West Point Aesthetic Center
Unlock Your Inner Beauty
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Effective Date: April 14, 2003
This medical practice attains health information about you and stores it in a chart and a computer to maintain your medical record. While the information in medical records belongs to you, the medical record itself the property of this medical practice. We are committed to preserving the privacy and confidentiality of your health information, which is created and/or maintained at our medical office. State and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of you health information. This includes any information that we receive from other health care providers or facilities. The Notice describes the way in which we may use or disclose your health information and your rights and our obligations concerning such uses or disclosures.
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 health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
Treatment- We may use health information about you to coordinate your medical treatment and services. We may disclose health information about you to doctors, nurses, technicians, medical students, interns, or other allied health personnel who are involved in taking care of you during your visit with us. We may also communicate information to another non-WPMC health care provider for the purposes of coordinating your continued care.
Payment - We may use and disclose your information for billing, and to arrange for payment from you, an insurance company, a third party or collection agency. This may also include the disclosure of health information to obtain prior authorization for treatment and procedures from your insurance plan.
Health Care Operations - Uses and disclosures of health information are necessary to operate our health care facility and to make sure all of our patients receive quality care. We may use and disclose relevant health information about you for health care operations. Examples include quality assurance activities, post-discharge telephone calls to follow up on your health status, granting medical staff credentials, administrative activities including WPMC Health financial and business planning and development, customer service activities including investigation of complaints, and certain marketing activities such as health education options for treatment and services.
Appointment Reminders - We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care at our health care facility. These appointment reminders may be initiated by an automated voice message system.
Individuals Involved in Your Care or Payment for Your Care - We may disclose health information about you to a friend or family member who is involved in your medical care or payment for your care, or providing translation, such as your family or a friend you bring with you. We may make such disclosures when: (a) we have your verbal agreement to do so; (b) we make such disclosures and you do not object; or (c) we can infer from the circumstances that you would not object to such disclosures, for example if that person come into the exam room with you. We may also notify your family about your location or general condition or disclose such information in and emergency, to an entity assisting in a disaster relief effort. If you are unable or unavailable to agree or object, our health professional will use their best judgment in communication with your family and others.
Marketing - We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatment or health-related benefits and services that my be of interest to you., or provide you with promotional items.
SPECIAL SITUATIONS THAT DO NOT REQUIRE YOUR INFORMATION CONSENT OR AUTHORIZATION
The following disclosures of your health information are permitted by law without any oral or written permission from you:
Organ and Tissue Donation- If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans - If you are a member of the armed forces, we may release health information about you as required by military command authorities.
Worker's Compensation - We may release health information about you for worker's compensation or similar programs if you have a work related injury. These programs provide benefits for work related injuries.
Averting a Serious Threat to Health or Safety - We may use and disclose health information about you when necessary to prevent a serious threat to your health or safety or the health and safety of another person or the public. These disclosures would be made only to someone able to help prevent the threat.
Public Health Activities - We may disclose health information about you for public health activities. These generally include the following:
Health Oversight Activities- We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections and licensure. These activities are necessary for the government and other authorized bodies to monitor the health care system, government programs and compliance with civil rights laws.
Inmates- If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose health information about you to the correctional institution or the law enforcement official. This is necessary for the correctional institution to provide you with health care, to protect your health and safety and the health and safety of others, or for the safety and security of the correctional institution. Lawsuits and Disputes - If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may disclose health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.
Law Enforcement - We may disclose health information if asked to do so by law enforcement officials for the following reasons:
Research That Does Not Involve Your Treatment - When a research study does not involve any treatment, we may disclose your health information to researchers when an Investigational Research Committee has reviewed the research protocol has established appropriate protocols to ensure the privacy of your health information and has waived the need for authorization.
Coroners, Medical Examiners and Funeral Home Directors - We may disclose health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death of a person. We may also release health information about patients at our facility to funeral home directors as necessary to carry out their duties.
National Security and Intelligence Activities - We may disclose health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Legal Requirements - We will disclose health information about you without your permission when required to do so by federal, state or local law.
Situations Requiring Your Written Authorization
If there are reasons we need to use your information that have not been described in the sections above, we will obtain your written permission (called an "authorization.") If you authorize us to use or disclose health information about you, we may continue to do so until you revoke your authorization or the authorization expires. You may revoke your authorization at any time, in writing. Please understand that we are unable to take back any disclosures or uses we have already made with your permission, and we are required to retain our records of care that we provided to you. Some typical disclosures that would require your specific authorization are:
Special Categories of Treatment Information: In most cases, federal or state law requires your written authorization or the written authorization of your legal representative for disclosures of drug and alcohol abuse treatment, Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) test results, and mental health treatment.
Research Involving Your Treatment: When a research study involves your treatment, we may disclose your health information to researchers only after you have signed a specific written authorization. In addition, an Institutional Review Committee (IRC) will already have reviewed the research proposal, established appropriate protocols to ensure the privacy of your health information and approved the research. You do not have to sign the authorization, but if you refuse you cannot be part of the research study and may be denied research related treatment.
YOUR MEDICAL INFORMATION RIGHTS
Although your health record is the physical property of WPMC Health entity that created it, the information belongs to you.
You have the right to:
Questions or Complains
If you have any questions regarding this Notice please ask the receptions for the Manager. If you believe your privacy rights have been violated, you many file a complaint with our manger. If a favorable resolution has not been reached you may contact our Medical Director at:
Atul Bembi D.O.
7798 Cherry Ave.
Fontana, CA 92336
If not resolved:
Secretary of the Department of Health and Human Services
Office of Civil Right, Hubert H. Humphrey Bldg.
200 Indolence Ave. S. W. Room 509F HHH Building
Washington, DC 20201