Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Effective Date: August 30, 2023

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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

In this Notice, we use the terms “we,” “us,” “our” and the “Practice” to refer to Salar Hazany M.D. Inc., doing business also as Scar Healing Institute (the “Practice”, “we” or “us”) and its physicians, employees, staff, and other personnel. This Notice applies to all services offered by the Practice. Applicable law mandates that our office offers patients a copy of this Notice of Privacy Practices regarding their Protected Health Information (PHI).

1. Our Commitment to Your Privacy:

The Practice strives to maintain the privacy of your individually identifiable health information (i.e., your protected health information or PHI). In providing services to you, we will create records of your treatment and the services we provide to you. By law, we are required to maintain the privacy of PHI, to provide you with this Notice of our legal duties and privacy practices that the Practice upholds concerning your PHI, and to notify affected individuals following any breach of unsecured PHI. Federal and state law mandates we follow the terms of the Notice of Privacy Practices currently in effect.

This Notice provides the following important information:

• How the Practice may use and disclose your PHI to carry out treatment, payment, and health care operations and for other purposes that are permitted or required by law; and
• Your privacy rights concerning your PHI and how you may exercise those rights.

This Notice’s terms apply to all records that the Practice creates or retains that contain your PHI. The Practice reserves the right to amend or revise this Notice of Privacy Practices. Any amendment or revision to this Notice applies to all of your records that the Practice has created or maintained in the past and for future records that we may create or maintain. The Practice will post a copy of our most current Notice in a visible location in our office at all times. We will also post a copy of our most current Notice on our web site. You may request a copy of our most current Notice at any time.

2. For Questions About This Notice, Please Contact:

Please contact the Practice as provided below if you have any questions regarding this Notice or our health information privacy policies:

Salar Hazany, M.D., Inc.

Email: drsalar@hazanyderm.com

Mail: 421 N. Rodeo Dr. Suite T-13 Beverly Hills, CA 90210

Office: (310)-571-8435

 

3. The Practice May Use and Disclose Your PHI in the Following Ways:

The following categories outline the different ways in which we may use and disclose your PHI:

1. The Practice may use your PHI to inform your treatment plan, provide you treatment or services, or provide you with information about treatment or services. For example, the Practice may request you undergo laboratory tests (e.g., blood work or urine tests), and we may use the results to facilitate a proper diagnosis. The Practice may use your PHI to write a prescription for you, or we may disclose your PHI to a pharmacy to order a prescription on your behalf. Many staff members who work for the Practice – including, but not limited to, our doctors, physician assistants, medical assistants, back-office managers, and front office managers – may use or disclose your PHI to provide treatment or facilitate your treatment. Lastly, we may disclose your PHI to other healthcare providers who are not employees of the Practice (such as your primary care physician) to facilitate your treatment or for the purpose of a consultation.
2. The Practice may use and disclose your PHI to others so that we can collect payment and bill you for the services and items we may provide to you. For instance, we may contact your insurance to certify your eligibility for benefits; we may provide your insurer with details about your treatment to determine if your insurance will cover your treatment costs. Additionally, the Practice may use and disclose your PHI to collect payment from third parties that may be financially responsible (e.g., your financial institution, family members or guardians). Moreover, we may use your PHI to bill you for items, services, or treatment directly. The Practice also may disclose your PHI to other healthcare entities to facilitate their billing efforts.
3. Healthcare Operations. The Practice may use and disclose your PHI to operate the Practice. For example, the Practice may use and disclose your PHI for the evaluation of our quality of care, the facilitation of business operation evaluations, provide training, credentialing/accreditation, the facilitation of future business planning, and for other essential activities. We may also disclose your PHI to a third party that performs services, such as billing and collection, on our behalf. In these cases, we will enter into a written agreement with the third party to ensure they protect the privacy of your PHI. Lastly, the Practice may disclose your PHI to other healthcare providers to assist and inform their healthcare operations.
4. Appointment Reminders. The Practice may use and disclose your PHI to contact you to remind you about future appointments.

5. Treatment Options. The Practice may use and disclose your PHI to provide you with information about potential treatment plans.
6. Health-related Benefits and Services. The Practice may use and disclose your PHI to provide you with information about health-related benefits or services that might be of particular interest to you.
7. Release of Information to Family, Friends, or Other Individuals. With your authorization, the Practice may release your PHI to friends, family members, or other individuals involved in patient care or who assist in providing care. For instance, a parent or guardian may ask a babysitter to take their child to the pediatrician’s office to treat an infection. In this example, the babysitter may be granted access to the child’s PHI.
8. Disclosures Required by Law. The Practice will use and disclose your PHI when federal, state, or local law requires us to do so.

4. Use and Disclosure of Your PHI in Particular and Special Circumstances:

The following categories describe unique circumstances in which the Practice may use or disclose your identifiable health information:

1. Risks to Public Health. The Practice may disclose your PHI to authorities of public health institutions or agencies that are legally authorized to collect PHI information for:

• Maintaining vital records, including births and deaths,
• Notifying the appropriate government agencies and authorities regarding the potential abuse or neglect of adult patients (including, but not limited to, domestic violence); however, the Practice will only disclose this information if the patient gives consent or if the law requires the disclosure of such information to a governmental entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with California law,
• Reporting child abuse or neglect,
• Notifying people who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading disease,
• Reporting potential drug reactions or defects concerning products or devices (including third-party products or devices),
• Notifying people if a product or device has a recall,
• Preventing, controlling, or mitigating disease, injury, or disability,
• Notifying your employer under particular circumstances related to a workplace injury, workplace illness, or medical surveillance.

2. Health Oversight Activities. For activities that are legally authorized, the Practice may disclose your PHI to health oversight agencies. Oversight activities include, but are not limited to, investigations, inspections, audits, surveys, licensure, or disciplinary actions; civil, administrative, or criminal procedures or actions; or other government activities necessary to monitor government programs, to evaluate the healthcare system in general, and ensure civil rights law compliance.
3. Lawsuits and Similar Proceedings. In response to a court or administrative order, the Practice may use and disclose your PHI if you are involved in a lawsuit or a similar legal proceeding. The Practice may also disclose your PHI in response to a discovery request, subpoena, or other lawful processes.
4. Law enforcement. The Practice may release or disclose PHI if requested by a law enforcement official, including, but not limited to, the following circumstances:

• With regard to a crime victim in certain circumstances,
• With regard to a death that is suspected to involve criminal conduct,
• With regard to criminal conduct at our office,
• In response to warrants, court orders, subpoenas, or other similar legal processes,
• To identify or locate a suspect, a fugitive, a missing person, or a material witness,
• Or, in an emergency situation, to report a crime (including, but not limited to, disclosing the location of the crime, the victims of the crime, or the description, the identity, or the location of the suspected perpetrator).

5. Deceased Patients. The Practice may release PHI to a medical examiner or coroner to identify a deceased individual or determine the cause of death. If it is necessary, the Practice may also release information to assist funeral directors in performing their duties.
6. Organ and Tissue Donation. If you are an organ donor, the Practice may release your PHI to institutions or organizations that manage organ, eye, or tissue procurement or transplantation, including but not limited to organ donation banks to facilitate organ or tissue donation and transplantation.
7. The Practice may use and disclose your PHI for research in circumstances where we obtain your written authorization. We will obtain your written consent to use your PHI for research purposes except when an Internal Review Board or Privacy Board determines that the waiver of your authorization satisfies each of the following conditions:

• The use or disclosure entails no more than a minimal risk to your privacy based on the following conditions: (i) an adequate plan to protect identifiers from improper use and disclosure; (ii) an adequate plan to destroy identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (iii) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted;
• The research could not practicably be conducted without the waiver;
• The research could not practicably be conducted without access to and use of the PHI.

8. Serious Threats to Personal or Public Safety or Health. The Practice may use and disclose your PHI to reduce or prevent serious health threats to yourself, another individual, or the public. Under exigent circumstances, we will only disclose PHI to a person or organization that can reduce or prevent such health threats.
9. Military. The Practice may disclose your PHI if you are a member of the U.S. military or foreign military forces (including veterans) and if the appropriate authorities require your PHI.
10. National Security. The Practice may use and disclose your PHI to federal intelligence or national security officials when legally authorized. The Practice may also disclose your PHI to federal officials to protect government officials, including the president, other officials, or foreign heads of state, or conduct investigations pertaining to national security.
11. The Practice may use and disclose your PHI to law enforcement officials or correctional institutions if you are an inmate or under the custody of a law enforcement official. It would be necessary to disclose for the aforementioned purposes if: (a) the designated institution provides healthcare services to you, (b) the safety and security of the institution is jeopardized or under a threat that can be addressed by disclosing your PHI, and/or (c) your safety or health, or the safety or health of other individuals can be addressed or protected by the disclosure of your PHI.
12. Workers’ Compensation. The Practice may use and disclose your PHI for workers’ compensation and similar programs when necessary.
13. Uses And Disclosures That Require Your Authorization:
    In the following cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Psychotherapy notes (unless otherwise permitted or required by law)
  • Psychotherapy notes means: notes recorded, in any medium, by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record, but not including any medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.
    
    As a patient of Salar Hazany, M.D., you have the following rights concerning the PHI that the Practice maintains about you:

1. Confidential Communications. You retain the right to request that the Practice communicates with you in a particular manner or at a certain location. For example, you may request that we contact you on your mobile phone, rather than on your home phone. To request a certain manner of confidential communication, you must submit a written request to the Practice, that specifies your requested method of contact or the location where you desire to be contacted. The Practice will accommodate requests we deem reasonable. You may but are not required to provide a reason or justification for your request.
2. Requesting Restrictions. You retain the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or healthcare operations. Additionally, you retain the right to request that we restrict our PHI disclosure to only certain individuals who are involved in your care or involved in the payment for your care, (e.g., family members, friends, or guardians). We are not required to agree to your request; however, if we agree, we are bound by our agreement unless we are otherwise required by law, in emergencies, or when the information is necessary. To request a restriction in the Practice’s use or disclosure of your PHI, you must make your request in writing to the Practice. Your request must clearly and concisely describe the following information:

• The information you want to restrict;
• Whether your request entails limiting the Practice’s use, disclosure, or both; and
• The circumstances in which, and the individuals to whom, the limits apply.

3. Inspection and copies. You retain the right to inspect and obtain a copy of the PHI that the Practice may use to make decisions about your treatment and healthcare, including patient medical records and billing records. To access a copy of your PHI, you must submit your request in writing to the Practice. The Practice may charge a fee for the costs associated with your request, including, but not limited to, the costs of copying, mailing, labor, and supplies. The Practice retains the right to deny your request to inspect or receive a copy of PHI in certain limited circumstances; however, you may request to review our denial. Another healthcare professional selected by the Practice will conduct any review.
4. Amendment. You may ask the Practice to amend your health information if you believe it is incorrect or incomplete. You may request an amendment for the duration your information is kept by or for the Practice. Your amendment request must be written and submitted to the Practice. You must provide us with reasoning that supports your amendment request. If you do not submit your request and reasons supporting your request in writing, the Practice will deny your request. Additionally, we may deny your request if you ask us to amend information that we deem (a) accurate; (b) complete; (c) not contained in the PHI held and maintained by or for the Practice; (d) not contained in the PHI which you would be permitted to inspect and copy; or (e) not written or created by the Practice, unless the individual or entity that created the information is unavailable to amend your information.
5. Accounting of Disclosures. All our patients retain the right to request an “accounting of disclosures,” which is a list of particular non-routine disclosures the Practice has made of your PHI for purposes unrelated to treatment, payment, or operations. The use of your PHI as part of the routine patient care in the Practice is not mandated to be documented – for instance, the doctor using your information to discuss treatment with a nurse or medical assistant or sharing information with an insurer to file your insurance claim. You must submit a written request to the Practice to obtain an accounting of disclosures. We will respond to your request no later than sixty (60) days after receipt of such request. All accounting of disclosures requests must indicate a time period, which must not be longer than six (6) years from the date of disclosure. The first accounting of disclosures you request within 12 months will be free, but the Practice may bill for additional lists requested within the same 12-month period. We will notify you about the costs of additional requests, and you may withdraw your request before incurring any costs.
6. Right to a Copy of this Notice. You are entitled to receive either an electronic or a paper copy of this Notice. You may ask the Practice to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, please contact the Practice, as provided herein.
7. Right to File a Complaint. If you believe the Practice has violated your privacy rights, you may file a written complaint with the Practice:

Salar Hazany, M.D., Inc.

Email: drsalar@hazanyderm.com

Mail: 421 N. Rodeo Dr. Suite T-13 Beverly Hills, CA 90210

Office: (310)-571-8435

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures. The Practice will obtain your written authorization for uses and disclosures that are not detailed or identified by this Notice or permitted by law. Any authorization you provide to the Practice concerning the use and disclosure of your PHI may be revoked at any time by written submission. Once you revoke authorization, the Practice will no longer use or disclose your PHI for reasons outlined in the authorization. Note: the Practice is required to retain records of your care.