Notice of Privacy Practices
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.
Aesthetic Associates, Inc, PS, dba , The Seattle Facial Plastic Surgery Center, Inc., P.S. (“Aesthetic Associates, Inc, PS, dba , The Seattle Facial Plastic Surgery Center”) respects your privacy. We understand that your personal health information is sensitive. The law protects the privacy of the health information we create and obtain in providing care and services to you. Your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers and billing and payment information relating to these services. We will not use or disclose your protected health information to others without your authorization, except as described in this Notice or as required by law.
Your Health Information Rights
The health and billing records we create and store are the property of Aesthetic Associates, Inc, PS, dba , The Seattle Facial Plastic Surgery Center. The protected health information in it, however, generally belongs to you. You have a right to:
For help with these rights during normal business hours, please contact:
We are required to:
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our office to pick it up.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to Debbie at Aesthetic Associates, Inc, PS, dba , The Seattle Facial Plastic Surgery Center. You may also file a complaint with the Department of Health and Human Services Office for Civil Rights (“OCR”).
We respect your right to file a complaint with us or with the OCR. If you complain, we will not retaliate against you.
How We May Use and Disclose Your Protected Health Information
Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways we may use and disclose your protected health information. For each category, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose health information will fall within one of the categories.
Examples of Uses and Disclosures of Protected Health Information for Treatment, Payment and Health Care Operations
For health care operations
Statements about certain uses and disclosures
Some Other Ways That We May Use or Disclose Your Protected Health Information without Your Authorization Are As Follows
Required by Law. We must make any disclosure required by state, federal, or local law.
Business Associates. We contract with individuals and entities to perform jobs for us or to provide certain types of services that may require them to create, maintain, use, and/or disclose your health information. We may disclose your health information to a business associate, but only after they agree in writing to safeguard your health information.
Examples include billing services, accountants, and others who perform health care operations for us.
Notification of Family and Others. Unless you object, we may release health 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. We may tell your family or friends your condition and that you are in a hospital.
Public Health and Safety Purposes. As permitted or required by law, we may disclose protected health information:
Research. We may disclose protected health information to researchers if the research has been approved by an institutional review board or a privacy board and there are policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
Coroners, Medical Examiners, Funeral Directors. We may disclose protected health information to funeral directors and coroners consistent with applicable law to allow them to carry out their duties.
Organ-procurement Organizations. Consistent with applicable law, we may disclose protected health information to organ-procurement organizations (tissue donation and transplant) or persons who obtain, store or transplant organs.
Food and Drug Administration (“FDA”). For problems with food, supplements and products, we may disclose protected health information to the FDA or entities subject to the jurisdiction of the FDA.
Workplace Injury or Illness. Washington State law requires the disclosure of protected health information to the Department of Labor and Industries, the employer, and the payer (including a self-insured payer) for workers’ compensation and for crime victims’ claims. We also may disclose protected health information for work-related conditions that could affect employee health. For example, an employer may ask us to assess health risks on a job site.
Correctional Institutions. If you are in jail or prison, we may disclose your protected health information as necessary for your health and the health and safety of others.
Law Enforcement. We may disclose protected health information to law enforcement officials as required by law, such as reports of certain types of injuries or victims of a crime, or when we receive a warrant, subpoena, court order, or other legal process.
Government Health and Safety Oversight Activities. We may disclose protected health information to an oversight agency that may be conducting an investigation. For example, we may share health information with the Department of Health.
Disaster Relief. We may share protected health information with disaster relief agencies to assist in notification of your condition to family or others.
Military, Veteran, and Department of State. We may disclose protected health information to the military authorities of U.S. and foreign military personnel. For example, the law may require us to provide information necessary to a military mission.
Lawsuits and Disputes. We are permitted to disclose protected health information in the course of judicial/administrative proceedings at your request, or as directed by a subpoena or court order.
National Security. We are permitted to release protected health information to federal officials for national security purposes authorized by law.
De-identifying Information. We may use your protected health information by removing any information that could be used to identify you.
Effective date [Insert effective date of the Notice]