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.

As an essential part of our commitment to you, The Aesthetic Center for Plastic Surgery, LLP and ACPS- The Surgicentre, Dr. Patronella, Dr. Mentz, Dr. Newall, Dr. Bailey, and Dr. Fortes (collectively known as the "Center") maintain the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. Your PHI is information about you or information that could be used to identify you, as it relates to your past and present physical and mental health. As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, the Center is required by law to protect your health care information and to provide you with this Notice of Privacy Practices.

This Notice outlines the Center's legal duties and privacy practices with respect to your PHI, as well as your rights with respect to your PHI.

The Center is required to abide by the terms of the version of the Notice currently in effect. In most situations the Center may use this information as described in this Notice without your permission or authorization, but there are some situations where the Center may use it only after we obtain your written authorization for use or disclosure.

This Notice of Privacy Practices will be posted at our offices and be given to you upon your first meeting with us. This Notice will also be posted on our website at www.mybeautifulbody.com. The Center reserves the right to change its privacy practices and this Notice of Privacy Practices. Revisions to this Notice will be posted on our website and will be provided to you at our offices when revisions are made.

We respect your privacy and treat all health care information about our patients with care under strict policies of confidentiality that we are committed to following at all times.

The following are the ways the Center may use and disclose your PHI with examples of each use:

For Treatment: This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided by us and other medical professionals. For example, we may disclose your PHI to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care.

For Payment: This includes any activities we undertake in order to receive payment for the services we provide to you, including submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.

For our Administration and Health Care Operations: This includes activities necessary for our continuing operation such as quality assurance, licensing, and training programs to ensure that our personnel meet our standards of care, following established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints. We may also create reports that do not individually identify you for data collection purposes.

For Appointment Reminders, Treatment Alternatives, and Health Related Benefits and Services: This includes use and disclosure of your PHI to contact you and remind you that you have an appointment with us. We may also tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

As Required by Law: The Center is required to use or disclose your PHI as required and limited by law. We will also follow any applicable state law that is more stringent than the HIPAA Privacy Rules.

To a Family Member, Friend, or Other Person Involved in Your Health Care: This includes the use and disclosure of your PHI to family members or close friends if we obtain your agreement to do so, or if given an opportunity to object, you do not. We may also disclose your PHI to family or friends if we can infer from the circumstances, based on our professional judgment that you would not object. For example, we may assume you agree to disclosure when you allow a family member in the examination room for discussion, evaluation, or treatment.

For Public Health Activities: We may use and disclose your PHI for public health activities. These activities usually include disclosures for the purpose of preventing or controlling disease, injury, or disability and reporting instances of disease, injury and vital statistics such as birth or death. Other public health disclosures could be made for the purposes of reporting communicable or sexually transmitted diseases, reporting reactions to medication or problems with products, and notifying people of recalls of products they may be using.

To Report a Suspected Case of Abuse, Neglect, or Domestic Violence: This includes the use or disclosure of your PHI to a government authority, including a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

For Health Oversight Activities: This includes the use or disclosure of your PHI to a health oversight agency for oversight activities authorized by law, including audits; civil or criminal investigations; inspections, licensure or disciplinary actions.

For Legal and Administrative Proceedings: This includes the use and disclosure of your PHI to respond to a court order, a subpoena, discovery request, or other lawful process, provided that proper documentation is presented to us.

For Law Enforcement Purposes: This includes the release your PHI at the request of law enforcement officials for the purpose of: reporting certain types of wounds or physical injuries; responding to a court-ordered warrant, subpoena, or a grand jury subpoena; identifying or locating a suspect, fugitive, material witness, or missing person; reporting persons suspected to be victims of crime; and reporting crime in emergency situations.

To Coroners, Medical Examiners, and Funeral Directors: This includes PHI used or disclosed to a coroner or medical examiner for the purpose of identifying a deceased person or determining cause of death, or to funeral directors as necessary to carry out their duties with respect to the decedent.

For Organ, Eye, or Tissue Donation: If you are an organ donor, we may use or disclose your PHI to organizations that handle organ procurement or other entities engaged in procurement such as banking or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation and transplantation.

To Avert a Serious Threat to Health or Safety: This includes the use and disclosure of your PHI, if we believe in good faith, and is consistent with any applicable law and standards of ethical conduct, to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Disclosures will only be made to someone who may be able to help prevent the threat.

For Specialized Government Functions: This includes the use and disclosure of your PHI if you are military personnel or foreign military personnel. Other use and disclosure may be for national security and intelligence activities, protective services, correctional institutions, and law enforcement custodial situations.

For Workers' Compensation: This includes disclosure of your PHI as authorized by and to the extent necessary to comply with law relating to workers' compensation or other similar programs that provide benefits for work-related injuries without regard to fault.

For Disaster Relief Purposes: This includes the use or disclosure of your PHI to a public or private entity authorized by law to assist in disaster relief efforts.

As a patient, you have a number of rights with respect to the protection of your PHI, including:

The right to request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of our uses and disclosures of your PHI. However, we are not required to accommodate your request. If you wish to request additional restrictions, please contact our Privacy Officer. All restriction requests must be made in writing.

The right to receive confidential communications of PHI: You have the right to request that we communicate confidentially with you using an address or phone number other than your residence. If you wish to request a change in your communicating address and/or phone number, please contact our Privacy Officer. All requests for confidential communication must be made in writing. We are not required to accommodate any request made, however we will accommodate any reasonable request for confidential communication.

The right to access, copy, or inspect your PHI: You have the right to come to our offices and inspect and copy most of the PHI about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for you to copy any PHI that you have the right to access. In limited circumstances, we may deny you access to your PHI, and you may appeal certain types of denials. If you wish to inspect and copy your PHI, please contact our Privacy Officer. All access requests must be made in writing.

The right to amend your PHI: You have the right to ask us to amend written PHI that we may have about you. We will generally amend your PHI within 60 days of your request. We are permitted by law to deny your request to amend your PHI only in certain circumstances, like when we believe the information you have asked us to amend is correct. If you wish to amend your PHI, please contact our Privacy Officer. All amendment requests must be made in writing, and you must provide us documentation to support your request.

The right to receive an accounting of disclosures of PHI: You have the right to request an accounting of certain disclosures of your PHI we have made starting April 14, 2003. We will retain all disclosure records for six years from that date. We are not required to give you an accounting of information we have used or disclosed for purposes of treatment, payment or health care operations, or when we share your health information with our business associates. If you wish to request an accounting of disclosures, please contact our Privacy Officer. All requests for an accounting of disclosures must be in writing.

The right to receive additional copies of the Center's Notice of Privacy Practices: A copy of this Notice of Privacy Practices is posted on our website and will be given to you upon your first visit with us. You do have the right to receive this Notice in paper form. If you would like any additional copies this Notice sent to you in paper form, please request this from our Privacy Officer.

The right to file a Complaint: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services ("HHS") if you believe your privacy rights have been violated. To file a complaint directly to HHS, please contact: The U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. Should you wish to complain to the Center, please contact our Privacy Officer. All complaints must be made in writing. You will not be retaliated against in any way for filing a complaint with us or to the government.

The Center reserves the right to change and/or revise this Notice of Privacy Practices. The revised Notice will be available to all individuals. It will be posted on our website and be given to you upon your visit with us. Please check our website for revised Notices or contact our Privacy Officer.

Karen Husmann, Privacy Officer
The Aesthetic Center for Plastic Surgery
12727 Kimberley- Suite 300
Houston, TX 77024
Phone: 713-799-9999