Last Revised: December 1, 2016
NOTICE OF PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Procedures (the “Policy” or “Notice”) describes the practices of Ohio Clinic for Aesthetic and Plastic Surgery, Inc. (“OCAPS,” “we” or “us”) with respect to your protected medical information.
OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION
OCAPS understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care. This Policy applies to all of the records of your medical care which are received or created by OCAPS.
Your other medical treatment providers (e.g. doctors, hospitals, home health agencies, etc.) may have different policies regarding the use and disclosure of your medical information. This Policy describes the ways in which OCAPS may use and disclose medical information about you. Your medical information, also referred to as “protected health information” is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health information and related health care services. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
This Policy also describes your rights and certain of the obligations that OCAPS has regarding the use and disclosure of your protected health information. We are required to:
- Make sure that medical and other information that identifies you (protected health information) is kept private.
- Give you this notice of our legal duties and privacy practices with respect to protected health information about you.
- Follow the terms of the Policy that is currently in effect.
USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
If a doctor-patient relationship is formed between us, you are giving consent for OCAPS, OCAPS employees, and Dr. Michael H. Wojtanowski to use your protected health information for certain activities, including treatment, payment and other health care operations.
We may use and disclose protected health information about you so that OCAPS and its medical professionals can treat you. For example, we may use your past medical information in order to diagnose your present condition or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you. We may also use and disclose protected health information about you for OCAPS's health care operations, in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs or we may provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services in Ohio.
The following additional uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, but be assured that all uses and disclosures made by OCAPS are only those which are permitted under the law).
- Treatment Information. We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
- Licensure Proceedings by the American Board of Plastic Surgery.
- Uses and Disclosures for Appointment Reminders. We may use and disclose your medical information to contact you as a reminder that you have an appointment at the office. If you request that such communications be made confidentially, please contact our office in writing at:
Ohio Clinic for Aesthetic and Plastic Surgery
Westlake Corporate Park
2237 Crocker Road
Westlake, Ohio 44145
We will accommodate all reasonable requests.
- Uses and Disclosures to Others Involved In Your Health Care. We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your medical care. If you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
- Uses and Disclosures in Emergency Situations. We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician will attempt to obtain your acknowledgment of this Policy as soon as reasonably practicable after the delivery of treatment.
- Uses and Disclosures for Health-related Benefits or Services. From time to time, OCAPS may use and disclosure protected health information to tell you about certain health related benefits or services that may be of interest to you.
- Uses and Disclosures Required by Law. We will use or disclose protected health information about you when required to do so by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if the law requires us to do so, of any such uses or disclosures.
OTHER USES AND DISCLOSURES THAT MAY OCCUR OF PROTECTED HEALTH INFORMATION
In addition to disclosures of your protected health information for treatment, payment and health care operations, we disclose your protected health information in the following circumstances:
- Disclosure to the Department of Health and Human Resources. We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.
- Uses and Disclosures Related to 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.
- Disclosures of Abuse or Neglect. We may disclose your protected health information to a public health authority authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to a governmental entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with Ohio law.
- Disclosures for Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court order or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
- Law Enforcement. We may release protected health information if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process as well as disclosures to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.
- Disclosures to Coroners, Funeral Directors, and Organ Donation. We may disclose protected health information about you to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties required by law. We may also disclose protected health information about you to a funeral director in order to permit the funeral director to carry out legal duties, and may do so if death is reasonably anticipated. Your protected health information may also be disclosed for certain organ donations to which you may have agreed.
- Disclosures for Research. We may disclose your protected health information to researchers when their research has been approved and protocols have been established to ensure the privacy of your information. We may also disclose a limited set of your information, as allowed under the law, for research purposes.
- Disclosures Related to Criminal Activity. We may disclose your protected health information, consistent with federal and Ohio laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public, or if it is necessary for law enforcement authorities to identify or apprehend an individual.
- Disclosures for Workers' Compensation. We may release protected health information about you for Workers' Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
- Right to Inspect and Copy. You have the right to inspect and copy protected health information that may be used to make decisions about your medical care. This right includes both medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.
- Right to Request Restrictions. You have the right to request that we restrict the use and disclosure of your protected health information for treatment, payment and health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
If you pay for a service or health care item out of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” to this request unless the law requires us to share that information.
To request restrictions, you must make your request in writing to Ohio Clinic for Aesthetic and Plastic Surgery, Westlake Corporate Park, 2237 Crocker Road, Suite 140, Westlake, Ohio 44145.
In your written request, you must tell us: (1) What information you want to limit; (2) Whether you want to limit our use, disclosure, or both; and (3) To whom you want the limits to apply.
- Right to Confidential Communications. You have the right to request to receive private health information communications (such as appointment confirmations) by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Ohio Clinic for Aesthetic and Plastic Surgery, Westlake Corporate Park, 2237 Crocker Road, Suite 140, Westlake, Ohio 44145. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Amend. If you feel that the protected health information we have about you is incorrect or incomplete, you have the right to request that your protected health information be amended. Please note, however, that only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your protected health information is responsible for amending it.
- Right to an Accounting of Disclosures. You have a right to an accounting of disclosures of your protected health information, for purposes other than treatment, payment or health care operations by OCAPS or any of the people or companies who perform treatment, payment or health care operations on our behalf. To request this list of disclosures we made of protected health information about you, you must submit a request in writing to Ohio Clinic for Aesthetic and Plastic Surgery, Westlake Corporate Park, 2237 Crocker Road, Suite 140, Westlake, Ohio 44145. Your written request must state a time period which may not be longer than six (6) years prior to the date of your request. Your request should indicate the form in which you want the list (for example, on paper or electronically). You will be charged for photocopying.
- Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
- Right to a Paper Copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this notice at any time.
YOUR CHOICES REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
- Choice to Share Information. You have the right and choice to tell us to share information with your family, close friends or others involved in your care or share information in a disaster releif situation. We may also include your information in a patient directory. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
- Written Permission Required. We never share your information for marketing purposes unless you give us written permission. We will never sell your information without written permission. In most instances, we will not share psychotherapy notes without your written permission.
- Fundraising. We may contact you for fundraising efforts, but you can tell us not to contact you again.
CHANGES TO THIS NOTICE
OCAPS reserves the right to change this Notice. We reserve the right to make the revised or changed Notice effective for protected health information we already have about you, as well as any information we create or receive in the future. We will post a copy of the current Notice on OCAPS website: www.ohioclinic.com, at The Ohio Clinic for Aesthetic and Plastic Surgery, and will make paper copies available upon request. The Notice will contain, in the top left-hand corner, the effective date.
If you believe your privacy rights have been violated and/or that OCAPS, its employees or Dr. Michael H. Wojtanowski have not followed this Policy, you may file a complaint with Dr. Carlos Wolf, Office Manager or with the Secretary of the Department of Health and Human Services.
To file a complaint contact:
Ohio Clinic for Aesthetic and Plastic Surgery
Westlake Corporate Park
2237 Crocker Road
Westlake, Ohio 44145
Attention: Office Manager
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of your protected health information not covered by this Notice or the laws that apply to Dr. Michael H. Wojtanowski will be made only with your written permission (”authorization”). If you provide us authorization to use or disclose protected health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose protected health information about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical treatment or other services that we have provided to you.