HIPAA Notice of Privacy Practices

Peak Plastic Surgery Center is required by law to maintain the privacy of your protected health information ("PHI"), to provide you with this notice of our legal duties and privacy practices with respect to your PHI, and to notify you following a breach of unsecured PHI. We are required to abide by the terms of this notice currently in effect. PHI is information that may identify you and that relates to your past, present, or future physical or mental health, the health care you receive, or payment for that care.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your PHI without your written authorization:

• Treatment. We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. This includes sharing information with physicians, nurses, technicians, and other providers involved in your care, and with providers to whom we refer you.
• Payment. We may use and disclose your PHI to obtain payment for the services we provide. This may include billing you or your insurer, verifying coverage, obtaining prior authorization, and collecting outstanding balances.
• Health care operations. We may use and disclose your PHI for our operations, such as quality assessment and improvement, staff training and evaluation, licensing, accreditation, care coordination, and general administrative activities.

Other Permitted or Required Disclosures

We may also use or disclose your PHI without your authorization in the following circumstances, subject to applicable law:

• Appointment reminders, treatment alternatives, and health-related benefits or services;
• To individuals involved in your care or payment for your care, when permitted;
• As required by federal, state, or local law;
• For public health activities, such as reporting disease, injury, or adverse events;
• To report suspected abuse, neglect, or domestic violence;
• For health oversight activities such as audits and investigations;
• In response to a court order, subpoena, or other lawful process, and for law enforcement purposes;
• To coroners, medical examiners, and funeral directors;
• For organ and tissue donation, research under approved protocols, and to avert a serious threat to health or safety;
• For specialized government functions and for workers' compensation as authorized by law.

Other uses and disclosures not described in this notice will be made only with your written authorization. Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and disclosures that constitute a sale of PHI require your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

• Right to access. You may inspect and obtain a copy of the PHI we maintain about you in a designated record set, including an electronic copy where readily producible. We may charge a reasonable, cost-based fee.
• Right to amend. You may request that we amend PHI you believe is incorrect or incomplete. We may deny your request in certain circumstances and will provide a written explanation.
• Right to an accounting of disclosures. You may request a list of certain disclosures of your PHI made by us, other than those for treatment, payment, health care operations, and certain other exceptions.
• Right to request restrictions. You may request a restriction on how we use or disclose your PHI. We are not required to agree, except that we will honor a request to restrict disclosure to a health plan for a service you paid for in full out of pocket.
• Right to confidential communications. You may request that we communicate with you by alternative means or at an alternative location, and we will accommodate reasonable requests.
• Right to a paper copy. You may obtain a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Right to notification of a breach. You have the right to be notified if there is a breach of your unsecured PHI.

To exercise any of these rights, please submit your request in writing to the Privacy Officer at the address below.

Our Duties

We are required by law to maintain the privacy of your PHI, provide this notice of our legal duties and privacy practices, abide by the terms of the notice currently in effect, and notify you if a breach of your unsecured PHI occurs. We reserve the right to change this notice and to make the revised notice effective for PHI we already have as well as any information we receive in the future. If we make a material change, we will post the revised notice in our office and on this website and make it available upon request.

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer using the information below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Privacy Officer Contact

For questions about this notice, to exercise your rights, or to file a complaint with the practice, please contact: