Notice of Privacy Practices

You have certain rights regarding your health information. This section explains those rights and how you may exercise them.

Get a copy of your medical record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you.

We will provide a copy or summary of your health information within the time required by applicable law. We may charge a reasonable, cost-based fee where permitted by law.

Ask us to correct your medical record

You may ask us to correct health information about you that you believe is incorrect or incomplete.

We may deny your request in certain circumstances, but we will explain the reason in writing as required by law.

Request confidential communications

You may ask us to contact you in a specific way, such as by calling a particular phone number or sending correspondence to a particular address.

We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.

We are generally not required to agree to your request, except in certain circumstances required by law.

Get a list of certain disclosures

You may ask for an accounting of certain disclosures of your health information made during the six years before the date of your request.

The accounting generally does not include disclosures for treatment, payment, healthcare operations, or certain other disclosures permitted by law.

We will provide one accounting during any 12-month period at no charge. We may charge a reasonable, cost-based fee for additional requests during the same period.

Get a copy of this notice

You may ask for a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your privacy rights on your behalf.

We may verify that the person has appropriate authority before taking action.

File a complaint

You may file a complaint if you believe your privacy rights have been violated.

You may contact Well Aesthetics using the information at the bottom of this notice.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint.

For certain health information, you may tell us your preferences about what we share.

You may have choices regarding how we:

• Share information with family members, friends, or others involved in your care
• Share information in a disaster relief situation
• Contact you regarding certain health-related services or communications
• Use your information for certain marketing purposes

If you are unable to tell us your preference, such as if you are unconscious or otherwise unable to communicate, we may share information when we believe it is in your best interest and when permitted by law.

We will obtain your written authorization when required by law for uses and disclosures such as certain marketing activities or the sale of your health information.

Treat you

We may use your health information and share it with other healthcare professionals who are treating you.

Run our practice

We may use and share your health information to operate our practice, improve your care, manage our services, and contact you when necessary.

Bill for services

We may use and share your health information to bill and obtain payment from health plans or other responsible parties when applicable.

Help with public health and safety

We may disclose health information when permitted or required for certain public health and safety activities, including:

• Preventing or controlling disease
• Reporting suspected abuse, neglect, or domestic violence where required or permitted by law
• Preventing or reducing a serious threat to someone's health or safety
• Reporting adverse events or problems involving medications, products, or medical devices

Comply with the law

We may use or disclose your information when required by federal, state, or local law.

Respond to organ and tissue donation requests

Where applicable, we may share health information with organizations involved in organ, eye, or tissue donation and transplantation.

Work with medical examiners and funeral directors

We may disclose health information to a coroner, medical examiner, or funeral director when permitted or required by law.

Workers' compensation and other government requests

We may use or disclose health information for workers' compensation claims, certain law enforcement purposes, health oversight activities, and other government functions when permitted or required by law.

Respond to lawsuits and legal proceedings

We may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful legal process when permitted by law.

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice while it is in effect.
• We will provide you with a copy of this notice upon request.
• We will not use or disclose your health information in ways not described in this notice unless you provide written authorization or applicable law permits or requires us to do so.

If you provide written authorization for a use or disclosure, you may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.

We may change the terms of this Notice of Privacy Practices, and any revised notice may apply to health information we already maintain as well as information we receive in the future.

If we make a material change, the updated notice will be made available upon request, at our office, and on our website as required by law.

If you have questions about this notice, wish to exercise one of your privacy rights, or believe your privacy rights have been violated, please contact us.

You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights. Filing a complaint will not affect your care or result in retaliation.