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. 

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical  information. We make a record of the medical care we provide and may receive such records from others. We use  these records to provide or enable other health care providers to provide quality medical care, to obtain payment  for services provided to you as allowed by your health plan and to enable us to meet our professional and legal  obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected  health information, to provide individuals with notice of our legal duties and privacy practices with respect to  protected health information, and to notify affected individuals following a breach of unsecured protected health  information. This notice describes how we may use and disclose your medical information. It also describes your  rights and our legal obligations with respect to your medical information. If you have any questions about this  Notice, please contact our Privacy Officer listed above. 

A. How This Medical Practice May Use or Disclose Your Health Information 
The medical 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:

1. 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 that  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, or following your death. 

2. Payment. We use and disclose medical information about you to obtain payment for the services we provide.  For example, we give your health plan the information it requires for payment. We may also disclose information  to other health care providers to assist them in obtaining payment for services they have provided to you. In the  event of a financial dispute after the fact, you waive your right to privacy under the Health Insurance Portability  and Accountability Act of 1996 (HIPAA) so that Silicon Valley Institute for Aesthetics can support our claim(s). 3. Health Care Operations. We may use and disclose medical information about you to operate this medical  practice. For example, we may use and disclose this information to review and improve the quality of care we  provide, or the competence and qualifications of our professional staff. Or we may use and disclose this  information to get your health plan to authorize services or referrals. We may also use and disclose this  information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and  compliance programs and business planning and management. We may also share your medical information with  our “business associates,” such as our billing service, that perform administrative services for us. We have a  written contract with each of these business associates that contains terms requiring them and their  subcontractors to protect the confidentiality and security of your medical information. Although federal law does  not protect health information which is disclosed to someone other than another healthcare provider, health plan,  healthcare clearinghouse, or one of their business associates, California law prohibits all recipients of healthcare information from further disclosing it except as specifically required or permitted by law. We may also share your  information with other health care providers, health care clearinghouses or health plans that have a relationship  with you, when they request this information to help them with their quality assessment and improvement  activities, their patient-safety activities, their population-based efforts to improve health or reduce health care  costs, protocol development, case management or care coordination activities, their review of competence,  qualifications and performance of health care professionals, their training programs, their accreditation,  certification or licensing activities, their activities related to contracts of health insurance or health benefits, or  their health care fraud and abuse detection and compliance efforts.  

4. Appointment Reminders. We may use and disclose medical information to contact and remind you about  appointments. If you are not home, we may leave this information on your answering machine or in a message left  with the person answering the phone. 

5. Notification and Communication with Family. We may disclose your health information to notify or assist in  notifying a family member, your personal representative or another person responsible for your care about your  location, your general condition or, unless you have instructed us otherwise, in the event of your death. In the  event of a disaster, we may disclose information to a relief organization so that they may coordinate these  notification efforts. We may also disclose information to someone who is involved with your care or helps pay for  your care. If you are able and available to agree or object, we will give you the opportunity to object prior to  making these disclosures, although we may disclose this information in a disaster even over your objection if we  believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or  object, our health professionals will use their best judgment in communication with your family and others.

6. Marketing. Provided we do not receive any payment for making these communications, we may contact you to  encourage you to purchase or use products or services related to your treatment, case management or care  coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that  may be of interest to you. We may similarly describe products or services provided by this practice and tell you  which health plans we participate in. We will not otherwise use or disclose your medical information for marketing  purposes or accept any payment for other marketing communications without your prior written authorization.  The authorization will disclose whether we receive any financial compensation for any marketing activity you  authorize, and we will stop any future marketing activity to the extent you revoke that authorization.

7. Sale of Health Information. We will not sell your health information without your prior written authorization.  The authorization will disclose that we will receive compensation for your health information if you authorize us to  sell it, and we will stop any future sales of your information to the extent that you revoke that authorization.

8. 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. 

9. Public Health. We may, and are sometimes required by law to disclose your health information to public health  authorities for purposes related to: 1) preventing or controlling disease, injury or disability; 2) reporting child, elder  or dependent adult abuse or neglect; 3) reporting domestic violence; 4) reporting to the Food and Drug  Administration problems with products and reactions to medications; and 5) reporting disease or infection  exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or  your personal representative promptly unless in our best professional judgment, we believe the notification would  place you at risk of serious harm or would require informing a personal representative we believe is responsible for  the abuse or harm.

10. 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 California law.

11. 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. 

12. Law Enforcement. We may, and are sometimes required by law, to disclose your health information to a law  enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing  person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes. 13. Public Safety. We may, and are sometimes required by law, to disclose your health information to appropriate  persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person  or the general public.

14. Proof of Immunization. We will disclose proof of immunization to a school where the law requires the school  to have such information prior to admitting a student if you have agree to the disclosure on behalf of yourself or  your dependent. 

15. Specialized Government Functions. We may disclose your health information for military or national security  purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

16. Workers’ Compensation. We may disclose your health information as necessary to comply with workers’  compensation laws. For example, to the extent your care is covered by workers’ compensation, we will make  periodic reports to your employer about your condition. We are also required by law to report cases of  occupational injury or occupational illness to the employer or workers’ compensation insurer.

17. 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.

18. Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as  required by law. If you have provided us with a current email address, we may use email to communicate  information related to the breach. In some circumstances our business associate may provide the notification. We  may also provide notification by other methods as appropriate. [Note: Only use email notification if you are certain  it will not contain PHI and it will not disclose inappropriate information. For example if your email address is  “digestivediseaseassociates.com” an email sent with this address could, if intercepted, identify the patient and  their condition.] 

19. Research. We may disclose your health information to researchers conducting research with respect to which  your written authorization is not required as approved by an Institutional Review Board or privacy board, in  compliance with governing law. 

B. When This Medical Practice May Not Use or Disclose Your Health Information 
Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal  obligations, 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 
1. 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. If you tell us not to  disclose information to your commercial health plan concerning healthcare items or services for which you paid for  in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal  reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.

2. Right to Request Confidential Communications. You have the right to request that you receive your health  information in a specific way or at a specific location. For example, you may ask that we send information to a  particular email account or to your work address. We will comply with all reasonable requests submitted in writing  which specify how or where you wish to receive these communications. 

3. 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, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and  format. We will provide copies in your requested form and format if it is readily producible, or we will provide you  with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic  format, your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you  designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if  requested and agreed to in advance, the cost of preparing an explanation or summary, as allowed by federal and  California law. We may deny your request under limited circumstances. If we deny your request to access your  child’s records or the records of an incapacitated adult you are representing because we believe allowing access  would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision. If  we deny your request to access your psychotherapy notes, you will have the right to have them transferred to  another mental health professional. 

4. 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. If we  deny your request, you may submit a written statement of your disagreement with that decision, and we may, in  turn, prepare a written rebuttal. You also have the right to request that we add to your record a statement of up to  250 words concerning anything in the record you believe to be incomplete or incorrect. All information related to  any request to amend or supplement will be maintained and disclosed in conjunction with any subsequent  disclosure of the disputed information. 

5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health  information made by this medical practice, except that this medical practice does not have to account for the  disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment),  2 (payment), 3 (health care operations), 5 (notification and communication with family) and 17 (specialized  government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or  public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise  permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would  be reasonably likely to impede their activities. 

6. You have a right to notice of our legal duties and privacy practices with respect to your health information,  including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its  receipt by email. 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 Privacy Officer listed at the top of this Notice of Privacy Practices.

D. Changes to this Notice of Privacy Practices 
We reserve the right to amend our privacy practices and the terms of 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 a copy will be available at each appointment. We will also post the current notice on our  website. 

E. Complaints 
Complaints about this Notice of Privacy Practices or how this medical practice handles your health information  should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices. If you are not satisfied  with the manner in which this office handles a complaint, you may submit a formal complaint to:

Region IX 
Office for Civil Rights 
U.S. Department of Health & Human Services 
90 7th Street, Suite 4-100 
San Francisco, CA 94103 

(800) 368-1019; (800) 537-7697 (TDD) 

The complaint form may be found at www.hhs.gov/hipaa/filing-a-complaint/index.html.

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