HIPPA PRIVACY NOTICE

Notice of Privacy Practices
This Notice describes how Hogue Cosmetic Surgery may use and disclose your healthcare information and how you (as a patient of this practice) can obtain access to this information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review it carefully.

Hogue Cosmetic Surgery is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Hogue Cosmetic Surgery or received by Hogue Cosmetic Surgery from other healthcare providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice. Hogue Cosmetic Surgery will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information.

Uses and Disclosures of Your Protected Health Information Not Requiring Your Consent
Hogue Cosmetic Surgery may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment and healthcare operations.

For Treatment: We may use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party. For example, your protected health information may be provided to a physician to whom you have been referred, to ensure that the physician has the necessary information to diagnose or treat you.

For Payment: We may use and share medical information about you so we can be paid for treating you. An example is giving information about you to your health plan or to Medicare.

For Healthcare Operations: We may use and disclose your protected health information during routine healthcare operations including, without limitation, utilization review, evaluation of our staff, assessing the quality of care and outcomes in the patient’s case and similar cases, internal auditing, accreditation, certifications, licensing or credentialing activities, private health research and educational purposes.

Scheduling and Appointment Reminders:
We may use and disclose your protected health information obtained when scheduling medical or other healthcare services and when we contact the patient as a reminder of an appointment for services. We may also use and disclose protected health information to tell the patient or others of information about treatment alternatives or other health-related benefits and services of possible interest to the patient.

Treatment Alternatives:
We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Uses and Disclosure of your Protected Health Information in Certain Special Circumstances
Release of Information to Family/Friends: We may release your protected health information to a friend or family member who is involved in your care, or who assists in taking care of you.

To Avert a Serious Threat to Health and Safety: We may disclose protected health information to avert a serious threat to someone’s health or safety. We may also disclose protected health information to federal, state or local agencies engaged in a disaster relief or disaster assistance agencies to allow such entities to carry out their responsibilities in specific disaster situations.

For Law Enforcement or Specific Government Functions: We may disclose protected health information in response to a request by a law enforcement official made through a court order, subpoena, warrant, summons or similar process. We may disclose protected health information about you to federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Lawsuits or Similar Proceedings:
If you or your estate is involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose your protected health information about you in response to a subpoena, discovery request, or law process by someone else involved in the dispute.

Workers' Compensation:
Our practice may release your protected health information for workers’ compensation and similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risk:
We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability, or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.

Health Oversight Activities:
We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.

Coroners, Medical Examiners and Funeral Directors:
We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

Information Not Personally Identifiable:
We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Your Rights Regarding Health Information About You
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health information, such as medical and billing records, that we use to make decisions about your care. You must submit a written request to our Hogue Cosmetic Surgery (Maple Grove, MN – Corporate Office) Business Manager, Scott Roth, in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you make ask that the denial be reviewed. If law requires such a review, we will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.

Right to Request Confidential Communications: You have the right to request that we communicate with you about your protected health information in a certain way or at a certain location if you tell us that communication in another manner will endanger you. For example, you can ask that we only contact you at work or by mail. To request confidential communication, you must make your request in writing to our Hogue Cosmetic Surgery (Maple Grove, MN – Corporate Office) Business Manager, Scott Roth, and specify how or where you wish to be contacted. We will accommodate all reasonable requests. You do not need to give a reason for your request.

Right to Request Restrictions:
You have the right to request a restriction or limitation on health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your case or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a treatment that you had.

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 with emergency treatment. To request restrictions, you may submit a Request for Restriction on Use / Disclosure of Medical Information to our Hogue Cosmetic Surgery (Maple Grove, MN – Corporate Office) Business Manager, Scott Roth.

Changes to this Notice:
We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. You are entitled to a copy of the HIPAA Privacy Notice currently in effect.

Complaints:
You have the right to file a written complaint with our office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of Hogue Cosmetic Surgery. We will not retaliate against you for filing a complaint

Please contact our Hogue Cosmetic Surgery (Maple Grove, MN – Corporate Office) Business Manager, Scott Roth, for more information:

Hogue Cosmetic Surgery
ATTN: Scott Roth
7365 Kirkwood Ct N, Ste 120
Maple Grove, MN 55369
Tel: 763.447.2500
Fax: 763.447.2505
scott@drhogue.com