CHERNOFF COSMETIC SURGERY
Gregory Chernoff, MD
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.
Our Legal Duty
We are required by applicable federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice is currently in effect and will remain in effect until we replace it.
If you have any questions about this Notice, please contact our office directly.
Uses and Disclosures Based on Your Written Authorization. Other uses and disclosures of your protected health information will be made only with your authorization, unless otherwise permitted or required by law as described below.
A. How Chernoff Cosmetic Surgery. May Use or Disclose Your Health Information
- Medical Records: Chernoff Cosmetic Surgery 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:
- 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.
- Notification and Communication with Family: You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Without your written authorization, we will not disclose your health care information except as described in this notice.
- Appointment Reminders: We may use appointment information to contact and remind you about appointments. If you are not home, we may leave this information on your answering service or in a message left with the person answering the phone.
- Sign-In Sheet: We may use and disclose your name 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.
- Promotion: We may contact you to give you information about products or services related to your service/treatment or to recommend other treatments or services that may be of interest to you, or to provide you with small gifts. We will not disclose personal or other information for marketing purposes without your written authorization.
- 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.
- 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 Texas law.
- 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.
- 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, Chernoff Cosmetic Surgery 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 – Patient Rights
- 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.
- 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.
- 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.
- 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.
- Notice of Privacy Practices: 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 office.
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.
If you believe your privacy right have been violated, you may file a complaint with our office. Call: 707-544-3232 or send an email to email@example.com.