HUGHES CENTER FOR AESTHETIC MEDICINE

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

The Hughes Center for Aesthetic Medicine culture is based on an unwavering belief in integrity and fair dealing we take pride in treating our patients and each other with dignity and respect. Protecting your personal health information is very important to us. We want you to have a clear understanding of how we use and safeguard your protected health information.

This Notice of Privacy Practices describes how Hughes Center for Aesthetic Medicine may use and disclose your protected health information (PHI*) in order to carry out treatment, payment and health care operations and for other purposes permitted or required by law. It also describes your rights to access and control your PHI.

Hughes Center for Aesthetic Medicine is required to abide by the terms of this Notice. However, we may modify the terms of this Notice at any time, and the new notice will be effective for all PHI in our possession at the time of the change, and any received thereafter. Upon request, we will provide you with any revised Notice or you can review the Notice by accessing our website at http://www.drnewyou.com.

USE AND DISCLOSURES OF HEALTH INFORMATION

Hughes Center for Aesthetic Medicine uses PHI about you for treatment, payment and operational purposes. We may also use or disclose your PHI without your authorization for several other reasons. Subject to certain requirements, we may give out health information without your authorization for public health reasons, for auditing purposes, for research studies and for emergencies.

Treatment: Hughes Center for Aesthetic Medicine may use and disclose your PHI to assist your health care providers in your diagnosis and treatment. For example, we may disclose your PHI to providers to provide information about alternative treatments.

Payment: Hughes Center for Aesthetic Medicine may use and disclose your PHI in order to collect payment for the services and items you may receive. For example, we may contact your health insurance carrier to certify that you are eligible for treatment (and for what range of benefits), and we may disclose details regarding your treatment to determine if your benefits will cover, or pay for, your treatment. We may also disclose your PHI to obtain payment from your third party insurance carriers that may be responsible for such costs.

Health Care Operations: Hughes Center for Aesthetic Medicine may use and disclose your PHI to perform health care operations. For example, we may use your PHI for scheduling surgeries, processing laboratory test with whom we contracted within HIPAA compliant regulations.

In addition to the above mentioned uses of your PHI related to treatment, payment and health care operations, Hughes Center for Aesthetic Medicine may also use your PHI for the following purposes:

Appointment Reminders: The Hughes Center for Aesthetic Medicine reserves the right to use and disclose your PHI to contact you and remind you of your appointments.

Health Related Benefits and Services: The Hughes Center for Aesthetic Medicine may use and disclose PHI to inform you of health related benefits or services that may be of interest to you.

Release of Information to Family and Friends: The Hughes Center for Aesthetic Medicine may release your PHI to a friend or family member identified by you, that is helping you pay for your health care, or who assists in taking care of you.

Disclosure Required by Law: The Hughes Center for Aesthetic Medicine will use and disclose your PHI when we are required to do so by federal, state, or local law.

In addition to the above described uses and disclosures of your PHI, the Hughes Center for Aesthetic Medicine may also use and disclose your PHI under the following unique circumstances.

Public Health Risk: The Hughes Center for Aesthetic Medicine may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

• Maintaining vital records, such as births and deaths;
• Reporting child abuse or neglect;
• Preventing or controlling disease, injury or disability:
• Notifying a person regarding potential exposure to a communicable disease:
• Notifying a person regarding the potential risk for spreading or contracting a disease or condition:
• Reporting reactions to drugs or problems with products or devices:
• Notifying individuals if a product or device the may be using has been recalled:
• Notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult patient (including domestic violence): however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; and
• Notifying your employer under limited circumstance related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities: The Hughes Center for Aesthetic Medicine may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings: The Hughes Center for Aesthetic Medicine may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involve in the dispute, but only if we have made and effort to inform you of the request or to obtain an order protecting the information the party requested.

Law Enforcement: The Hughes Center for Aesthetic Medicine may release PHI if asked to do so by a law enforcement official:

• Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement;
• Concerning a death we believe might have resulted from criminal conduct;
• Regarding criminal conduct at our office:
• In response to a warrant, summons court order, subpoena or similar legal process;
• To identify and/or locate a suspect, material witness, fugitive or missing person; and
• In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

Serious Threats to Health or Safety: The Hughes Center for Aesthetic Medicine may use or disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety or the health and safety of another individual or the public. Under these circumstances, we only make disclosures to a person or organization able to help prevent the threat.

Military: The Hughes Center for Aesthetic Medicine may use and disclose your PHI if you are a member of United States or foreign military forces (including veterans) and if required by the appropriate military command authorities.

National Security: The Hughes Center for Aesthetic Medicine may use and disclose your PHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your PHI to federal official in order to protect the President, other officials or foreign heads of state, or to conduct investigation.

Inmates: The Hughes Center for Aesthetic Medicine may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosures for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/ or (c) to protect your health and safety or the health and safety of other individuals.

Workers’ Compensation: The Hughes Center for Aesthetic Medicine may release your PHI for workers’ compensation and similar programs.

Automobile Related Claims: The Hughes Center for Aesthetic Medicine may release your PHI for automobile related claims and similar programs.

YOUR RIGHTS

The Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI that we maintain and have in our possession, including medical records and billing records. If you request copies, we will charge you a fee for the costs of copying, mailing, labor and supplies associated with your request. To inspect and copy you PHI, you must submit your request in writing or obtain a request form from our Privacy Official.

Under certain circumstance we may deny your request to inspect and copy your PHI. If you are denied access to medical information, you have a right to have a determination reviewed. A licensed health care professional chosen by Hughes Center for Aesthetic Medicine will review you request and the denial. The person conducting the review will not be the person who denied your request. The Hughes Center for Aesthetic Medicine promises to comply with the outcome of the review.

The Review to Amend Your PHI: If you feel that any PHI we have about you is not correct or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by Hughes Center for Aesthetic Medicine. To request an amendment, your request must be in writing. Additionally, you must provide a reason that supports your request. You can obtain an Amendment Request Form from our Privacy Official.

The Hughes Center for Aesthetic Medicine reserves the right to deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by Hughes Center for Aesthetic Medicine, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for Hughes Center for Aesthetic Medicine;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

The Right to an Accounting of Disclosures: An accounting of disclosures is a list of the disclosures we have made, if any of your PHI.

You have the right to request and accounting of disclosures. This right applies to disclosures for purposes other than those made to carry out treatment, payment and health care operations as described in this notice. It excludes disclosures made to you, or those made for notification purposes.

Your request must be made in writing and state a time period that cannot be longer than six years and cannot include any dates before April 13, 2003. Your request should indicate in what form you want the list (e.g. paper, electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. You can obtain an Accounting of Disclosure request form from our Privacy Official.

The Right to Receive Communication of PHI by Alternative Means or at Alternative Locations: You have the right to request that Hughes Center for Aesthetic Medicine communicate with you or about your health and related issues in a particular manner or at a certain location. For example, you may ask that we contact you at work rather than at home. We will accommodate all reasonable requests made in writing. Your request to receive PHI by alternative means or at an alternative location must clearly state that you life could be endangered by the disclosure of all or part of you PHI.

The Right to Request Restriction: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations as described in this notice. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for you care (like a family member or friend), or for notification purposes as described in this notice.

The Hughes Center for Aesthetic Medicine is not required to agree to your request, however, if we do agree, we will comply with your request until we receive notice from you that you no longer want the restriction to apply (except as required by law or in emergency situation).

Any Request for a restriction on our use and disclosure of you PHI must be made in writing. Your request must describe in a clear and concise manner: (a) the information you wish restricted; (b) whether you are requesting to limit Hughes Center for Aesthetic Medicine’s use, disclosure or both; and (c) to whom you want the limits to apply. You can obtain a request form from our Privacy Official.

The Right to Provide an Authorization for Other Uses and Disclosures: The Hughes Center for Aesthetic Medicine will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose you PHI for the purpose described in the authorization, except under the following circumstances:

• We have taken action in reliance upon your authorization before we received your writer revocation.
• You were required to give us your authorization as a condition of obtaining coverage; or
• If state law gives us the right to contest a claim under your policy.

The Right to Obtain a Paper Copy of This Notice: Upon request, you have a right to a paper copy of this notice, even if you have agreed to accept this notice electronically.

How to Contact Us:

If you have any complaints or questions about this Notice or you want to submit a written request to Hughes Center for Aesthetic Medicine as required in any of the previous sections of this Notice, please call (856) 751-4554 or write to us at the address below:

Attention: Kristina Place-Privacy Officer

Address:
Hughes Center for Aesthetic Medicine

1765 South Springdale Road, Suite B-2

Cherry Hill, NJ 08003

*PHI is individually identifiable information (including demographic information) relating to your health, to the health care provided to you or to payment for health care.