Privacy Policy

NOTICE OF PRIVACY POLICIES AND PRACTICES
NOTICE OF PRIVACY PRACTICES (HIPAA)

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

Our Legal Duty

ADVANCED SKINCARE SURGERY & MEDCENTER is committed to protecting
your privacy and is required by applicable federal and state laws to maintain the
privacy of your protected health information. “Protected health information” is your
individually identifiable health information, including demographic information,
collected from you or created or received by a health care provider, a health plan,
your employer, or a health care clearinghouse that relates to: (1) your past,
present, or future physical or mental health or condition; (2) the provision of health
care to you; or (3) the past, present or future payment for the provision of health
care to you.

This notice describes our policies and practices for collecting, handling, and
protecting our patients’ protected health information. We are required to provide
you this notice about our privacy practices, our legal duties, and our rights
concerning your protected health information. We suggest that you read these
policies the first time you become an ADVANCED SKINCARE SURGERY &
MEDCENTER patient. We must follow the privacy practices that are described in
this notice while it is in effect. This notice takes effect on January 1, 2008, and will
remain in effect until we replace it.

We will continually review our privacy policies and practices and monitor our
business practices to help ensure the security of our patients’ protected health
information. Due to changing circumstances, it may become necessary to revise
our privacy policies and practices and the terms of this notice at any time, provided
that such changes are permitted by applicable law. We reserve the right to make
the changes in our privacy practices and the new terms of our notice effective for
all protected health information that we maintain, including protected health
information we created or received before we made the changes. Before we make
a significant change in our privacy practices, we will change this notice and notify
all affected patients in writing in advance of the change.

You may print a copy of our notice at any time from our web site. For more
information about our privacy practices, please contact us using the information
listed at the end of this notice.

Uses and Disclosures of Protected Health Information

Following are examples of permitted uses and disclosures of your protected health
information. These examples are not exhaustive.

Required Uses and Disclosures

By law, we must disclose your health information to you unless it has been
determined by a health care professional that it would be harmful to you. We must
also disclose health information to the Secretary of the Department of Health and
Human Services (DHHS) for investigations or determinations of our compliance
with laws on the protection of your health information.

Treatment

We will use and disclose your protected health information to provide, coordinate,
or manage your health care and any related services. This includes the
coordination or management of your health care with a third party. For example,
we may disclose your protected health information to another physician or health
care provider (e.g., a specialist, pharmacist, or laboratory) who, at the request of
your physician, becomes involved in your care by providing assistance with your
health care diagnosis or treatment. This includes pharmacists who may be
provided information on other drugs you have been prescribed to identify potential
interactions.

In emergencies, we will use and disclose your protected health information to
provide the treatment you require.

Payment

Your protected health information will be used, as needed, to obtain payment for
your health care services. This may include certain activities we may need to
undertake before your health care insurer approves or pays for the health care
services recommended for you, such as determining eligibility or coverage for
benefits, reviewing services provided to you for medical necessity, and
undertaking utilization review activities. For example, obtaining approval for a
surgical procedure might require that your relevant protected health information be
disclosed to obtain approval to perform the procedure at a particular facility.

Health Care Operations

We may use or disclose, as needed, your protected health information to support
our daily activities related to providing health care. These activities include, but are
not limited to, billing, collection, quality assessment activities, investigations,
oversight or staff performance reviews, licensing, communications about a product
or service, and conducting or arranging for other health care related activities.
For example, we may disclose your protected health information to an insurance
company in order to process claims for reimbursement for the services we provide
to you. We may call you by name in the waiting room when your provider is ready
to see you. We may use or disclose your protected health information, as
necessary, to contact you to remind you of your appointment. For example, we
may contact you at your home telephone number to remind you of your next
appointment and/or email or text an appointment reminder.

We will share your protected health information with other persons or entities that
perform various activities (e.g., a transcription service) for our Practice. These
business associates of our practice will also be required to protect your health
information. We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other health-related
benefits and services that might interest you. For example, your name and
address may be used to send you a newsletter about our Practice and the
services we offer. We may also send you information about products or services
that we believe might benefit you.

Required by Law

We may use or disclose your protected health information if law or regulation
requires the use or disclosure.

Public Health

We may disclose your protected health information to a public health authority that
is permitted by law to collect or receive the information. The disclosure may be
necessary to do the following:
• Prevent or control disease, injury, or disability
• Report births and deaths
• Report child abuse or neglect
• Report reactions to medications or problems with products
• Notify a person who may have been exposed to a disease or may be at risk
for contracting or spreading a disease or condition
• Notify the appropriate government authority if we believe a patient has been
the victim of abuse, neglect, or domestic violence

Communicable Diseases

We may disclose your protected health information, if authorized by law, to a
person who might have been exposed to a communicable disease or might
otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight

We may disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections. These
health oversight agencies may include government agencies that oversee the
health care system, government benefit programs, other government regulatory
programs, and civil rights laws.

Food and Drug Administration

We may disclose protected health information to a person or company required by
the Food and Drug Administration to do the following:
• Report adverse events, product defects, or problems and biologic product deviations
• Track products
• Enable product recalls
• Make repairs or replacements
• Conduct post-marketing surveillance as required

Law Enforcement

We may disclose protected health information for law enforcement purposes,
including the following:
• Responses to legal proceedings
• Information requests for identification and location
• Circumstances pertaining to victims of a crime
• Death suspected from criminal conduct
• Crimes occurring on our premises
• Medical emergencies (not on our premises) believed to result from criminal conduct

Coroners, Funeral Directors, and Organ Donations

We may disclose protected health information to coroners or medical examiners
for identification to determine the cause of death or for the performance of other
duties authorized by law. We may also disclose protected health information to
funeral directors as authorized by law. Protected health information may be used
and disclosed for cadaveric organ, eye, or tissue donations.

Research

We may disclose protected health information to researchers when authorized by
law, for example, if their research has been approved by an institutional review
board that has reviewed the research proposal and established protocols to
ensure the privacy of your protected health information.

Criminal Activity

Under applicable federal and state laws, we may disclose your protected health
information if we believe that its 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. We may also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.

Military Activity and National Security

When the appropriate conditions apply, we may use or disclose protected health
information of individuals who are Armed Forces personnel (1) for activities
believed necessary by appropriate military command authorities to ensure the
proper execution of the military mission including determination of fitness for duty;
or (2) to a foreign military authority if you are a member of that foreign military
service. We may also disclose your protected health information to authorized
Federal officials for conducting national security and intelligence activities
including protective services to the President or others.

Workers’ Compensation

We may disclose your protected health information to comply with compensation
laws and other similar legally established programs.

Inmates

We may use or disclose your protected health information if you are an inmate of a
correctional facility, and we created or received your protected health information
while providing care to you. This disclosure would be necessary (1) for the
institution to provide you with health care, (2) for your health and safety or the
health and safety of others, or (3) for the safety and security of the correctional
institution.

Parental Access

State laws concerning minors permit or require certain disclosure of protected
health information to parents, guardians, and persons acting in a similar legal
status. We will act consistently with the laws of this state and will make disclosures
following such laws.

Uses and Disclosures of Protected Health Information Requiring Your Permission

In some circumstances, you have the opportunity to agree or object to the use or
disclosure of all or part of your protected health information. Following are
examples in which your agreement or objection is required.

Individuals Involved in Your Health Care

Unless you object, we may disclose to a member of your family, a relative, a close
friend, or any other person you identify, your protected health information that
directly relates to that person’s involvement in your health care. We may also give
information to someone who helps pay for your care. Additionally, we may 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, of your location, general condition, or death. Finally, we may use or disclose
your protected health information to an authorized public or private entity to assist
in disaster relief efforts and coordinate uses and disclosures to family or other
individuals involved in your health care.

Individual Rights

You may exercise the following rights by submitting a written request to our
Privacy Officer. Our Privacy Officer can guide you in pursuing these options.
Please be aware that our Practice may deny your request; however, you may seek
a review of the denial.

Right to Inspect and Copy

You may inspect and obtain a copy of your protected health information that is
contained in a “designated record set” for as long as we maintain the protected
health information. A designated record set contains medical and billing records
and any other records that our Practice uses for making decisions about you.
This right does not include inspection and copying of the following records:
psychotherapy notes; information compiled in reasonable anticipation of, or use in,
a civil, criminal, or administrative action or proceeding; and protected health
information that is subject to a law that prohibits access to protected health
information.

Right to Request Restrictions

You may ask us not to use or disclose any part of your protected health
information for treatment, payment, or health care operations. Your request must
be made in writing to our Privacy Officer. In your request, you must tell us (1) what
information you want restricted; (2) whether you want to restrict our use or
disclosure, or both; (3) to whom you want the restriction to apply, for example,
disclosures to your spouse; and (4) an expiration date.
If we believe that the restriction is not in the best interest of either party, or that we
cannot reasonably accommodate the request, we are not required to agree to your
request. If the restriction is mutually agreed upon, we will not use or disclose your
protected health information in violation of that restriction, unless it is needed to
provide emergency treatment.

You may revoke a previously agreed upon restriction, at any time, in writing.

Right to Request Confidential Communications

You may request that we communicate with you using alternative means or at an
alternative location. We will not ask you the reason for your request. We will
accommodate reasonable requests, when possible.

Right to Request Amendment

If you believe that the information we have about you is incorrect or incomplete,
you may request an amendment to your protected health information as long as
we maintain this information. While we will accept requests for amendment, we are
not required to agree to the amendment.

Right to an Accounting of Disclosures

You may request that we provide you with an accounting of the disclosures we
have made of your protected health information. This right applies to disclosures
made for purposes other than treatment, payment, or health care operations as
described in this Notice of Privacy Practices. The disclosure must have been
made after January 1, 2008, and no more than six (6) years from the date of
request. This right excludes disclosures made directly to you, to others pursuant to
an authorization from you, to family members or friends involved in your care, or
for notification purposes. The right to receive this information is subject to
additional exceptions, restrictions, and limitations as described earlier in this
Notice.

Right to Obtain a Copy of this Notice

You may obtain a paper copy of this notice from us by requesting one or view it or
download it electronically at our Practice’s website.

Special Protections

This Notice of Privacy Practices is provided to you as a requirement of the Health
Insurance Portability and Accountability Act (HIPAA). There are several other
privacy laws that also apply to HIV-related information, mental health information,
and substance abuse information. These laws have not been superseded and
have been taken into consideration in developing our policies and this notice of
how we will use and disclose your protected health information.

Complaints

If you believe these privacy rights have been violated, you may file a written
complaint with our Privacy Officer or with the Department of Health and Human
Services. No retaliation will occur against you for filing a complaint.

Contact Information
Our Privacy Officer is our Operations Director, and can be contacted at this office
or by calling our telephone number: (714) 879-9936. You may contact our Privacy
Officer for further information about our complaint process, or for further
explanation of this Notice of Privacy Practices. You may also e-mail questions to
rubenc@ascmedcenter.com.