Dr. Michael Ablavsky
Ablavsky Plastic Surgery
19222 Stonehue Suite 104
San Antonio, TX 78258
Phone: (210) 942-6672
Monday–Friday : 8 a.m.–6 p.m.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO TIDS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice describes how Aesthetic Enhancement Cosmetic and Laser Center (AECLC) uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Aesthetic Enhancement Cosmetic and Laser Center.
This notice also describes your rights to access and control your health information. Health information is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
How Aesthetic Enhancement Cosmetic and Laser Center May Use or Disclose Your Health Information
For Treatment: AECLC, our physicians, our medical and office staff and others outside of our office that are involved in your care and treatment may use your health information to provide you with medical treatment or services. For example, a health care provider, such as a physician, nurse or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment: AECLC, our physicians, our medical and office staff and others outside of our office that are involved in your care and treatment may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations: AECLC, our physicians, our medical and office staff and others outside of our office that are involved in your care and treatment may use and disclose health information about you for operational and business pm-poses. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
- Evaluate the performance of our staff;
- Assess the quality of care and outcomes in your case and similar cases;
- Learn how to improve our facilities and services; and
- Determine how to continually improve the quality and effectiveness of the health care we provide.
Other examples include disclosing and or sharing your health information with third party “business associates” that perform various activities (e.g., billing, and transcription services) for AECLC. Whenever an arrangement between AECLC and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Appointments: AECLC, may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual. We may also use a sign-in sheet to identify your presence for an appointment and call you by name when it is time for your appointment.
Others involved in Your Healthcare: Unless you object, AECLC 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 health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may 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.
Required by Law: AECLC may use and disclose information about you as required by law. For example, AECLC may disclose information for the following purposes:
- For judicial and administrative proceedings pursuant to legal authority;
- To report information related to victims of abuse, neglect or domestic violence; and
- To assist law enforcement officials in their law enforcement duties.
Public Health: Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
Decedents: Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Research: AECLC may use your health information for research purposes when an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Health and Safety: Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions: Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.
Workers Compensation: Your health information may be used or disclosed in order to comply with laws and regulations related to Workers Compensation.
Your Health Information Rights
You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR164.522; however, AECLC is not required to agree to a requested restriction;
- Obtain a paper copy of the notice of information upon request;
- Inspect and obtain a copy of your health record as provided in 45 CFR164.524;
- Amend your health record as provided in 45 CFR164.526;
- Request communications of your health information by alternative means or at alternate locations;
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
- Receive an accounting of disclosures made of your health information as provided by 45 CFR 164.528.
You may complain to AECLC and to the Department of Health and Human Services if you believe your privacy right have been violated. You will not be retaliated against for filing a complaint.
Obligations of Aesthetic Enhancement Cosmetic and Laser Center
AECLC is required to:
- Maintain the privacy of protected health information;
- Provide you with this notice of its legal duties and privacy practices with respect to your health information;
- Abide by the terms of this notice;
- Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
- Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
- Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.
Aesthetic Enhancement Cosmetic and Laser Center reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you by providing you a revised copy at your appointment.
If you have any questions or complaints, please contact:
525 Oak Centre, Suite 260
San Antonio, Texas 78258