NOTICE OF PRIVACY PRACTICES
SELV HEALTH & AESTHETICS
IMPORTANT NOTICE
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.
Selv Health & Aesthetics is committed to protecting the privacy and security of your protected health information, also known as PHI. This Notice of Privacy Practices explains how we may use and disclose your health information, your rights regarding your health information, and our responsibilities to protect it.
WEBSITE COMMUNICATION NOTICE
Please do not submit protected health information, medical history, symptoms, photographs, treatment questions, insurance information, or other sensitive health details through this website, email, social media messages, or general contact forms.
Communications made through this website, including email or contact forms, may not be encrypted and are not intended for sharing protected health information.
If you need to share medical information, ask treatment-related questions, or communicate about your care, please contact Selv Health & Aesthetics directly so we can direct you to the appropriate secure communication method.
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
GET AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD
You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
ASK US TO CORRECT YOUR MEDICAL RECORD
You may ask us to correct health information about you that you believe is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
REQUEST CONFIDENTIAL COMMUNICATIONS
You may ask us to contact you in a specific way, such as by phone, email, or mail, or to send communications to a different address. We will say “yes” to all reasonable requests.
ASK US TO LIMIT WHAT WE USE OR SHARE
You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a healthcare item or service out-of-pocket in full, you may ask us not to share that information with your health insurer for payment or healthcare operations purposes. We will say “yes” unless a law requires us to share that information.
GET A LIST OF THOSE WITH WHOM WE HAVE SHARED INFORMATION
You may ask for a list, also called an accounting of disclosures, of the times we have shared your health information for six years prior to the date of your request, who we shared it with, and why.
We will include all disclosures except those related to treatment, payment, healthcare operations, and certain other disclosures, such as those you asked us to make. We will provide one accounting per year for free, but we may charge a reasonable, cost-based fee if you request another one within 12 months.
GET A COPY OF THIS NOTICE
You may ask for a paper copy of this Notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.
CHOOSE SOMEONE TO ACT FOR YOU
If you have given someone medical power of attorney, or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will verify that the person has authority to act for you before taking action.
FILE A COMPLAINT IF YOU BELIEVE YOUR RIGHTS HAVE BEEN VIOLATED
You may file a complaint if you believe we have violated your privacy rights by contacting us at:
Privacy Contact: Je’Nae Thomas, NP
Email: info@selvhealth.com
Phone: 470-610-3430
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
You may also call 1-877-696-6775 or visit HHS.gov.
We will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you may tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, please tell us what you want us to do, and we will follow your instructions when required or permitted by law.
You have both the right and choice to tell us to:
Share information with your family, close friends, caregivers, or others involved in your care.
Share information in a disaster relief situation.
Contact you using your preferred communication method, when reasonable.
If you are not able to tell us your preference, such as in an emergency situation, we may share your information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.
USES AND DISCLOSURESE REQUIRING WRITTEN AUTHORIZATION
We will not use or disclose your protected health information for the following purposes unless you give us written authorization:
Marketing purposes, when required by law.
Sale of your protected health information.
Other uses and disclosures not described in this Notice.
If you authorize us to use or disclose your information, you may revoke that authorization in writing at any time. We will honor your revocation going forward, but we cannot take back disclosures already made based on your prior authorization.
FUNDRAISING
Selv Health & Aesthetics does not use your protected health information for fundraising communications.
HOW WE USE AND DISCLOSE YOUR INFORMATION
We typically use or share your health information in the following ways.
TO TREAT YOU
We may use your health information and share it with other professionals who are treating you.
Example: A healthcare provider involved in your care may ask about your health history, treatment plan, medications, lab work, allergies, symptoms, or other relevant information.
TO RUN OUR ORGANIZATION
We may use and share your health information to run our practice, improve your care, manage appointments, provide customer service, support internal operations, and contact you when necessary.
Example: We may use health information to manage your treatment, coordinate services, review quality of care, or follow up about your visit.
TO BILL FOR OUR SERVICES
We may use and share your health information to bill and receive payment from you, your health plan, or other responsible entities, when applicable.
Example: We may provide information to your health insurance plan, payment processor, or billing provider so services may be paid for.
OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
We may use or disclose your protected health information in the following situations without your written authorization, when permitted or required by law.
PUBLIC HEALTH AND SAFETY
We may share health information for public health and safety activities, such as:
Preventing disease.
Helping with product recalls.
Reporting adverse reactions to medications or treatments.
Reporting suspected abuse, neglect, or domestic violence.
Preventing or reducing a serious threat to anyone’s health or safety.
COMPLYING WITH THE LAW
We will share information about you if state or federal laws require it, including with the U.S. Department of Health and Human Services if it wants to confirm that we are complying with federal privacy law.
HEALTH OVERSIGHT ACTIVITIES
We may share health information with health oversight agencies for activities authorized by law, such as audits, investigations, inspections, licensing, or disciplinary actions.
LEGAL PROCEEDINGS
We may share health information about you in response to a court or administrative order, subpoena, discovery request, or other lawful process, when legally required or permitted.
LAW ENFORCEMENT
We may share health information for law enforcement purposes when required or permitted by law.
WORKERS’ COMPENSATION
We may use or disclose health information for workers’ compensation claims or similar programs, when applicable.
MEDICAL EXAMINERS, CORONERS AND FUNERAL DIRECTORS
We may share health information with a coroner, medical examiner, or funeral director when an individual dies.
ORGAN AND TISSUE DONATION
If applicable, we may share health information with organ procurement organizations.
RESEARCH
We may use or share your information for health research when permitted by law and when applicable privacy protections are in place.
SPECIALIZED GOVERNMENT FUNCTIONS
We may share health information for specialized government functions, such as military, national security, or protective services, when required or permitted by law.
OUR RESPONSIBILITIES
Selv Health & Aesthetics is required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this Notice and provide you with a copy of it.
We will not use or share your information other than as described in this Notice unless you authorize us to do so in writing. If you authorize us to use or share your information, you may change your mind at any time by notifying us in writing.
SECURE PATIENT COMMUNICATIONS
Selv Health & Aesthetics uses secure communication methods, when appropriate, for medical communications and the exchange of protected health information.
Patients should not use general website forms, standard email, social media messages, or other non-secure communication channels to submit protected health information.
If you need to send protected health information to Selv Health & Aesthetics , please contact us first so we can provide instructions for a secure method of communication.
WEBSITE DATE IS ADDRESSED SEPARATELY
This Notice applies to protected health information used or maintained by Selv Health & Aesthetics in connection with healthcare services.
This Notice does not fully describe how our website may collect non-medical technical information, such as cookies, browser data, device information, website analytics, or marketing-related data. That information is addressed in a separate Website Privacy Policy.
CHANGES TO THE TERMS OF THIS NOTICE
We may change the terms of this Notice at any time. Changes will apply to all information we have about you.
The updated Notice will be available upon request, in our office, and on our website.
CONTACT INFORMATION
For more information about our privacy practices, to ask questions, to request a copy of this Notice, or to report a concern, please contact:
Selv Health & Aesthetics
Privacy Contact: Je’Nae Thomas, NP
Email: info@selvhealth.com
Phone: 470-610-3430