Notice of Privacy Practices:
This Notice of Privacy Practices describes how Laser Aesthetics LLC may use and disclose your protected health/personal information (PHI) to carry out treatment, payment, or healthcare operations (TPO) and for other purposes that are permitted or required by law. It also describes our rights to access and control your protected information. “Protected health/personal 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.

Uses and Disclosures of Protected Health/Personal Information:
Your PHI may be used and disclosed by our medical director, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you to support business operations of this office if requested by you to a finance company to pay for your care and any other use required by law.

Treatment:
We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any other related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your PHI as necessary, if, as a result of our service you require treatment by a physician. Your PHI may be provided to a physician to whom you have been referred, to ensure that the physician has the necessary information in order to obtain approval.

Payment:
Your PHI will be used, if requested, to obtain payment for your services. For example, if you desire to finance the costs of your treatment, this may involve disclosing relevant protected private information in order to obtain approval.

Healthcare Operations:
We may use or disclose, as needed, your PHI in order to support the business activities of this office. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting and arranging for other business activities. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when we are ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.

We may use or disclose your PHI in the following situations without your authorization. These situations include: as required by law, public health issues, communicable diseases, health oversight, abuse or neglect, Food and Drug Administration requirements, legal, proceedings, law enforcement, coroners, funeral directors and organ donation, research, criminal activity and national security, workers’ compensation, inmates, and required uses and disclosures. Under the law, we must make the disclosure to you and, when required by the Secretary of the U.S. Department of Health and Human Services, to investigate or determine our compliance with the requirements of the Standards for Privacy of Individually Identifiable Health Information set forth at 45 C.F.R. parts 160 and 164.

Other Permitted and Required Uses and Disclosures will be made only with your written authorization or opportunity to object unless required by law.

You may revoke this authorization, at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS:
Following is a statement of your rights with respect to your protected health/personal information.

You have the right to inspect and copy PHI. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

You have the right to require a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Policies. Your request must state the specific restriction requested and to whom you want the restriction to apply.

We are not required to agree to a restriction that you may request. If our medical director believes it is in your best interest to permit the use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another service provider.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us; upon request, even if you have agreed to accept this notice alternatively, i.e., electronically.

You may have the right to amend your PHI. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare for the rebuttal to our statement and will provide you a copy of such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.

We reserve the right to change the terms of this notice and make the new notice provisions effective to all PHI we maintain. We will inform you by mail of any changes. You then have the rights to object or withdraw as provided in this notice.

COMPLAINTS

You may complain to us or to the Secretary of the U.s. Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our HIPPA Compliance Officer of your complaint. We will not retaliate against you for filing a complaint.