Privacy
Rule, Sections 164510(b). Except in certain instances, the Practice may
not be obligated to agree to any requested restrictions. To request
restrictions, you must inform the Practice of what information you want
to limit, whether you want to limit the Practice's use and disclosure,
or both, and to whom you want the limits to apply. If the Practice
agrees to your request, the Practice will comply with your request
unless the information is needed in order to provide you with emergency
treatment.
(c) Receive confidential communications or PHI by alternative means or
at alternative locations as provided by Privacy Rule, Section
164.522(b). For instance, you may request all written communications to
you marked "Confidential Protected Health Information." You must make
your request in writing to the Practice's Privacy Officer. The Practice
will accommodate all reasonable requests.
(d) Inspect and copy your PHI as provided by federal law (including
Privacy Rule, Section 164.524) and state law. To inspect and copy your
PHI, you must submit a written request to the Practice's Privacy
Officer. The Practice can charge you a fee for the cost of copying,
mailing or other supplies associated with your request. In certain
situations that are defined by law, the Practice may deny your request,
but you will have the right to have the denial reviewed as set forth
more fully in the written denial notice.
(e) Amend you PHI as provided by federal law (including Privacy Rule,
Section 164.526) and state law. To request an amendment, you must submit
a written request to the Practice's Privacy Officer. You must provide a
reason that supports your request. The Practice may deny your request,
if the information to be amended was not created by the Practice (unless
the entity that created the information is no longer available), if the
information is not part of your PHI maintained by the Practice, if the
information is not part of the information you would be permitted to
inspect and copy, and/or if the information is accurate and complete. If
you disagree with the Practice's denial, you will have the right tot
submit a written statement of disagreement.
(f) Receive an accounting of disclosures of your PHI as provided by
federal law (including Privacy Rule Section 164.528) and state law. To
request an accounting, you must submit a written request tot he
Practice's Privacy Officer. The request must state a time period, which
may not be longer than six (6) years and may not include dates before
April 14, 2003. The request should indicate in what form you want the
list (such as a paper or electronic copy). The first list you request
within a twelve (12) month periods will be free, but the Practice may
charge you for the cost of providing additional lists. The Practice will
notify you of the costs involved and you can decide to with draw or
modify your request before any costs are incurred.
(g) Receive a paper copy of the Privacy Notice from the Practice (as
provided by the Privacy Rule Section 164520(b)(1)(iv)(F)) upon request
to the Practice's Privacy Officer.
(h) Complain to the Practice or to the Secretary of HHS (as provided by
Privacy Rule Section 164.520(b)(1)(vi)) if you believe your privacy
rights have been violated. To file a complaint with the Practice, you
must contact the Practice's Privacy Officer. All complaints must be in
writing.
To obtain more information about your privacy rights or if you questions
you want answered about your privacy rights (as provided by Privacy Rule
Section 164.520(b)(2)(vii)), you may contact the Practice's Privacy
Officer as follows:
Name: Heather Jahangani
Address: 7600 Dr. Phillips Blvd.
Suite 74 & 58
Orlando, FL 32828
Telephone No.: 407-226-0609
PRACTICE'S REQUIREMENTS
The Practice:
(a) Is required by federal law to maintain the privacy of your PHI and
to provide you with this Privacy Notice detailing the Practice's legal
duties and privacy practices with respect to your PHI.
(b) Under the Privacy Rule, May be required by State law to grant
greater access or maintain greater restrictions on the use or release of
your PHI than that which is provided for under federal law.
(c) Is required to abide by the terms of this Privacy Notice.
(d) Reserves the right to change the terms of this Privacy Notice and to
make the new Privacy Notice provisions effective for all of your PHI
that it maintains.
(e) Will post a copy of the current notice in the Practice. The notice
will contain on the first page, at the top of the first column, the date
of the last revision and effective date. In addition, each time you
visit the Practice for treatment or health care services you may request
a copy of the current notice in effect prior to implementation.
(f) Will not retaliate against you for filing a complaint.
