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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.
We understand the importance of
privacy and are committed to maintaining the confidentiality of your
medical information. We make a record of the medical care we provide
and may receive such records from others. We use these records to
provide or enable other health care providers to provide quality
medical care, to obtain payment for services provided to you as
allowed by your health plan, and to enable us to meet our
professional and legal obligations to operate this medical practice
properly.
We are
required by law to maintain the privacy of protected health
information and to provide individuals with notice of our legal
duties and privacy practices with respect to protected health
information. This notice describes how we may use and disclose your
medical information. It also describes your rights and our legal
obligations with respect to your medical information. If you have
any questions about this Notice, please contact our office directly.
A.
How
Aesthetique Cosmetic and Laser Center
or
Prasad Sureddi, M.D.
May Use Or Disclose Your Health Information
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Aesthetique Cosmetic and Laser Center
or
Prasad Sureddi, M.D.
collects health information about you and
stores it in a chart and on a computer. This is your medical
record. The medial record is the property of this medical
practice, but the information in the medical record belongs to
you. The law permits us to use or disclose your health
information for the following purposes:
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Treatment.
We use medical information about you to provide your medical
care. We disclose medical information to our employees and
others who are involved in providing the care you need. For
example, we may share your medical information with other
physicians or other health care providers who will provide
services which we do not provide. Or we may share this
information with a pharmacist who needs it to dispense a
prescription to you, or a laboratory that performs a test. We
may also disclose medical information to members of your family
or others who can help you when you are sick or injured.
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Payment.
We use and disclose medical information about you to obtain
payment for the services we provide. For example, we give your
health plan the information it requires before it will pay us.
We may also disclose information to other health care providers
to assist them in obtaining payment for services they have
provided to you.
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Health Care Operations.
We may use and disclose medical information about you to operate
this quality of care we provide, or the competence and
qualifications of our professional staff. Or we may use and
disclose this information to get your health plan to authorize
services or referrals. We may also use and disclose this
information as necessary for medical reviews, legal services and
audits, including fraud and abuse detection and compliance
programs and business planning and management. We may also share
your medical information with our “business associates”, such as
our billing service, that perform administrative services for
us. We have a written contract with each of these business
associates that contains terms requiring them to protect the
confidentiality of your medical information. Although federal
law does not protect health information which is disclosed to
someone other than another health care provider, health plan or
health care clearinghouse, under
Connecticut law all recipients of health care information
are prohibited from re-disclosing it except as specifically
required or permitted by law. We may also share your information
with other health care providers, health care clearinghouses or
health plans that have a relationship with you when they request
this information to help them with their quality assessment and
improvement activities, their efforts to improve health or
reduce health care costs, their review of competence,
qualifications and performance of health care professionals,
their training programs, their accreditation, certification or
licensing activities, or their health care fraud and abuse
detection and compliance efforts.
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Appointment Reminders.
We may use and disclose medical information to contact and
remind you about appointments. If you are not home, we may leave
this information on your answering machine or in a message left
with the person answering the phone.
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Sign In Sheet.
We may use and disclose medical information about you by having
you sign in when you arrive at our office. We may also call out
your name when we are ready to see you.
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Notification and
Communication with Family. We may
disclose your health information to notify or assist in
notifying a family member, your personal representative or
another person responsible for your care about your location,
your general condition or in the event of your death. In the
event of a disaster, we my disclose information to a relief
organization so that they may coordinate these notification
efforts. We may also disclose information to someone who is
involved with your care or helps pay for your care. If you are
able and available to agree or object, we will give you the
opportunity to object prior to making these disclosures,
although we may disclose this information in a disaster even
over your objection if we believe it is necessary to respond to
the emergency circumstances. If you are unable or unavailable to
agree or object, our health professionals will use their best
judgment in communication with your family and others.
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Marketing.
We may contact you to give you information about products or
services related to your treatment, case management or care
coordination, or to direct or recommend other treatments or
health-related benefits and services that may be of interest to
you, or to provide you with small gifts. We may also encourage
you to purchase a product or service when we see you. We will
not otherwise use or disclose your medical information for
marketing purposes without your written authorization.
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Required By Law.
As required by law, we will use and disclose your health
information, but we will limit our use or disclosure to the
relevant requirements of the law. When the law requires us to
report abuse, neglect or domestic violence, or respond to
judicial or administrative proceedings, or to law enforcement
officials, we will further comply with the requirement set forth
below concerning those activities.
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Public Health.
We may, and are sometimes required by law, to disclose your
health information to public authorities for purposes related
to: preventing or controlling disease, injury or disability;
reporting child, elder or dependent adult abuse or neglect;
reporting domestic violence; reporting to the Food and Drug
Administration problems with products and reactions to
medications; and reporting disease or infection exposure. When
we report suspected elder or dependent adult abuse or domestic
violence, we will inform you or your personal representative
promptly unless in our best professional judgment we believe the
notification would place you at risk of serious harm or would
require informing a personal representative we believe is
responsible for the abuse or harm.
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Health Oversight
Activities. We may, and are sometimes
required by law, to disclose your health information to health
oversight agencies during the course of audits, investigations,
inspections, licensure and other proceedings, subject to the
limitations imposed by federal and
Connecticut law.
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Judicial and
Administrative Proceedings. We may,
and are sometimes required by law, to disclose your health
information in the course of any administrative or judicial
proceeding to the extent expressly authorized by a court or
administrative order. We may also disclose information about you
in response to a subpoena, discovery request or other lawful
process if reasonable efforts have been made to notify you of
the request and you have not objected, or if your objections
have been resolved by a court or administrative order.
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Law Enforcement.
We may, and are sometimes required by law, to disclose your
health information to a law enforcement official for purposes
such as identifying or locating a suspect, fugitive, material
witness or missing person, complying with a court order,
warrant, grand jury subpoena and other law enforcement purposes.
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Coroners.
We may, and are often required by law, to disclose your health
information to coroners in connection with their investigations
of deaths.
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Organ or Tissue Donation.
We may disclose your health information to organizations
involved in procuring, banking or transplanting organs and
tissues.
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Public Safety.
We may, and are sometimes required by law, to disclose your
health information to appropriate persons in order to prevent or
lessen a serious and imminent threat to the health or safety of
a particular person or the general public.
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Specialized Government
Functions. We may disclose your health
information for military or national security purposes or to
correctional institutions or law enforcement officers that have
you in their lawful custody.
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Worker’s Compensation.
We may disclose your health information as necessary to comply
with worker’s compensation laws. For example, to the extent your
care is covered by workers’ compensation, we will make periodic
reports to your employer about your condition. We are also
required by law to report cases of occupational injury or
occupational illness to the employer or workers’ compensation
insurer.
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Change of Ownership.
In the event that this medical
practice is sold or merged with another organization, your
health information/record will become the property of the new
owner, although you will maintain the right to request that
copies of your health information be transferred to another
physician or medical group.
B. When
This Medical Practice May Not Use or Disclose Your Health
Information.
Except as described in this Notice of Privacy Practices,
Aesthetique Cosmetic and Laser Center
or
Prasad Sureddi, M.D.
will
not use or disclose health information which identifies you without
your written authorization. If you do authorize this medical
practice to use or disclose your health information for another
purpose, you may revoke your authorization in writing at any time.
C. Your
Health Information Rights
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Right to Request Special
Privacy Protections. You have the
right to request restrictions on certain uses and disclosures of
your health information by a written request specifying what
information you want to limit and what limitations on our use or
disclosure of that information you wish to have imposed. We
reserve the right to accept or reject your request and will
notify you of our decision.
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Right to Request
Confidential Communications. You have
the right to request that you receive your health information
either mailed to a specific location or you or someone you have
authorized in writing may pick up the information in person.
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Right to Inspect and
Copy. You have the right to inspect
and copy your health information, with limited exceptions. To
access your medical information, you must submit a written
request detailing what information you want access to and
whether you want to inspect it or get a copy of it. We will
charge a reasonable fee, as allowed by State and federal law. We
may deny your request under limited circumstances. If we deny
your request to access your child’s records or the records of an
incapacitated adult you are representing because we believe
allowing access would be reasonably likely to cause substantial
harm to the patient, you will have a right to appeal our
decision. If we deny your request to access your psychotherapy
notes, you will have the right to have them transferred to
another mental health professional.
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Right to Amend or
Supplement. You have a right to
request that we amend your health information that you believe
is incorrect or incomplete. You must make a request to amend in
writing and include the reasons you believe the information is
inaccurate or incomplete. We are not required to change your
health information, and will provide you with information about
this medical practice’s denial and how you can disagree with the
denial. We may deny your request if we do not have the
information, if we did not create the information (unless the
person or entity that created the information is no longer
available to make the amendment), if you would not be permitted
to inspect or copy the information at issue, or if the
information is accurate and complete as is. You also have the
right to request that we add to your record a statement of up to
250 words concerning any statement or item you believe to be
incomplete or incorrect.
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Right to an Accounting of
Disclosures. You have a right to
receive an accounting of disclosures of your health information
made by this medical practice, except that this medical practice
does not have to account for the disclosures provide to you or
pursuant to your written authorization, or as described in
paragraphs 1(treatment), 2 (payment), 3 (health care
operations), 6 (notification and communication with family) and
16 (specialized government functions) of Section A of this
Notice of Privacy Practices or disclosures for purposes of
research or public health which exclude direct patient
identifiers, or which are incident to a use or disclosure
otherwise permitted or authorized by law, or the disclosures to
a health oversight agency or law enforcement official to the
extent this medical practice has received notice from that
agency or official that providing this accounting would be
reasonably likely to impede their activities.
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You have a right to a
paper copy of this Notice of Privacy Practices, even if you have
previously requested its receipt. If
you would like to have a more detailed explanation of these
rights or if you would like to exercise one or more of these
rights, contact our Privacy Officer listed at the top of this
Notice of Privacy Practices.
D. Changes
to this Notice of Privacy Practices
We reserve
the right to amend this Notice of Privacy Practices at any time in
the future. Until such amendment is made, we are required by law to
comply with this Notice. After an amendment is made, the revised
Notice of Privacy Protections will apply to all protected health
information that we maintain, regardless of when it was created or
received. We will keep a copy of the current notice posted in our
reception area and will offer you a copy. We will also post the
current notice on our website.
E. Complaints
If you believe your privacy right have
been violated, you may file a complaint with our office.
Visit our
plastic /
cosmetic surgery,
and
medical spa
office
located in
Waterbury
and
Southbury,
Connecticut (CT) conveniently near from
Hartford, CT and the
New York Area. |