Privacy Policy

Cosmetic Enhancement Center of New England. – NOTICE OF PRIVACY PRACTICES

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.

A. OUR OBLIGATION TO YOU

We are committed to protecting the privacy of your health care and medical information. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your “Protected Health Information”. “Protected Health Information”, also known as “PHI” includes information that identifies you and the health care you receive. We may use or disclose your PHI to provide treatment to you, to seek payment for the treatment provided, to support our health care operations, and for other purposes that are permitted or required by law. We are required by law to maintain the privacy of your PHI. We are required to give you this Notice to describe our legal duties and privacy practices concerning your PHI and your rights. We must abide by the terms of this Notice, as it may be changed from time-to-time.

This Notice is provided under the HIPAA Privacy Standards. There are other laws and rules that provide additional protections for health information related to treatment for mental health, alcohol and other substance abuse, and HIV/AIDS. To the extent that State or Federal laws and rules are more stringent than the HIPAA Privacy Standards, we will continue to follow these law and rules.

B. HOW WE USE AND DISCLOSE INFORMATION

We will use and disclose your PHI for the following types of activities. Please note that not every type of use or disclosure is listed in this Notice.

For TREATMENT. “Treatment” means the provision, coordination, or management of your health care and related services by us and other health care providers involved in your care. It includes the coordination or management of health care by us with third-party, consultations between our practice and other health care providers relating to your care, or our practice’s referral of you to another health care provider or facility, such as a laboratory. For example, we may use your PHI within our office for treatment with other health care providers. We may disclose your PHI outside our office, such as by sending your medical record to a physician who is also providing you treatment. As between health care providers, requests for your PHI is assumed to be made for the minimum amount necessary for that treatment.

For PAYMENT. Payment means our activities to obtain reimbursement for the health care treatment provided to you, including billing, claims management, and collection activities. Payment also may include your insurance company’s work to determine eligibility, for claims processing, to assess medical necessity, and for utilization review. For example, prior to providing treatment, we may use your PHI to confirm that your health insurer will pay for the treatment. We may disclose your payment information to an insurance company in order for us to receive payment for our services.

For HEALTH CARE OPERATIONS. Health care operations means our business activities that are necessary to run our office and to make sure patients receive quality care. These activities include, but are not limited to, quality assessment and improvement activities; peer review of health care professionals; medical review, legal services and auditing functions; business planning and development; and business management and general administrative activities. For example, we may use your PHI to review the treatment by our health care providers. We may disclose your PHI to another health care provider for its operation activities under certain circumstances, such as for quality assessment.

To OTHER PROVIDERS. We may disclose your PHI for other health care providers’ treatment, payment and operations relating to you.

To THIRD-PARTIES. We may disclose PHI to other persons and companies who perform services related to our treatment, payment or health care operations for you, such as for clearinghouse operations and transcriptions services. These third-parties are our “Business Associates”. We require these third-parties to protect your privacy based on the same legal standards that we follow.

To PERSONS INVOLVED IN YOUR CARE OR INVOLVED IN PAYMENT FOR YOUR CARE, AND NOTIFICATION. Unless you object, we may disclose to a family member, other relative, close personal friend or any other person identified by you, your PHI related to that person’s involvement in your health care or payment related to your health care. We may also use PHI to notify a family member or other person responsible for your care (or a disaster relief organization) about your health condition or location. You may restrict disclosures of PHI to certain family members and other relatives, or to only such persons that you identify as permitted to receive PHI.

For APPOINTMENTS AND SERVICES. We may use or disclose your PHI to notify or remind you of an appointment. We may call your home or business, leave a message for you, or mail a post-card. We may also use or disclose your PHI to contact you about treatment alternatives or health-related benefits or services that may be of interest to you.

C. USES AND DISCLOSURES WITH YOUR WRITTEN AUTHORIZATION. Except as otherwise described in this Notice, we may not use or disclose PHI without your written authorization, which you may revoke.

You may request that we use or disclose all or part of your PHI. Use and disclose may be authorized to specific individuals or other recipients for a defined purpose over a particular timeframe. Authorizations will be required to disclose sensitive PHI, such as information about mental health or psychiatric treatment (unless an emergency situation exists), HIV status, substance abuse treatment, or for Psychotherapy Notes. While most authorizations must be in writing, in certain circumstances, we will accept oral authorizations to the extent permitted by Maine law. The minimum necessity amount of your PHI will be disclosed to comply with your authorization.

You may revoke your authorization at any time, but only regarding future uses or disclosures and only to the extent we have not already used or disclosed your PHI in reliance on your authorization. If your authorization was provided as a condition of your obtaining insurance coverage, then if the insurer has a right to contest a claim, the revocation may be ineffective. We may also accept oral revocations and certain electronic revocations of authorizations, but we request that you follow this with a revocation in writing.

D. USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION

In EMERGENCIES. If you are unable to provide an authorization or are otherwise incapacitated, and require emergency medical treatment, we will use and disclose your PHI for you to receive health care treatment. We will attempt to obtain your authorization as soon as practical.

For REQUIRED BY LAW. In certain circumstances, we may disclose your PHI to the extent and under the circumstances Required by Law.

For PUBLIC HELATH ACTIVITIES. We may disclose your PHI for public health activities, such as keeping birth or death records, preventing or controlling communicable diease, ensuring the safety of drugs and medical devices, reporting child abuse or neglect, or for workplace surveillance or work-related illness and injury.

To REPORT ADULT ABUSE OR NEGLECT; DOMESTIC VIOLENCE; INFORMATION TO PATIENT. We may disclose your PHI in connection with reports that we may be required or authorized to make regarding abuse, neglect or domestic violence. Such disclosures will be limited to the extent required by law, or if disclosure is authorized but not required, we will be made as necessary to prevent serious harm to you or others. We may also make such disclosure if you agree to it. To the extent that the disclosure will be made, we will promptly inform you or your Personal Representative, unless we believe that informing your or your Personal Representative would place you at risk of serious harm.

For HEALTH OVERSIGHT ACTIVITIES. We may disclose your PHI to health oversight agencies for activities authorized by law, including audits, civil, administrative or criminal investigations, licensure or disciplinary actions, and monitoring or compliance with applicable civil rights law and government benefit programs such as Medicaid and Medicare.

In JUDICIAL PROCEEDINGS. We may, under certain circumstances, disclose your PHI in response to court or administrative orders; or subpoenas, discovery requests or other process after reasonable efforts to notify you or obtain a qualified protective order.

To LAW ENFORECEMENT. We may disclose your PHI if the disclosure is required by law or in compliance with certain warrants or subpoenas, court or administrative oders; to identify or locate suspects, fugitives, witnesses or missing persons; and regarding victims or perpetrators of crimes or suspected crimes (with your consent in some circumstances).

To CORONERS, MEDICAL EXAMINERS, and FUNERAL DIRECTORS. We may disclose your PHI to identify a deceased person, to determine cause of death, or as reasonably necessary to permit them to carry out their lawful duties.

To PREVENT A SERIOUS THREAWT TO HEALTH OR SAFETY. We may disclose your PHI in a manner that is consistent with applicable laws and professional ethics, to prevent or lessen a serious and imminent threat to the health or safety or any person or the public, and disclose PHI to someone in a position to prevent or lessen the threat, including to the target of the threat. Disclosure may also be made to law enforcement officials to identify or apprehend a person involved in a violent crime involving serious physical harm to a person, or if escape from a correctional institution or lawful custody is believed to have occurred.

To MILITARY AND VERTERANS. We may disclose your PHI if you are in the armed forces, as required by command authorities, for the proper execution of a military mission.

For NATIONAL SECURITY, INTELLIGENCE ACTIVITIES, AND PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS. We may disclose your PHI to officials as authorized by law to perform their duties and conduct investigation.

To CORRECTIONAL FACILITIES. Regarding inmates, we may disclose your PHI to a correctional institution or law enforcement official to the extent required by law, by court order or as authorized by law or rule.

For WORKERS COMPENSATION. We may disclose your PHI as authorized by and to the extent necessary to comply with the Maine Workers’ Compensation Act or other similar programs that provide benefits for work-related injuries or illness without regard to fault.

To THE U.S. DHHS. We must disclose your PHI to the Secretary of the U.S. Department of Health & Human Services to investigate or determine our compliance with the federal laws and regulations.

E. YOU HAVE THE FOLLOWING RIGHTS:

To exercise these rights see the contact information in this Notice.

To Obtain a Copy of this Notice on Request. You may request a paper copy of this Notice at our office, by making a request by telephone (see the Contact Information below), or electronically or from our website, listed in the Contact Information below.

To Request a Restriction on Certain Uses and Disclosures. You have the right to request that we restrict uses or discloses of your PHI to carry out treatment, payment and health care operations. We are not required to agree to any restrictions that you may request. If we agree with your request, we will comply, except to the extent that disclosure has already occurred or if disclosure is needed to provide emergency treatment.

To Request a Restriction on Certain Uses and Disclosures, Continued.

We have the right at our discretion to terminate our agreement to the restriction, if certain conditions are met.

To Inspect and Request a Copy of Your Health Record. Except for limited circumstances under State or Federal laws or regulations, you have the right to inspect and obtain a copy of your “Designated Record Set” (the treatment information and billing records used in your treatment) that is part of your PHI. Your right to inspect and obtain a copy to your Designated Record Set may be limited under law or rule, or if disclosure is detrimental to the health of the patient, in which case, we will as your appoint a Personal Representative to whom the Designated Record Set will be disclosed.

A fee may be charged to disclose a copy of your record. You may be provided with a narrative of your PHI, if you agree to receive one. You will be required to sign an authorization to receive your Designated Record Set. Unless Maine law or rules provide otherwise, we will respond top your request within a reasonable time, but no later than 30 days from the date of your request, unless we provide you with written notice regarding a delay.

If you are denied access to your Designated Record Set for any reason, we will inform you about the reason and your rights to challenge this decision. We are not required to provide you with access to your Psychotherapy Notes or personal notes not related to your health care. We also are not required to provide you with information complied in connection with a civil, criminal or administrative action or proceeding, or information obtained in other certain limited circumstances.

To Request an Amendment to Your Health Record. You have the right to request that we amend, correct or clarify the PHI in your “Designated Record Set” (the treatment information and billing records used in your treatment) that is part of your PHI. If you believe that your PHI is incorrect or needs clarification, you may request that we correct or clarify your health information, and you may provide information that corrects or clarifies your health information. Your request must be in writing and give reason. We will respond to your request no later than 60 days from the date of your request, unless we provide you with written notice regarding a delay. We may deny your request in certain circumstances, such as a request to amend billing information created by another health care provider. (if this occurs, we will provide you with a denial in writing and your rights to address the denial).

We will not delete any health information or PHI in your records. We may charge reasonable costs for correcting or clarifying your health information or amending your Designated Record Set. We may add a statement to your PHI in response to your correction or clarification, and if so, we will provide you with a copy of this statement.

We will require that you identify persons who have received disclosure of the PHI that you have corrected, clarified or amended and will request your agreement to share the corrected, clarified, or amended PHI with such person(s) and with our Business Associates or others that may have relied on the PHI to your detriment.

To Request an Accounting of Disclosures of Your Protected Health Information. Subject to certain limitations, you have the right to a written accounting of disclosures that we have made of your PHI. An accounting of disclosures will not include disclosures for more than 6 years prior to the date of your request for accounting.

This accounting will not include disclosures made for purpose of treatment, payment or health care operations. It will also not include disclosures to you or authorized by you; disclosures incidental to permitted disclosure; or certain other disclosures excluded by regulations.

The right to receive an accounting is subject to certain other exceptions, restrictions and limitations set froth in applicable statutes and regulations. We will respond to your request for an accounting no later than 60 days from the date of your request, unless we provide you with written notice regarding any delay. We will provide you with one accounting every 12 months free of charge. We may charge a fee for any additional accounting of disclosures within a one-year period.

To Request that We Contact you by Alternate Means. You have the right to reasonable accommodation of a request to receive communications of PHI by alternate means (for example, fax versus mail) or contact at an alternate location (address or phone number). Your request must be in writing, and we will agree if the request is reasonable. We will not require an explanation of your reason for the request as a condition to agreeing to your request, but we may require you to provide information regarding how payment will be handled and that you specify an alternate address or other method of contact.

F. CONTACT INFORMATION. To exercise any of the above rights or if you have any questions, contact our Privacy Official, at (207) 7610177.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with us, in writing, addressed to –

Privacy Official

1375 Congress Street

Portland, Maine 04102

207.761.0177

Fax 207 .780.1055

www.cecofne.com

There will be no retaliation for filing a complaint. You also may complain to the Secretary of the Department of Health and Human Services.

G. CHANGES TO THIS NOTICE. We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI that we already have about you as well as for any PHI we receive in the future. We will post a copy of the current Notice at your office and on our website at www.cecofne.com. You may obtain a paper copy of the current Notice in effect by calling us at any time and requesting that one be sent to you by mail or by asking for one when you are at the office

Notice of Privacy Practice, rev. 05-2006/mle