Clymer Facial Plastic Surgery

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. These are regulatory requirements and guidelines so the information may nor may not be applicable to your care by Clymer Facial Plastic Surgery.

Patient Health Information

Under federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your health information also includes payment, billing, and insurance information.

How We Use Your Patient Health Information (PHI)

We use health information about you for treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances, we may be required to use or disclose the information even without your permission.

Examples of Treatment, Payment, and Health Care Operations

Treatment: We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.

Payment: We will use and disclose your health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment. We will submit bills and maintain records of payments from your health plan.

Health Care Operations: We will use and disclose your health information to conduct our standard internal information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it.

Special Uses

We may use your information to contact you with appointment reminders. We may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. You have the right to determine your preferred method of contact including phone, mail, or email. You are entitled to change your preference at any time. If your preferred method should be email, be advised you are giving your consent to communicate with unencrypted emails.

Other Uses and Disclosures

We may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, we are permitted to give out health information without your permission for the following purposes:
* Required by Law: We may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
* Public Health Activities: As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
* Health oversight: We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
* Judicial and administrative proceedings: We may disclose information in response to an appropriate subpoena or court order.
* Law enforcement purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials.
* Serious threat to health or safety: We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
* Workers Compensation: We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.
In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

Individual Rights

You have the following rights with regard to your health information. Please contact the person listed below to obtain the appropriate form for exercising these rights.

Request Restrictions: You may request restrictions on certain uses and disclosures of your health information, including requesting that a health plan not be informed of treatment for which you paid entirely out of pocket. We are not required to agree to such restrictions, but if we do agree, we must abide by those restrictions.

Confidential Communications: You may ask us to communicate with you confidentially by, for example, sending notices to a special address or not using postcards to remind you of appointments.

Inspect and Obtain Copies: In most cases you have the right to look at or get a copy of your health information. There may be a small charge for the copies. We will respond to your request within 30 days and may take one 30-day extension.

Amend Information: If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

Accounting of Disclosures: You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or health care operations.

Sale of PHI: You may prohibit the sale of your health information, its use for marketing purposes, or participation in research.

Breach of Unsecured PHI: This practice is required by law to notify you following a breach of any unsecured PHI.

Our Legal Duty

We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.

Minimum Necessary Standard

When using or disclosing your health information or when requesting health information from another covered entity, we will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. However, the minimum necessary standard will not apply in the following situations:
disclosures to or requests by a health care provider for treatment;
uses or disclosures made to the individual;
disclosures made to the Secretary of the U.S. Department of Health and Human Services;
uses or disclosed that are required by law; and,
uses or disclosures that are required for us to remain compliant with legal regulations.
Changes in Privacy Practices

We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.

Complaints

If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Healthy and Human Services.

Contact Person

If you have any questions, requests, or complaints, please contact:
Annie Vogel Practice Administrator, 1800 Mallory Ln. Ste A3, Brentwood, TN 37027
(615)307-6041

Effective Date: The effective date of this Notice is April 14, 2003