HIPAA Privacy Policy

Uses and Disclosures for Treatment, Payment, and Health Care Operations

By becoming a patient at D-Essence Wellness, you are giving consent for D-Essence Wellness to use your protected health information for certain activities, including treatment, payment, and other health care operations (“TPO”).

Treatment: We may use and disclose protected health information about you so that D-Essence Wellness and its medical professionals can treat you. For example, we may use your past medical information to diagnose your present condition, or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care.

Payment: We may use and disclose protected health information about you so that we may be paid for the medical treatment we provide to you. For example, we will submit protected health information about you to your insurance company to receive payment for services we have provided to you.

Health Care Operations: We may use and disclose protected health information about you for D-Essence Wellness’ health care operations—those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs, or provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services.

Other Uses and Disclosures of Your Protected Health Information

The following uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, but all uses and disclosures made by D-Essence Wellness are only those permitted under the law).

• Licensure Proceedings: Licensure proceedings by the American Board of Plastic Surgery.
• Appointment Reminders: We may use and disclose your medical information to contact you as a reminder that you have an appointment at the office. If you request that such communications be made confidentially, please contact our office in writing at 871 Blooming Grove Turnpike Suite 102, New Windsor, New York 12553. We will accommodate all reasonable requests.
• Involvement in Your Healthcare: We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care. If you are unable to agree or object, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person responsible for your care of your location, general condition, or death. We may also use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.
• Emergency Situations: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician will attempt to obtain your acknowledgment of this Notice as soon as reasonably practicable after the delivery of treatment.
• Health-Related Benefits or Services: From time to time, D-Essence Wellness may use and disclose protected health information to tell you about certain health-related benefits or services that may be of interest to you.
• Required by Law: We will use or disclose protected health information about you when required to do so by federal, state, or local law, limited to the relevant requirements of the law. You will be notified if the law requires us to do so. We must make disclosures to you and, when required, to the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the law.
• Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
• Health Oversight Activities: We may disclose protected health information to a health oversight agency for activities authorized by law, including audits, investigations, and inspections.
• Abuse or Neglect: We may disclose your protected health information to a public health authority authorized by law to receive reports of child abuse or neglect, or if we believe you have been a victim of abuse, neglect, or domestic violence, consistent with law.
• Food and Drug Administration: We may disclose your protected health information to a person or company required by the FDA to report adverse events, product defects or problems, biologic product deviations, track products, enable product recalls, make repairs or replacements, or conduct post-market surveillance.
• Lawsuits and Disputes: We may disclose protected health information about you in response to a court or administrative order, or in response to a subpoena or discovery request when permitted by law.
• Law Enforcement: We may release protected health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process.
• Other Related Disclosures: Including disclosures relating to Armed Forces personnel, to national security and intelligence agencies, as well as to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.
• Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information about you to a coroner or medical examiner, to funeral directors as needed to carry out their duties, and for certain organ donations to which you may have agreed.
• Research: We may disclose your protected health information to researchers when their research has been approved and protocols established to ensure the privacy of your information. We may also disclose a limited set of your information, as allowed under the law, for research purposes.
• Criminal Activity: We may disclose your protected health information, consistent with federal and state laws, if we believe it is necessary to prevent or lessen a serious or imminent threat to health or safety, or to help law enforcement identify or apprehend an individual.
• Workers’ Compensation: We may release protected health information about you for Workers’ Compensation or similar programs that provide benefits for work-related injuries or illnesses.

Your Rights Regarding Protected Health Information About You

Right to Inspect and Copy: You have the right to inspect and copy protected health information that may be used to make decisions about your medical care (usually medical and billing records). Requests must be submitted in writing. We may charge a reasonable fee for copying, mailing, or supplies. Limited denials may apply; you may request a review of any denial.

Right to Request Restrictions: You may request that we restrict the use and disclosure of your protected health information for treatment, payment, and healthcare operations. We are not required to agree, but if we do, we will comply unless needed for emergency treatment.

To request restrictions, write to: 871 Blooming Grove Turnpike Suite 102, New Windsor, New York 12553. Include:

• What information you want to limit.
• Whether you want to limit our use, disclosure, or both.
• To whom you want the limits to apply.

Right to Confidential Communications: You may request to receive communications (such as appointment confirmations) by alternative means or at alternative locations (e.g., only at work or by mail). Make your request in writing to the address above. We will accommodate all reasonable requests; specify how or where you wish to be contacted.

Right to Amend: If you feel the protected health information we have is incorrect or incomplete, you may request an amendment. Only the health care entity that created your information is responsible for amending it. For procedures, contact the address above.

Right to an Accounting of Disclosures: You may request an accounting of disclosures of your protected health information for purposes other than treatment, payment, or healthcare operations by D-Essence Wellness or contractors acting on our behalf. Submit a written request to the address above. State a time period (no longer than six (6) years prior to your request and not before August 1, 2005) and your preferred format (paper or electronic). Photocopying charges may apply.

Right to a Paper Copy of This Notice: You may obtain a paper copy at any time. You can also access this Notice on our website: www.d-essencewellness.com. To obtain a paper copy, contact (845) 282-6437.

To learn more about these procedures, or to make any of these requests, contact our Office Manager at (845) 282-6437.

Changes to This Notice

D-Essence Wellness reserves the right to change this notice. We may make the revised or changed Notice effective for protected health information we already have about you, as well as any information we create or receive in the future. We will post a copy of the current Notice on D-Essence Wellness' website: www.d-essencewellness.com. The Notice will contain, in the top right-hand corner, the effective date.

Complaints

If you believe your privacy rights have been violated and/or that D-Essence Wellness has not followed this policy, you may file a complaint with the Office Manager or with the Secretary of the Department of Health and Human Services.

To file a complaint with D-Essence Wellness, contact our Office Manager at 871 Blooming Grove Turnpike Suite 102, New Windsor, New York 12553. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Other Uses of Protected Health Information

Other uses and disclosures of your protected health information not covered by this notice or the laws that apply to D-Essence Wellness will be made only with your written permission (“authorization”). If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical treatment or other services that we have provided to you.

Questions?

If you have any questions regarding this notice, please contact the Office Manager at D-Essence Wellness.