Effective Date: August 9, 2024

Introduction

Welcome to Aesthetic Island (“Practice”). We are committed to protecting your medical information. This Privacy Policy outlines how we handle your medical information, your rights, and our responsibilities concerning your medical information.

Understanding Your Health Record/Information

This notice covers the practices of Aesthetic Island and its staff, as well as any physicians or providers with staff privileges regarding your protected health information (PHI). We create records of the care and services you receive to provide high-quality care and to comply with legal requirements.

Your Health Information Rights

• Requesting Restrictions: You can request restrictions on how your information is used or disclosed for treatment, payment, and healthcare operations. We are not required to agree to your request, except when it relates to disclosures to your health insurer for services paid out-of-pocket in full.
• Obtaining a Copy: You can obtain a paper copy of this notice.
• Inspecting and Copying: You can inspect and request a copy of your health record.
• Requesting Amendments: You can request an amendment to your health record if you believe it is incorrect or incomplete.
• Accounting of Disclosures: You can request an accounting of disclosures of your health information.
• Confidential Communications: You can request communications of your health information by alternative means or at alternative locations.

To exercise these rights, provide a written request to Aesthetic Island, 2784 Coney Island Ave, Suite 301, Brooklyn, NY 11235.

Our Responsibilities

We are required to:

• Maintain the privacy of your health information.
• Provide notice of any unauthorized acquisition, access, use, or disclosure of your protected health information.
• Provide you with a notice of our legal duties and privacy practices concerning information we maintain about you.
• Abide by the terms of this notice.
• Notify you if we cannot agree to a requested restriction on certain uses and disclosures.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain, including information created or received before the change. We will make the revised notice available upon request at the Practice.

Uses and Disclosures of Medical Information That Do Not Require Your Authorization

We may use and disclose your medical information without your authorization in the following ways:

• Treatment: To provide, coordinate, or manage your healthcare and related services.
• Payment: To obtain payment for healthcare services provided to you.
• Healthcare Operations: For our regular healthcare operations, such as quality assessments and improvement activities.

Other uses and disclosures without your authorization may include:

• Business Associates: For services provided through agreements with business associates.
• Notification: To notify or assist in notifying a family member, personal representative, or another person responsible for your care.
• Individuals Involved in Your Care: To a family member, another relative, a close personal friend, or another person you identify, relevant to their involvement in your care or payment for your care.
• Disaster Relief: To public or private disaster relief organizations.
• Research: For research purposes, under certain conditions.
• Treatment Alternatives and Appointment Reminders: To provide appointment reminders or information about treatment alternatives.
• FDA: To the FDA concerning adverse events, product defects, or other required disclosures.
• Worker's Compensation: To comply with laws relating to worker's compensation.
• Public Health: To public health authorities to prevent or control disease, injury, or disability.
• Abuse, Neglect, or Domestic Violence: To government authorities authorized to receive such reports.
• Judicial, Administrative, and Law Enforcement Purposes: For judicial, administrative, or law enforcement purposes.
• Health Oversight Activities: For audits, investigations, inspections, and licensure.
• Threats to Health or Safety: To prevent a serious threat to health or safety.
• Special Government Functions: For national security and intelligence activities.
• Required or Allowed by Law: When required or allowed by federal, state, or local law.

When We Need Your Written Authorization

We will not use or disclose your health information without your written authorization except as described in this notice. Situations requiring your authorization may include marketing purposes.

For More Information or to Report a Problem

If you have questions or believe your privacy rights have been violated, you may contact the Practice at (917) 438-4185 or send a complaint to the Director of Practice at 2784 Coney Island Ave, Suite 301, Brooklyn, NY 11235, or to the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Notice of Privacy Practices Acknowledgement

By acknowledging this notice, you understand your rights under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), including:

• Conducting treatment and follow-up among multiple healthcare providers.
• Obtaining payment from third-party payers.
• Conducting normal healthcare operations.

Contact Information

Aesthetic Island
2784 Coney Island Ave, Suite 301
Brooklyn, NY 11235
Phone: (917) 438-4185