HIPAA Notice of Privacy Practices
Effective date: [DATE — set at launch]
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.
Our Commitment to Your Privacy
Balance Skin & Wellness Institute is required by law to maintain the privacy of your protected health information (“PHI”), provide you this Notice of our legal duties and privacy practices, and abide by the terms of the Notice currently in effect.
How We May Use and Disclose Your PHI
- Treatment. We may use and share your PHI to provide, coordinate, and manage your care, including sharing with other providers involved in your treatment.
- Payment. We may use and share your PHI to bill and collect payment for services provided to you.
- Healthcare operations. We may use and share your PHI to run our practice, improve quality of care, and train staff.
- As required by law, including public health reporting, health oversight activities, and lawful requests by authorities.
Other uses and disclosures — including most marketing uses and any sale of PHI — will be made only with your written authorization, which you may revoke at any time.
Your Rights Regarding Your PHI
- Request a copy of your medical record (electronic or paper)
- Request corrections to your record
- Request confidential communications (for example, contacting you only at a specific phone number)
- Request limits on what we use or share
- Receive a list of certain disclosures we have made
- Receive a paper copy of this Notice
- Choose someone to act for you (such as a medical power of attorney)
- File a complaint if you believe your privacy rights have been violated
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office using the contact information on our Contact page, or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. The current Notice will be posted in our office and on this Site.
Contact
Privacy questions may be directed to our office: 8516 South Portland Ave, Oklahoma City, OK 73159, or by phone via our Contact page.