NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES Effect Date of this Notice: April 10, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

UNDERSTANDING YOUR HEALTH RECORD INFORMATION
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a basis for planning your care and treatment and serves as a means of communication among the many healthcare professionals who contribute to your care. Understanding what is in your medical record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.

We, at William E. LoVerme, M.D., dba/Accurate Aesthetics Plastic Surgery, pledge to provide you with the highest quality of care and to build a relationship that is based on trust, This trust includes our commitment to respect the privacy and confidentiality of your health information.

This Notice of our Privacy Practices is being given to you because federal law gives you the right to be told ahead of time about:

1. How William E. LoVerme, M.D. will handle your medical information
2. What our legal duties are related to your medical information
3. What your rights are with regard to your medical information
4. A method for filing complaints about our privacy practices

1.   HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
When you need health care, you give information about yourself and your health to doctors, nurses, and other health care workers and staff. This information, along with the record of care you receive, is “protected health information” (or “health information). This information is kept in a paper form such as your medical record and in an electronic form on the computer.

(A)   William E. LoVerme, M.D. uses and discloses (shares) health information for many different reasons. For some of these uses and disclosures, we will need to obtain prior written authorization (permission). However,
William E. LoVerme, M.D. may legally use or disclose your health information for treatment, payment, and health care operations. We do not need to receive prior authorization for uses and disclosures described within the following categories:

For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories:

For treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose (share) medical information about you to other doctors, and health care providers involved in your care. Example: A primary care physician may refer you to a specialist such as a radiologist or a surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the doctors in this example will share medical information about you. This is to coordinate care before, during and after you go into the hospital.

For payment. We may use and disclose (share) your health information in order to bill and collect payment for the treatment and services provided you. Example: A bill may be sent to you or a third party payer. If you have health insurance, information on or accompanying the bill may include a portion of your health information that identifies you, as well as, your diagnosis, procedures and supplies used for treatment. The insurance company uses the information to tell if you are eligible for benefits or if the services you received were medically needed for payment purposes. We may also provide your health information to our business associates, such as a billing company, claims processing companies and, others that process our health care claims.

For health care operations. We may disclose (share) your health information for activities that are known as health care operations. These activities use health care information for the purpose of evaluating our performance and finding better ways to provide care. We may use your health information in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also share your health information with outside parties (“business associates”) who perform services on behalf of William E. LoVerme, M.D. These business associates must agree to keep your health information private. Examples of activities that make up health care operations include; legal counsel, transcription, storage, auditing, and consulting services.

(B)    Other uses of your health information.
William E. LoVerme, M.D. may use your health information to contact you about;
scheduled appointments, registration/insurance updates, pre-procedure assessments or test results; with information about patient care issues and treatment choices; with other health-related benefits and services that may be of interest to you.

(C)    We may disclose (share) your health information to others without your consent in certain situations. Example: If you need emergency treatment, or if you are unable to communicate with us (unconscious or in severe pain). In each of these situations we will try to get your consent. But, if you are unable to agree or disagree to consent and if we think you would consent if your were able to do so, we will disclose health information without consent.

(D)    Other Specific Uses and Disclosures that DO NOT REQUIRE YOUR CONSENT.

(a)    When disclosure of health information is required by federal, state, or local law, administrative or legal proceedings, health oversight activities, or by law enforcement. Examples of some required reporting include; health information about victims of abuse, neglect, or domestic violence: patients with gunshot and or other wounds. In addition we disclose health information when ordered in a legal or administrative proceeding.

(b)    For public health activities. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Example, we report information about births, deaths, and various diseases to the government officials in charge of collecting that data consistent with applicable law to carry out their duties.

(c)    For business associates. There are some services provided in our practice through contracts with business associates. Examples include (lab,.home health care, etc). When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have requested them to do and, bill you or a third party payer for services rendered.

(d)    For purpose of organ donation. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in procuring, banking, or transplantation of organs, eye or tissue donation and transplants.

(e)    For research purposes. In certain circumstances this practice may provide health information in order to conduct or participate in medical research. Your health information will only be used/or disclosed to researchers when their research has been approved by an Institutional Review Board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. An example of this research would be to assess the outcomes of patients who had received specific therapy treatments.

(f)    To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide health information to law enforcement personnel or persons able to prevent or lessen such harm.

(g)    For specific government functions. We may disclose health information of military personnel and veterans in certain situations. And we may disclose health information for national security purposes, such as protecting the president of the United States or conducting intelligence operations.

(h)    For worker’s compensation purposes. We may provide health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs.

(i)    Appointment reminders and health related-benefits or services. We may use health information to provide appointment reminders or give you information about, treatment alternatives, or other health care services or benefits we offer.

(E)    The Use and Disclosure Requiring You to Have the Opportunity to Object. Disclosure to family, friends or others.
William E. LoVerme, M.D. using its best judgement, may disclose health information to a family member, friend, or other person that you indicate, unless you object in whole or in part, health information relevant to that person’s involvement in your care or payment related to your care. The opportunity to get your authorization may be obtained retroactively in emergency situations.

(F)    All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections 1 (A) through (E), we will ask for your written authorization before using or disclosing any of your health information.

2.    OUR LEGAL DUTIES TO PROTECT YOUR HEALTH INFORMATION
William E. LoVerme, M.D. is required by law to;
Make sure that medical information that identifies you is kept private; provide you with this notice that explains our privacy practices and how, when, and why we use and/or disclose (share) your health information; follow the terms of the Notice currently in effect. However, we reserve the right to change our privacy policies and the terms of this notice at any time. Any changes will apply to the health information we already have. Before any important policy change goes into effect, we will change this Notice; the new Notice will be posted on our web site and in a clearly visible location within our practice site(s) for public viewing. You may request a copy of this notice at any time from
William E. LoVerme, M.D.

3.    YOUR HEALTH INFORMATION RIGHTS:
Unless otherwise required by law your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

(A)   Request Limits on Uses and Disclosures of Your Health Information: You have the right to ask for restrictions on the use and disclosure (sharing) of your health information for treatment, payment or health care operations. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that are legally required or allowed to make.

(B)   The Right to ask that Your Health Information Be Communicated to you in a Confidential Manner: You have the right to ask for your health information to be sent to you in different ways. For example you may ask for the Practice to contact you by mail rather than telephone, or only call at your home rather than at work. Your request must be in writing and explain the method of contact and location where your wish to be contacted. We will try to honor your request so long as we can easily provide it in the format you request.

(C)   The Right to See and Get Copies of Your Health Information: In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request, in writing. We will respond within thirty (30) days from the receipt of your request. If you ask for a copy of your records, you will be charged a fee. If your request is denied, we will inform you, in writing, our reasons for the denial and explain your right to have the denial reviewed. We may offer to give you a summary or explanation of the information your requested as long as you agree in advance to this and to any fees that this might cost. If you ask for information we do not have, but we know where it is, we must tell you where to direct your request.

(D)   The Right to Receive an Accounting of Disclosures (a record of when and to whom, your health information was shared without your authorization). You have the right to obtain a list of the instances that we have shared your health information. You must make this request in writing. You may request as far back as six years, beginning April 14, 2003. The listing you get will include the date, name, and address (if known) of the person or organization receiving it. It will also include a brief description of the information given, a brief statement on why the information was shared, or a copy of the written request for the information.

The list will not include uses or disclosures that you have already consented to, such as those made for the treatment, payment, or health care operations, directly to you or your family. The list also will not include uses or disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003.

We have 60 days to respond to your written request. If we are not act on your request within the 60 days, we will notify you that we are extending the response time by 30 days. If we do that we will explain the delay in writing and give you a new date of when to expect a response. We will provide this list at no charge, but if you make more that one request in the same year, we will charge you for each additional request.

(E)   The Right to Correct or Update your Health Information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing.

We have 60 days to respond to your request. We may deny your request, in writing, if the health information is; (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your rights to file a written statement of disagreement with the denial. If you do not file a written statement of disagreement, you have the right to request that your request and our denial be attached to all future disclosures of your health information. it, and tell others that need to know about the change to your PHI.

(F)   The Right to Get This Notice by E-Mail. You have the right to get a copy of this Notice by e-mail. Even if you have agreed to receive this notice via e-mail you also have the right to request a paper copy of this notice.

4.   HOW TO COMPLAIN ABOUT YOUR PRIVACY PRACTICES
If you think that William E. LoVerme, M.D. may have violated your privacy rights, or you disagree with a decision we made about access to your health information, you may file a complaint. To file a written complaint you can send to:

William E. LoVerme, M.D. will take no retaliatory action against you if you file a complaint about our privacy practices.