Cosmetique Aesthetics Notice of Privacy Practices
Effective as of August 1, 2005
This NOTICE describes how MEDICAL INFORMATION ABOUT YOU, CAN BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO IT. PLEASE READ CAREFULLY.
WHO WILL FOLLOW THIS NOTICE?
This Notice describes the Cosmetique Aesthetics practices and practices that will be followed by all members of the Cosmetique Aesthetics workforce that handle your medical information.
OUR COMMITMENT REGARDING PROTECTED MEDICAL INFORMATION
Cosmetique Aesthetics understands that medical information about you and your health is personal. We are committed to protecting your medical information. We maintain our records and carry out the relevant actions in our environment with the aim of providing the highest level of protection of your medical information, while also providing you with the highest level of medical care. This Notice applies to all records of your medical care we receive, or we believe them in Cosmetique Aesthetics.
Your other medical treatment providers (for example, doctors, hospitals, home health agencies, etc.) may have different policies regarding the use and disclosure of your medical information.
This notice will tell you about the ways in which Cosmetique Aesthetics may use and disclose your medical information. Your medical information, also known as “protected health information” is information about you, including demographic information, that can identify you and that relates to your past, present or future physical or mental health information and related health services.
In this notice, we also describe your rights and certain obligations that Cosmetique Aesthetics has regarding the use and disclosure of your protected health information. We are required to:
1-Ensure that medical information and others that identify you (protected health information) are kept reserved.
2-Give you this notice of our legal obligations and our Privacy Practices regarding protected health information.
3-Follow the terms of the Notice that is currently in effect.
USE AND DISCLOSURE FOR TREATMENTS, PAYMENTS AND CARE OF MEDICAL CARE
By becoming a Cosmetique Aesthetics patient, you are giving Cosmetique Aesthetics your consent to use your protected health information for certain activities, including treatments , payments and other health care operations . Sometimes, you may hear these three activities that we have referred to above, such as: «TPO».
First, we can use and disclose your health information so that Cosmetique Aesthetics and its medical professionals can do the treatment. For example, we may use your past medical information in order to diagnose your current condition or we may provide information about your health status to another doctor to whom we refer you for additional care. We may also use and disclose your health information so that we can obtain payment for the medical treatment we offer. For example, we will present your health information to your insurance company in order to receive payment for the services we provide to you. We may also use and disclose your health information for Cosmetique Aesthetics health care operations, that is, those other tasks that we have to perform to ensure that the highest quality of medical care is provided. For example, we may use your protected health information to assess how we can best meet your needs, or we may provide your health information to an auditor who reviews our books so that we can maintain our License for the provision of Medical Services in the state of California .
Other uses and disclosures of your protected health information
The following uses of your protected health information may be made without any additional authorization on your part. (Not all possible uses or disclosures are included, but you can be sure that all uses and disclosures made by Cosmetique Aesthetics are only those allowed by current legislation).
The licensing procedures are by the American Board of Plastic Surgery (by its original name in English).
Uses and disclosures for appointment reminders
We may use and disclose your medical information to contact you and remind you that you have an appointment at the office. If you request that such communications be made confidentially, please contact our office in writing at 10744 West Washington Boulevard, Culver City, CA 90232. We will comply with all requests within reason.
Uses and disclosures to other people involved in your medical care
We may disclose to a family member, a relative, a close friend, or any other person you identify, regarding your protected health information that is directly related to that person’s participation in your medical care. If you are not in a position to agree with this, or if you object to this description, we may disclose information when necessary if we determine that it is in your best interest, based on our professional judgment. We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person who is responsible for your care, your location, general condition or death. By last,
Uses and disclosures in emergency situations
We may use or disclose your protected health information in an emergency treatment situation. If this happens, the doctor will attempt to obtain the acknowledgment of receipt of this notification as soon as reasonably possible, after the administration of a treatment.
Uses and disclosures for health-related benefits or services
From time to time, Cosmetique Aesthetics may use and disclose your protected health information to inform you of certain health-related benefits or services that may be of interest to you.
Uses and disclosures required by law
We will use or disclose your health information when required by federal, state or local laws. The use or disclosure is made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if the law requires us to do so, of any such uses or disclosures. We must make disclosures to you and when required by the Department of Health and Human Services Secretariat to investigate or determine our compliance with the law.
Uses and disclosures related to communicable diseases
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or who may be at risk of contracting or spreading the disease or condition.
Disclosures for health oversight activities
We may disclose protected health information to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations and inspections. These activities are necessary for the government to control the health care system, the provision of health care, government benefit programs, other government regulatory programs and civil rights laws.
Disclosures of abuse or neglect
We may disclose your protected health information to a public health authority authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been the victim of abuse, neglect or domestic violence, to a government entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with California law.
Disclosure of information to the Food and Drug Administration
We may disclose your protected health information to a person or company, as required by the Federal Food and Drug Administration (FDA) to report adverse events, product defects or other problems, biological deviations, follow-up. of products; to allow the withdrawal of products; to make repairs or replacements; or to carry out post-marketing surveillance, as necessary.
Disclosures for lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, petition or summons or other similar legal process, by another person involved in the dispute, but only if efforts have been made to inform you about the request or to obtain an order to protect The required information.
Public Order Disclosures
We may disclose your protected health information if we are asked to do so by a law enforcement officer, in response to a court order, subpoena, order, subpoena or similar process. Other situations for the disclosure of protected health information may include disclosures related to individuals who are members of the Armed Forces, national security and intelligence agencies, as well as disclosure to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign Heads of State.
Disclosure of information to coroners, funeral directors and organ donation
We may disclose your health information to a coroner for identification purposes, determine the cause of death, or so that the coroner can perform other tasks required by law. We may also disclose protected health information to a funeral director in order to allow him to carry out his legal obligations, and we can do so if the death is reasonably predictable. Your protected health information may also be disclosed for certain organ donations to which you have committed.
We may disclose your protected health information to researchers when their research has been approved and protocols have been established to ensure the privacy of your information. We may also disclose a limited set of your information, as permitted by law, for research purposes.
Disclosures related to criminal activity
We may disclose your protected health information, in accordance with federal and California laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or if It is necessary for law enforcement authorities to identify or detain an individual.
Workers Compensation Disclosures
We may disclose your health information for Workers Compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Your rights to protected health information
Right to inspect and copy
You have the right to inspect and copy protected health information that may be used to make decisions about your medical care. Generally, this right includes both medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have the right to request that the denial be reviewed.
Right to request restrictions
You have the right to request that we restrict the use and disclosure of your protected health information for treatment, payments and medical care. We are not required to accept your request. If we agree, we will comply with your request, unless the information is necessary to provide emergency treatment.
To request restrictions, you must make your request in writing to 10744 West Washington Boulevard, Culver City, CA 90232. In your request, you must tell us:
What information do you want to limit?
If you want to limit our use, disclosure or both.
Who do you want us to limit the application to?
Right to confidential communications
You also have the right to request to receive private health information communications (such as appointment confirmations) by alternative means or at alternative locations. For example, you can request that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to 10744 West Washington Boulevard, Culver City, CA 90232. We will not ask you the reason for your request. We will comply with all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to modify
If you understand that the medical information we have about you is incorrect or incomplete, you have the right to request that your protected health information be modified. Only the health care entity (for example, doctor, hospital, clinic, etc.) that created your protected health information is responsible for its modifications. For more information on the procedures for submitting such an application, contact 10744 West Washington Boulevard, Culver City, CA 90232.
Right to a disclosure report
You have the right to a report of the disclosures of your protected health information, for purposes other than treatment, payment or medical care operations by Cosmetique Aesthetics or any of the persons or companies that perform treatment, payment or medical care operations in our name. To request this list of disclosures we have made of protected health information about you, you must submit a written request to us at 10744 West Washington Boulevard, Culver City, CA 90232. Your request must state a period of time that cannot be longer. six (6) years before the date of your request and may not include dates before August 1, 2005. Your request must state the way you want the list (for example, on paper or electronically). You will be charged for photocopies.
Right to a paper copy of this notice
You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
You can obtain a copy of this Notice on our website: https://www.cosmetiquemedspa.com
To obtain a paper copy of this Notice, contact (310) 837-5555
For more information on these procedures, or to make any of these requests, you should contact our Office Manager at (310) 837-5555.
Changes to this Notice
Cosmetique Aesthetics reserves the right to modify this Notice. We reserve the right to have the Notice reviewed or changed by medical information we already have about you, as well as any information we believe or receive in the future. A copy of the current Notice will be placed on the Cosmetique Aesthetics website: https://www.cosmetiquemedspa.com. The Notice will contain, in the upper right corner, the effective date.
If you believe that your privacy rights have been violated and / or that Cosmetique Aesthetics or Dr. Ramin Sarshad have not followed this policy, you may file a complaint with the Office Manager of Dr. Ramin Sarshad or with the Secretary of the Department of Health and Human Services (Department of Health and Human Services Secretariat).
To file a complaint with Dr. Ramin Sarshad contact the Office Manager at 10744 West Washington Boulevard, Culver City, CA 90232. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses of protected health information
Other uses and disclosures of your protected health information not covered by this notice or the laws that apply to Dr. Ramin Sarshad will be made only with your written authorization (“authorization”). If you give us permission to use or disclose your health information, you may revoke that permission in writing, at any time. If you revoke your authorization, we will no longer be able to use or disclose your health information for the reasons stated in your authorization. You understand that we cannot withdraw any disclosures we have already made with your permission, and that we are required to retain our records of medical care or other services that we have provided to you.
If you have any questions about this Notice, please contact the Office Manager at Cosmetique Aesthetics.