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.
THIS NOTICE IS FROM ROBERT M. SCHWARCZ, MD, FACS,
INC., A PROFESSIONAL MEDICAL CORPORATION, DBA
WWW.DRSCHWARCZ.COM,
WWW.NATURALFACEDR.COM
and WWW.CARAESTHETICA.COM(COLLECTIVELY REFERRED TO
HEREIN AS "PROVIDER").
PROVIDER ("PROVIDER") provides plastic surgery,
dermatology, outpatient surgery and related
services. PROVIDER desires to maintain the privacy
of health information and desires to provide
patients with a notice of its legal duties and
privacy practices. PROVIDER will not use or disclose
private health information except as described in
this notice. "Private Health Information" is
information about you which was created or received
by PROVIDER and that relates to a past, present or
future physical or mental health or condition, or
the provision of, or payment for, health care and
which could be used to identify the patient.
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND
HEALTH OPERATIONS. The following categories describe
the ways that PROVIDER may use and disclose private
health information without written authorization.
Treatment:
PROVIDER will use health information in the
provision and coordination of healthcare. We may
disclose all or any portion of private health
information, such as medical reports, to attending
physicians and other health care providers who have
a need for such information in the care and
continued treatment of the patient. PROVIDER also
may disclose health information to other people,
such as family members, clergy and others who may be
involved in the patient's care.
Payment:
PROVIDER may release private health information
about the patient for the purposes of determining
coverage, billing, claims management, private health
data processing, and reimbursement. The information
may be released to a health plan or health insurer,
or a workers compensation or other insurance company
responsible for payment of our services, an employer
involved in a workers' compensation program, and a
third party payer or other entity (or their
authorized representatives) involved in the payment
of the patient's medical bill, and may include
copies or excerpts of the private health record
which are necessary for payment of the account. For
example, a bill sent to a third party payer may
include information that identifies the patient, the
diagnosis, and the modalities used, and may include
a copy of the medical report.
Health
Care Operations:
PROVIDER may use and disclose private health
information during routine healthcare operations
including, without limitation, utilization review,
evaluation of our staff, assessing the quality of
care and outcomes in the patient's case and similar
cases, internal auditing, accreditation,
certification, licensing or credentialing
activities, private health research and educational
purposes.
Scheduling and Appointment Reminders:
PROVIDER may use and disclose private health
information obtained when scheduling medical or
other healthcare services and when it contacts the
patient as a reminder of an appointment for
services. PROVIDER may also use and disclose private
health information to tell the patient or others of
information about treatment alternatives or other
health-related benefits and services of possible
interest to the patient.
Business Associates:
PROVIDER may use and disclose certain private health
information about the patient to business
associates. A business associate is an individual or
entity under contract with the PROVIDER to perform
or assist PROVIDER in a function or activity which
necessitates access to, or the use or disclosure of,
private health information. Examples of business
associates, include, but are not limited to, a copy
service used by PROVIDER to copy private health
records, consultants, accountants, lawyers, practice
management organizations, private health
transcriptionists, case managers, marketing and
customer service personnel and third-party billing
companies. PROVIDER will attempt to require the
business associate to protect the confidentiality of
private health information.
Regulatory Agencies:
PROVIDER may disclose private health information to
a health oversight agency for activities authorized
by law, including, but not limited to, licensure,
certification, audits, investigations and
inspections.
Law
Enforcement/Litigation:
PROVIDER may disclose private health information for
law enforcement purposes as required by law or in
response to a valid subpoena or court order.
Public
Health:
PROVIDER may disclose private health information to
public health or legal authorities charged with
preventing or controlling disease, injury or
disability. For example, PROVIDER may be required to
report the existence of a communicable disease to
the Department of Health to protect the health and
wellbeing of the general public.
Workers Compensation:
PROVIDER may release private health information to
employers, health care providers, examiners, judges,
insurance companies, and others with a need to know,
in connection with workers' compensation or similar
programs. These programs provide benefits for
work-related injuries or illnesses.
Military/Veterans:
PROVIDER may disclose private health information as
required by military command authorities, if the
patient is a member of the armed forces.
Required by Law:
PROVIDER will disclose private health information
about you when required to do so by law including,
without limitation, for judicial or administrative
proceedings, to report information related to
victims of abuse, neglect or violence, to assist law
enforcement officials in their law enforcement
duties.
Coroners, Medical Examiners, Funeral Directors:
PROVIDER may release private health information to a
coroner or private health examiner. This may be
necessary, for example, to identify a deceased
person or to determine a cause of death. PROVIDER
may also release private health information to
funeral directors as necessary to carry out their
duties.
Other
Uses:
Any other uses and disclosures will be made only
with written authorization.
PATIENT HEALTH INFORMATION RIGHTS:
Although all records concerning treatment are the
property of PROVIDER you have the following rights
concerning private health information. ("CFR" below
stands for the Code of Federal Regulations). To
exercise any of these rights, please contact the
Privacy Officer identified below, in writing.
Right
to Confidential Communications:
You have the right to receive confidential
communications of your private health information by
alternative means or at alternative locations as
provided by 45 CFR § 164.522. For example, you may
request that PROVIDER only contact you at work or by
mail.
Right
to Inspect and Copy:
You have the right to inspect and copy your private
health information as provided by 45 CFR §164.524.
Right
to Amend:
You have the right to amend your private health
information as provided by 45 CFR §164.526.
Right
to an Accounting:
You have the right to receive an accounting of
disclosures of your private health information as
provided by 45 CFR §164.528.
Right
to Request Restrictions:
You have the right to request restrictions on
certain uses and disclosures of your private health
information as provided by 45 CFR §164.522. PROVIDER
may not agree to honor the request.
Right
to Receive Copy of this Notice:
You have the right to receive a paper copy of this
Notice, upon request.
Right
to Revoke Authorization:
You have the right to revoke your authorization to
use or disclose your private health information
except to the extent that action has already been
taken in reliance on your authorization.
FOR
MORE INFORMATION OR TO REPORT A PROBLEM:
If you believe your privacy rights have been
violated, you may file a complaint with PROVIDER
and/or with the Secretary of the U.S. Department of
Health and Human Services.
CHANGES TO THIS NOTICE:
PROVIDER will abide by the terms of the Notice of
Health Information Practices currently in effect.
PROVIDER reserves the right to change the terms of
its notice and to make the new notice provisions
effective for all protected health information that
it maintains. PROVIDER will post any revised Notice
(prior to implementation of same).
