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.

This notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It will provide you with information on how we may use or disclose your protected health information (PHI) to carry out treatment, payment, or healthcare operations and for other purposes permitted or required by law. This notice also describes your rights to access and amend your protected health information. "Protected health information" is information about you, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

For Treatment: We may use your health information to provide you with medical treatment or services. We may disclose information about you to other doctors, nurses, home health care, labs, surgery scheduling office at the hospital or surgicenter, company representatives related to their involvement in providing appropriate implant choices, and other offices' staff or personnel involved in taking care of your health needs.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This office may bill and collect payment from you, your insurance company or other third party involved in payment services for your visit to our office or surgical procedures. This may include certain activities your insurance company requires such as pre-certification and enrollment and coverage verification. For example, we may disclose information to your health plan to get approval for a procedure or surgery that we have scheduled for you.

Healthcare Operations: We may use or disclose, if needed, your protected health information in order to support our business activities for this practice. These activities include, but are not limited to, quality assessment activities, employee evaluation activities, licensing requirement, or review information to determine the need for additional services to be offered. We may also share your information with "business associates" who perform various activities such as billing assistance or transcription services.

Telephone Reminders: We may contact you to remind you of an appointment, to tell you your surgery time or the need to have you contact us.

Website: We may maintain a website related to our services that provide valuable information for patients, families, or potential patients. No patient identifiable information will be accessible through this site without your written authorization.

Health Related Products and Services: We may tell you about health-related products or services that may be of interest to you. We may send out newsletters with information related to an area of interest to you. Please notify us if you do not wish to be contacted about appointments or scheduling reminders, or if you do not wish to receive communications about health related products, services or newsletters. If you advise us in writing that you do not wish to receive such communications, we will not use or disclose your information for these purposes.

OTHER PERMITTED USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke an authorization, at any time, in writing, except to the extent that your physician or the practice has taken action in reliance on the use or disclosure indicated in the authorization.

OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT

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 PHI for public health activities and purposes to a public health authority that is permitted to collect or receive information by law. The purpose of the disclosure will be for the purpose of controlling disease, injury or disability. We may disclose information related to suspected abuse or neglect, reactions to medications or problems with products. For example, the FDA, Center for Disease Control and Department of Health.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Agencies seeking this information include government benefits programs such as Medicare/Medicaid and other government regulatory programs.

To Avert Serious Threat to Health or Safety: We may use or disclose health information about you if necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military, Veterans, National Security and Intelligence: If you are a member of the armed forces, or were a member, or part of the national security or intelligence services, we may be required by military command or other government authorities to release health information about you.

Worker's Compensation: We may release health information about you for worker's compensation or similar programs.

Law Enforcement: We may also disclose protected health information, if applicable legal requirements are met, for law enforcement purposes. They may include legal proceedings, limited information for identification and location purposes, pertaining to victims of a crime, suspicion of death related to criminal conduct, or if a crime is committed on our premises. We may disclose information about you in response to a court or administrative order, subpoena, warrant, summons, or other applicable processes.

Coroners, Funeral Directors, Organ Procurement: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death, or to perform other duties authorized by law. We may also provide information to a funeral director, as authorized by law, to carry out their duties.

Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your health information in the course of providing treatment to you.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of 45 CFR (HIPAA).

OTHER PERMITTED USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT

We may use or disclose your protected health information in some instances where you have the opportunity to agree or object. If you are not present or able to agree or object to the use or disclosure, we may, using our professional judgment, determine whether the disclosure is in your best interest. If this is the case, only the PHI that is relevant to your health care will be disclosed.

Others Involved in Your Care: Unless you object, we may disclose information to a member of your family, a relative, close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your care. We may use our professional judgment, if you are unable to agree or object, in releasing PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location or general condition.

Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens we will try to obtain your authorization as soon as reasonably possible after the delivery of your care. If we attempt and are unable to get your authorization we will use or disclose your PHI in order to treat you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

The following is a summary of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

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 information. A designated record set contains medical and billing records that this practice uses for making decisions about your care.

Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access. Depending upon the circumstances, our decision to deny access may be Reviewable. Please contact our Privacy Contact if you have questions about access to your designated record set (medical record).

Right to Request Restriction of Protected Health Information

You may request that we not use or disclose any part of your PHI for treatment, payment, or healthcare operations. Your request must be made in writing (you may ask for our pre-printed form) to our Privacy Officer. You may also request we not disclose all or part of your PHI to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply.

We are not required to agree to a restriction that you request. If we believe it is in your best interest to permit use or disclosure of your PHI, your information will not be restricted. If we do agree, we may not use or disclose that information in violation of the restriction unless we need to do so to provide emergency care. Please discuss any restrictions you may have with us.

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 the request. We will accommodate all reasonable requests, if possible

.

Right to Request an Amendment

If you believe 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 the information. While we will accept a request for amendment, we are not required to agree to the amendment. If we deny the request, you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of this rebuttal. Please contact our Privacy Contact if you have questions regarding amending your record.

Right to an Accounting of Disclosures

You may request that we provide you an accounting of disclosures made regarding your protected health information. The right applies to disclosures for purposes other than treatment, payment, and healthcare operations as described in this notice. It does not include disclosures made to you, your family or friends involved in your care, or for notification purposes. This right involves disclosures that occur after April 14, 2003. The right to receive this accounting is subject to certain exceptions, restrictions, and limitations.

Right to Obtain Copy of This Notice

You may obtain a paper copy of this notice at our office. You will be asked to sign an acknowledgment of receipt of the notice. We want to make you aware of the possible uses and disclosures of PHI. The delivery of healthcare will in no way be conditioned on your signed acknowledgment.

CHANGES TO THIS NOTICE

We reserve the right to change this notice, and to make the revised notice effective for medical information we already have about you as well as any information we receive in the future. We will post our current notice in the office with its effective date in the top left hand corner.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services.

To file a complaint with our office, please contact our Privacy Contact at 732-683-1033 who is responsible for handling complaints. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with the Department of Health and Human Services:

Region II, Office for Civil Rights
U.S. Dept. of Health & Human Services
Jacob Javits Federal Bldg.
26 Federal Plaza, Suite 3312
New York, NY 10278
PH: 212-264-3313
FAX: 212-264-3039
TDD: 212-264-2355


Contact Plastic Surgery Plus for your private consultation.
55 Schanck Road, Suite A4   Freehold, NJ 07728
Voice: (732) 683-1033    Fax: (732) 683-2477

Why choose a board certified plastic surgeon?
Meet Dr. Bhattacharya

Good credentials can't guarantee a successful breast lift, tummy tuck or body contouring after weight loss; however, they can significantly increase the likelihood.

Choose a plastic surgeon certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties to certify in plastic surgery of the face and of the entire body.

Certification by the ABPS is "the gold standard" for plastic surgeons because it signifies that your surgeon has had formal training in an accredited plastic surgery residency program. You can rest assured that he or she has completed at least five years of surgical residency training after medical school, including at least two years in plastic surgery, has passed comprehensive cosmetic and reconstructive surgery exams and is qualified to perform cosmetic and reconstructive procedures - everything from liposuction and facelifts to intricate wound repair.


Jon Ric International Medical Salon | Freehold, New Jersey
A.K. Bhattacharya, MD, FACS
Board Certified Plastic Surgeon & Medical Director