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HIPAA Notice of Privacy Practices in Jamestown, ND

This notice describes how Medi Spa information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

OUR RESPONSIBILITY

Medallus Medi Spa  is committed to protecting the privacy of your Medi Spa information. Your care and treatment is recorded in a Medi Spa record that is considered protected health information (“PHI”). To best meet your Medi Spa needs, we share your PHI with the providers and facilities involved in your care. We share your information only to the extent necessary to collect payment for services we provide and to conduct our business operations. We train our associates and providers to be sensitive to the privacy and confidentiality of your PHI. Except as outlined below, we will not use or disclose your PHI for any other purpose unless you have signed a Spa Record Authorization form.

USES AND DISCLOSURE OF YOUR PHI

We may use and share your PHI in the following ways without requiring your authorization. It should be noted that while not every use or disclosure will be listed, each of the ways we are permitted to use or disclose information will fall into one of the following areas:
  • To provide, coordinate or manage your Medi Spa treatment and services. For instance, doctors, nurses and other professionals involved in your care, will use information in your Medi Spa record to plan a course of treatment for you that may include procedure, medications, tests, ect. We may also disclose your PHI to institutions and individuals outside of Medallus Medi Spa  that are or will be providing treatment to you.
  • To bill and receive payment for the treatment and services you received. For instance, we may
    forward information regarding your Medi Spa procedures and treatment to your insurance
    company to arrange payment for the services provided to you or we may use your information
    to prepare a bill to send to you or to the person responsible for your payment.
  • To run our practice, improve your care, and contact you when necessary. For example we may
    use your PHI in order to conduct an evaluation of treatment and services we provide.
    We may use your PHI to remind you about appointments and from time to time, to communicate
    with you about treatment alternatives and other health-related benefits and service that may be
    of interest to you.
  • For workers’ compensation or similar programs.
  • For public health safety issues such as preventing disease, helping with product recall, reporting
    adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence
  • For health oversight agency, such as the Utah Health Department, HHS or Animal Control
  • In response to a court order, subpoena, or warrant and to law enforcement officials in certain
    limited circumstances.

RIGHTS THAT YOU HAVE

  • When it comes to your health information, you have certain rights. This section explains your
    rights and some of our responsibilities to help you.
  • You can ask to see or get an electronic or paper copy of your Medi Spa record, by filling out a
    Spa Record Authorization form and submitting it to our Main Office. We will provide a copy of
    your Medi Spa record, within 30 days of your request.
  • You can ask us to correct your Medi Spa record if you think it is incorrect or incomplete. You will need to complete a Health Information Amendment form and submit it to the Main Office. We may decline your request, but we’ll tell you why in writing within 60 days.
  • You can ask us not to share certain Medi Spa record information for treatment or payment.
  • You can ask for an accounting of the times we have shared your Medi Spa record for the last 6
    years, who we shared it with and why.
  • You can ask for a paper copy of this notice at any time.
  • You can choose someone to whom information may be disclosed or if someone is your legal
    guardian, that person can make choices about your Medi Spa record.

BREACH NOTIFICATION

We are required to notify you in writing of any breach of your unsecured PHI as soon as possible, but in any event, no later than 60 days after we discovered the breach.

BUSINESS ASSOCIATES

At times it may be necessary for us to provide your PHI to one or more outside persons or organizations who assist us with our payment/billing activities and healthcare operations. In each case, we require these business associates and any of their subcontractors, to appropriately safeguard the privacy of you information.

OUR NOTICE OF PRIVACY PRACTICE

We are required by law to maintain the privacy of our patients’ PHI. We are required to abide by the terms of this Notice of Privacy Practice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practice as necessary. You may receive a copy of any revised notice at any of our clinic locations. The terms of this notice apply to all of our clinic locations equally.

EFFECTIVE DATE

This Notice of Privacy Practice is effective August 1, 2014

COMPLAINTS

If you think that we have not respected the privacy of your health information, you are free to express concerns by contacting the Medallus Medi Spa  Compliance Office at 801-260-1919 or by sending a letter to After Hours Spa Compliance Office, PO Box 1000 Draper, UT 84020.

Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by sending a letter to: 200 Independence Avenue, S.W., Washington, DC 20201, Calling 1-877-696-6775, or visiting ww.hhs.gov/ocr/privacy/hippa/complaints/.
721B 1st Ave South Jamestown,
North Dakota 58401

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