Your Health Information and Our Privacy Commitment to You
This notice describes how Pure Envy Medspa L.L.C. may use and disclose your health information, as well as how you can access your health information. This notice details our privacy practices, our legal duties, and your rights concerning your health information. We have followed the privacy practices that are set forth in this notice. Please review this notice carefully. The privacy of your personal health information and the responsibility to protect it is very important to us. Each time that you visit a hospital, a physician, a medspa or another health care provider, a record of your encounter is made. Typically, this record contains your name, date of birth, sex, financial information, insurance information, health history, current symptoms, examination, test results, diagnoses, treatment, and plan for future care or treatment. This information is called your health information. We care about your privacy. Only people who have both the need and the legal right may have access to your health information without your authorization. Unless you give us permission in writing, we will only use or disclosure health information for purposes of treatment, payment, and healthcare operations or for the other purposes described below where appropriate, we use or disclose only the health information that is minimally necessary to accomplish the intended purpose. As permitted by HIPAA and Florida state law, Pure Envy Medspa L.L.C. may use or disclose your health information for several purposes as listed below. Disclosures of your medical information for purposes described in this notice may be made in writing, orally, electronically, or by facsimile.
Our Legal Duty
We are required by law to protect the privacy and security of your health care information, to provide this notice about our information practices, to follow the information practices that are described in this notice, to accommodate reasonable requests you may have to communicate health information, and to notify you if we are unable to agree with this request. We are also required by law to obtain your signed acknowledgment of receiving this notice. Please know that you can refuse to acknowledge receipt of this notice and still receive treatment from Pure Envy Medspa providers. The privacy practices described in this form will still be followed. You will not be treated differently. We may change our privacy practices at any time and our new practices will apply to all health information we hold. Before we make a significant change, we will change its notice and post the new notice on the Pure Envy Medspa website and at its office(s). You can also request a copy of this notice at any time through your Pure Envy Medspa provider. If you have any questions or would like more information about our privacy practices, please ask your Pure Envy Medspa provider.
Uses and Disclosures of Your Health Information
Treatment
We are committed to maintaining the privacy of your protected health information (PHI). We create a record of the care and services you receive at our medspa to provide quality treatment and comply with legal requirements. This notice explains how we may use and disclose your information and your rights regarding your health information.
- For Treatment: We may use and share your PHI with doctors, physician assistants, nurse practitioners, nurses, aestheticians, and other staff involved in your care to coordinate treatment and services you receive. For example, sharing information with a compounding pharmacy to prepare a prescribed medication, a lab or any other provider involved in your care.
- For Payment: We may use and disclose your PHI to obtain payment for services. This can include working with third-party payers or financing request (e.g. CareCredit, Cherry). If insurance is used for certain services, we may provide necessary information for billing.
- For MedSpa Operations: We may use and disclose your PHI for business operations, such as quality improvement, staff training, accreditation, or licensing. We may also use it to manage scheduling, training, quality checks, or technology support (e.g. our electronic health records provider securely maintains PHI on our behalf).
- Appointment Reminders and Treatment Options: We may contact you to remind you of appointments, offer follow-up care, or inform you about treatment alternatives and services that may be of interest. We may use your health information to discuss lab or testing results, or to obtain additional demographic or contact information, through phone calls, voicemail messages, emails, postcards, or letters.
Business Associates
We may provide and receive some services through contracts with business associates or affiliates. When we use these services, we may disclose your health information to the business associates or affiliates so that they can perform the function(s) that we have contracted with them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information using HIPPA laws.
Your Care or Payment for Care
We may use or disclose health information to assist in the notification of a family member/personal representative regarding your general condition, treatment plan, or death. If you are present, prior to use or disclosure of your health information, we will provide you with the opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information about you. Based on a determination using our professional judgment, we will disclose only pertinent health information directly relevant to the person’s involvement in your healthcare. With your consent, we may disclose your health information to a family member, friend, or other person to the extent necessary to help with your health care or with payment information.
Required By Law
We may use or disclose your health information as required by any statute, regulation, court order, or other mandate enforceable in a court of law. To comply with state or federal law, report adverse reactions, respond to a subpoena, or if disclosure is necessary to protect health or safety.
Abuse or Neglect
We may disclose your health information to the appropriate government agency if we reasonably suspect that you are a victim of abuse, neglect, domestic violence, or other crime and we are required or permitted by law to make the disclosure. We will promptly inform you that such a disclosure has been made unless it is determined that doing so would not be in your best interest. We may also use or disclose your health information to the extent necessary to avert a serious threat to your health or safety or to the health or safety of others.
Public Health
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.
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.
Communication Barriers
We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician/provider determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances. We also use language interpretation companies and for communication purposes, your protected health information will be used during translation services.
Worker’s Compensation Purposes
We may disclose 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 established by law.
Judicial and Administrative Proceedings
We may disclose your health information in an administrative or judicial proceeding in response to a subpoena or request to produce documents. We will disclose your health information only if the requesting party first provides written documentation that the privacy of your health information will be protected.
Health Oversight Activities
If employees of Pure Envy Medspa or our business associates believe in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public, we may disclose your health information to health oversight agencies and/or public health authorities such as the Department of Health.
Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance as required.
Criminal Activity
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Incidental Uses and Disclosures
We may use or disclose your health information in a manner which is incidental to the uses and disclosures described in this notice.
Patient Authorization to Use or Disclose Health Information
In addition to using your health information for treatment, payment and healthcare operations, you may give Pure Envy Medspa L.L.C. written authorization to use your health information or disclose it to anyone for any purpose. If you give us written authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted during the time your authorization was in effect. If you do not give us written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Research
We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Inmates
We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Military Activity and National Security
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Individual Rights
Access
You have the right to read, review, and copy your health information, with limited exceptions. You may request that Pure Envy Medspa L.L.C. provide copies in a format other than photocopies. We will use the format you request unless we cannot practically do so, and provided the request is compliant with HIPAA guidelines. You may request access by contacting the office of Pure Envy Medspa L.L.C. You may also request access by sending a letter to the address at the end of this notice. We may charge you a reasonable cost-based fee for expenses such as copier usage, supplies, and staff time. Please contact our office to receive a full explanation of our fee structure for records.
Amendment
You have the right to request that we amend your health information if you believe that your record is incomplete or incorrect. Your request must be submitted to Pure Envy Medspa L.L.C. in writing, and you must provide an explanation to support the request. We may deny your request if our information is complete and accurate, was not created by us, or is not part of the health information kept by Pure Envy Medspa L.L.C.
Disclosure Accounting
You have the right to obtain an accounting of non-routine uses and disclosures of your health information, other than those for treatment, payment, and health care operations. We thank you for limiting your request to no more than six years at a time. If you request this accounting more than once in a twelve-month period, we may charge you a reasonable cost-based fee for processing these additional requests. If there is a charge, the office of Pure Envy Medspa L.L.C. will first contact you to determine whether you wish to modify or withdraw your request.
Restrictions
You have the right to request that we place additional restrictions on the use or disclosure of your health information for treatment, payment, or health care operations. The right to request restriction does not extend to uses or disclosures permitted or required under certain sections of the federal privacy regulations. We do not have to agree to the restriction, however if we do, we will adhere to it unless you request otherwise, or we give you advance notice.
Confidential Communication
You have the right to request that we communicate with you about your health information by alternative means or to an alternative location. You may, for example, request that we communicate your health information privately, that we do not communicate with other family members, or that we communicate with you though mailed communications that are sealed. You must provide this request in writing. We will honor your request for confidential communication.
Request a Paper Copy of This Notice
You have a right to obtain a copy of this Notice of Privacy Practices and Individual Rights at any time. Contact the Pure Envy Medspa L.L.C. office for paper or electronic copies of the notice or visit our website at www.pureenvymedspa.com.
In addition to providing, you your rights, as detailed above, the federal privacy standard requires us to take the following measures:
- Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.
- Provide you with this notice as to our legal duties and privacy practices with respect to individually identifiable health information that we collect and maintain about you.
- Abide by the terms of this notice.
- Train our personnel concerning privacy and confidentiality. Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard thereto.
- Mitigate (lessen the harm of) any breach of privacy/confidentiality.
- We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law.
Pure Envy Medspa L.L.C. reserves the right to change our privacy practices and terms of this notice at any time as long as the law permits it. We reserve the right to develop new terms of notification procedures in order to maintain alignment with legal and governmental requirements. Updates to this notice and new notices will be available as changes to our privacy practices occur.
For More Information or to Report a Problem
If you are concerned about a violation of your privacy rights, you may contact any of the Pure Envy Medspa providers. If you are concerned that we have violated your privacy rights or disagree with a decision we made about access to your records you can file a complaint with Pure Envy Medspa L.L.C. Privacy Officer as listed below. You may be asked to submit your concern in writing. We encourage you to express any concerns you may have regarding the privacy of your information.
Attn: Ethics & Compliance Officer Pure Envy Medspa, L.L.C.
7524 W. Sandlake Rd. Orlando, FL. 32819
Phone: 407-426-4801
Fax: 407-426-4801
www.pureenvymedspa.com
You will not be penalized for filing a complaint.
You may also file a complaint with
Region IV Office for Civil Rights
US Department of Health and Human Services 61 Forsyth Street, S.W. Atlanta, GA 30303-8909
Voice Phone (404)562-7886
FAX (404)562-7881.
You will not be penalized for filing a complaint with the federal government.