Mariam Awada, MD, FACS Board Certified Plastic Surgeon HIPAA Privacy Policy

Michigan Cosmetic Surgery notice of Privacy Practices

Effective August 1, 2005

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.

WHO WILL FOLLOW THIS NOTICE?

This notice describes the practices of Michigan Cosmetic Surgery and the practices that will be followed by all of Michigan Cosmetic Surgery workforce members who handle your medical information.

OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION

Michigan Cosmetic Surgery 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 notice applies to all of the records of your medical care which are received or created by Michigan Cosmetic Surgery.

Your other medical treatment providers (e.g. doctors, hospitals, home health agencies, etc.) may have different policies or notices regarding the use and disclosure of your medical information.

This notice will tell you about the ways in which Michigan Cosmetic Surgery 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.

In this notice, we also describe your rights and certain obligations Michigan Cosmetic Surgery has regarding the use and disclosure of your protected health information. We are required by name 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 notice that is currently in effect.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

By becoming a patient at Michigan Cosmetic Surgery, you are giving consent for Michigan Cosmetic Surgery to use your protected health information for certain activities, including treatment, payment and other health care operations. Sometimes, you may hear these three activities referred to as “TPO”.

First of all, we may use and disclose protected health information about you so that Michigan Cosmetic Surgery 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. For example, we will submit protected health information about you to your insurance company in order to receive payment for services we have provided to you. We may also use and disclose protected health information about you for Michigan Cosmetic Surgery‘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.

Other uses and disclosures of your protected health information

The following 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 Michigan Cosmetic Surgery are only those which are permitted under the law).

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 29110 Inkster Rd., Suite 250 Southfield, MI 48034 . We will accommodate all reasonable requests.

Uses and disclosures to others involved in your healthcare

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 Notice as soon as reasonably practicable after the delivery of treatment.

Uses and disclosures for health-related benefits or services

From time to time, Michigan Cosmetic Surgery may use and disclose 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. You will be notified, if the law requires us to do so, of any such uses or disclosures.

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 for health oversight activities

We may disclose protected health information to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, the delivery of health care, government benefit programs, other government regulatory programs and civil rights laws.

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 state law.

Disclosures to the food and drug administration

We may disclose your protected health information to a person or company required by the FDA to report adverse events, product defects, etc., and conduct product recalls or safety audits.

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 or administrative order. We may also respond to a subpoena or discovery request if proper safeguards are in place.

Disclosures to law enforcement

We may release protected health information if asked to do so by a law enforcement official, in accordance with applicable legal processes.

Disclosures to coroners, funeral directors, and organ donation

We may disclose information to coroners or funeral directors as required by law, or in anticipation of death, and to facilitate organ donation arrangements.

Disclosures for research

We may disclose protected health information for research purposes when approved by appropriate authorities and with safeguards in place.

Disclosures related to criminal activity

We may disclose protected health information if necessary to prevent a serious threat to health or safety or to identify a suspect, fugitive, witness, or missing person.

Disclosures for Workers’ Compensation

We may release protected health information as required for Workers’ Compensation claims.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

Right to inspect and copy

You have the right to inspect and request copies of your medical information. Requests must be made in writing. A fee may apply for copies.

Right to request restrictions

You may request limitations on how we use or share your medical information. Requests must be submitted in writing to 29110 Inkster Rd., Suite 250 Southfield, MI 48034 .

Right to confidential communications

You may request that we contact you using specific methods or locations. Requests must be submitted in writing to 29110 Inkster Rd., Suite 250 Southfield, MI 48034 .

Right to amend

If you believe your information is incorrect or incomplete, you may request an amendment by contacting 29110 Inkster Rd., Suite 250 Southfield, MI 48034 .

Right to an accounting of disclosures

You may request a list of certain disclosures of your protected health information. Requests must be submitted in writing.

Right to a paper copy of this notice

You have the right to request a paper copy of this Notice. You can also download it at https://sage.michigancosmeticsurgery.com/.

Changes to this notice

Michigan Cosmetic Surgery reserves the right to revise this notice at any time. Updates will be available at https://sage.michigancosmeticsurgery.com/.

Complaints

If you believe your rights have been violated, contact Dr. Mariam Awada at 29110 Inkster Rd., Suite 250 Southfield, MI 48034 . Complaints must be in writing.

Other uses of protected health information

All other uses and disclosures require your written permission. You may revoke authorization at any time in writing.

Questions?

If you have any questions about this notice, contact the Office Manager at Michigan Cosmetic Surgery or call 248-948-5500.