HIPAA Policy

Phil Bellocchio, M.D., F.A.C.S., P.C.
Aesthetic and Reconstructive Plastic Surgery
710 Park Avenue
Seattle, Washington 98101
111-111-1111
https://seattlefaceliftsurgeons.com/

NOTICE OF PRIVACY PRACTICES

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.

I. What This Is

This Notice explains the privacy practices of Dr. Phil Bellocchio.

II. Our Privacy Obligations

We are legally required to maintain the privacy of your medical and health information (“Protected Health Information” or “PHI”) and to provide you with this Notice outlining our legal duties and privacy practices. Whenever we use or disclose PHI, we must follow the terms of this Notice (or the version that is in effect at that time).

III. Permissible Uses and Disclosures Without Written Authorization

Certain situations require your written authorization, which we explain in Section IV. However, in the following cases, your authorization is not required:

• Treatment: We may use or share PHI to diagnose and treat you, coordinate your care, provide appointment reminders, or recommend treatment alternatives.

• Payment: We may use or disclose PHI to obtain payment for services—for example, with your insurer or HMO.

• Health Care Operations: PHI may be used internally to evaluate and improve quality of care, resolve concerns, and ensure smooth practice operations.

• Relatives, Close Friends, and Caregivers: With your agreement (or in your best interest if you’re not available), we may share PHI with family or close contacts involved in your care.

• Public Health Activities: For reporting illness, communicable diseases, child abuse, or workplace-related conditions.

• Victims of Abuse/Neglect: If we reasonably suspect abuse or neglect, PHI may be disclosed to authorized agencies.

• Oversight Agencies: To comply with government health programs (e.g., Medicare, Medicaid).

• Legal or Law Enforcement: PHI may be disclosed in judicial proceedings, in response to lawful orders, or as required by law enforcement.

• Decedents: Information may be provided to coroners or medical examiners.

• Organ/Tissue Donation: Shared with authorized procurement organizations.

• Research: Under approved conditions by an Institutional Review Board.

• Health & Safety: To prevent or lessen imminent threats.

• Special Government Functions: In cases involving military, national security, or as otherwise required by law.

• Workers’ Compensation: Where necessary to comply with related laws.

IV. Uses and Disclosures Requiring Written Authorization

For any purpose not listed above, we require your written authorization. Examples include:

• Sending records to your life insurance company or attorney.

• Confidential HIV-related information, which requires a special New York State-approved authorization form.

V. Your Individual Rights

You have important rights regarding your PHI:

• Request Restrictions: You may request limits on how your PHI is used or shared.

• Confidential Communications: You may request alternative communication methods or locations.

• Inspect and Copy Records: You may review or obtain copies of your medical and billing records (with some exceptions).

• Revoke Authorization: You may revoke prior authorizations in writing.

• Amend Records: You may request corrections to your records.

• Accounting of Disclosures: You may request a history of certain disclosures of your PHI.

• Paper Copy: You may request a paper copy of this Notice at any time.

VI. Effective Date and Changes to This Notice

• Effective Date: This Notice is effective as of April 14, 2003.

• Right to Change Terms: We reserve the right to change this Notice and apply updates to all PHI we maintain. Updated versions will be posted in our office and available upon request.

VII. Contact Information

You may contact Ms. Karen Schabert, Office Manager and Privacy Policy Officer, at 111-111-1111 for questions, requests, or complaints.