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.

In accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have a right to adequate notice of the uses and disclosures of your protected health information (“PHI”) (i.e., information that discloses your identity or leads to disclosure of your identity) that may be made by this medical practice.  You will be provided a notice of your rights and responsibilities and the duties of this practice with respect to your PHI.

We respect your right to privacy and understand that your medical information is personal to you.  In order to provide medical services to you, we create paper records about your health and the care we provide.  Your PHI is confidential and this notice is intended to help you understand how our practice uses and discloses your PHI and what rights you have in regards to your medical information.  It is essential to note that only PHI which is pertinent to the entity will be disclosed; i.e., if a physician’s office is requesting current lab results, we would provide the individual with only the requested information.

PV Peninsula Plastic Surgery Center has the following duties with respect to your PHI:

  1. We are required by law to maintain the privacy of your PHI
  2. We must provide you with notice of our legal duties and privacy practices with respect to PHI.
  3. We must abide by the terms of the notice of privacy practices that is currently in effect.

How We May Use and Disclose Your Information
The following describes how our practice is permitted by law to share your PHI with others in order to provide you with medical care.  This notice does not describe every use or disclosure our practice makes; it is intended as a general summary.

Medical Treatment.  We may need to share information about you in order to provide medical care to you.  For example, we may share information with other physicians, nurses or healthcare professionals entering information into your medical care and treatment.  We may share information about you including, but not limited to x-rays, prescriptions and requests for lab results.

Payment.  We may need to disclose information about the treatment, procedures or care our practice provided to you in order to bill and receive payment for services rendered.  We may share this information with you, an insurance company or any third party responsible for payment.  We may also need to disclose PHI about you with your health plan and/or referring physician in order to obtain prior authorization for treatment, to determine whether payment for the treatment is covered by your plan or to facilitate payment of a referring physician.

Required by Law.  We will disclose medical information related to you if required to do so by state, federal or local law.

Public Health Activities/Risks.  Your medical information may be disclosed to a public health authority that is authorized by law to collect or receive such information for public health activities.  Certain disclosures may be made for public health activities in the following circumstances.

  1. To prevent or control disease, injury or disability
  2. To report of births or deaths
  3. To report child abuse or neglect
  4. To report elder abuse or neglect
  5. To report reactions to medications or product defects
  6. To notify individuals of product recalls
  7. To notify a person who may have been exposed to a communicable disease or at risk of contracting or spreading a disease
  8. If our practice reasonably believes a person is the victim of abuse, neglect, or domestic violence, we may disclose PHI to the appropriate authority.  We will only make this disclosure if you agree to the disclosure or we are required or authorized to do so by law without your permission.

Appointment Reminders.  Our practice may use and disclose medical information about you to provide you with reminders that you have an upcoming appointment.  You have the right to select which method of communication you prefer; i.e., phone, text, e-mail, fax.  We will make every effort to protect your privacy when leaving a message for you and will reveal as little confidential information as possible.

To Avert Serious Threat to Health or Safety.  If our practice believes, in good faith, that a use or disclosure of your medical information is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, we may disclose your medical information.

Worker’s Compensation.  We may release medical information about you for work-related illness or injury for workers compensation or other related programs.

Health Oversight Activities.  Your PHI may be disclosed to federal, state or local authorities as part of an investigation or government activity authorized by law.  This may include audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions or other activities necessary for the oversight of the health care system, government benefit programs and compliance with government regulatory programs or civil rights laws.

Law Enforcement.  We may need to disclose your PHI to law enforcement agencies if we are required to comply by law.  We may also disclose medical information about you in compliance with a court order, warrant or subpoena or summons issued by the court.  We will make every effort to contact you about these types of requests so that you can obtain an order restricting or prohibiting disclosure of the requested information.  We may also use such information to defend ourselves in actions or threatened actions that may be brought against our practice.   We may use or release your PHI if you are an inmate of a correctional facility and your physician created or received your PHI in the course of providing care to you.

Medical Examiners, Coroners, Tissue Donation.  We may release PHI to the aforementioned individuals for the purposes of identification, determining cause of death or other duties as authorized by law.  We may also release medical information to funeral directors as necessary to carry out their duties with respect to the deceased.  We may also disclose PHI to organ procurement organizations, or other entities that facilitate tissue donation or transplantation.

About this notice.
We may change the terms of our notice at any time.  The new notice will be effective for all PHI that we maintain at that time.  You can receive a copy of any revised Notice of Privacy Practices by calling our office at (310) 326-3636 and request that a revised copy be sent to you in the mail, or by requesting the revised policy at the time of your next appointment.
Other uses and disclosures will be made only with your written authorization and you are entitled to revoke your authorization at any time.