NOTICE OF PRIVACY PRACTICES
AIVI Aesthetics Skin Health Clinic
Effective Date: 01/01/2025
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.
WHO WILL FOLLOW THIS NOTICE
This notice describes the privacy practices of AIVI Aesthetics Skin Health Clinic and applies to all employees, staff, and other personnel who work at our facility.
OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. This notice describes our privacy practices and applies to all records of your care generated or maintained by Aivi Aesthetics.
Your other healthcare providers may have different policies or notices regarding their use and disclosure of your medical information.
SUMMARY OF THIS NOTICE
This notice will tell you about the ways we may use and disclose medical information about you. It also describes your rights and our obligations regarding the use and disclosure of your protected health information.
We are required by law to:
- Maintain the privacy of your protected health information
- Give you this notice of our legal duties and privacy practices
- Follow the terms of the notice currently in effect
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
For Treatment
We may use your health information to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you.
Example: A nurse obtaining information about your medical history to determine your eligibility for treatment, or a physician reviewing your medical information to prescribe appropriate treatment.
For Payment
We may use and disclose your health information so that the treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party.
Example: We may need to give your health information to your health insurance plan so they will pay for services.
For Health Care Operations
We may use and disclose your health information for our health care operations. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care.
Example: We may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you.
Appointment Reminders
We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care.
Treatment Alternatives
We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Services and Benefits
We may use and disclose health information to tell you about health-related services or benefits that may be of interest to you.
Fundraising
If we maintain substance use disorder treatment records subject to 42 CFR Part 2 and intend to use or disclose such records for fundraising, you must first be provided with a clear opportunity to opt out of receiving fundraising communications.
Business Associates
We may disclose your health information to our business associates that perform functions on our behalf or provide us with services. For example, we may contract with a company to perform billing services. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
OTHER USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION
We may use or disclose your health information for the following purposes without your written authorization:
- As Required by Law: When required by federal, state, or local law
- Public Health Activities: To prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report adverse events or product defects
- Health Oversight Activities: To a health oversight agency for authorized activities such as audits, investigations, inspections, and licensure
- Judicial and Administrative Proceedings: In response to a court or administrative order, subpoena, discovery request, or other lawful process
- Law Enforcement: For law enforcement purposes as required by law or in response to a valid subpoena or court order
- Coroners, Medical Examiners, and Funeral Directors: To identify a deceased person or determine cause of death
- Organ and Tissue Donation: For organ procurement or transplant purposes
- Research: For research purposes when approved by an institutional review board or privacy board
- To Avert a Serious Threat: When necessary to prevent a serious threat to health or safety
- Specialized Government Functions: For military, national security, or other specialized government functions
- Workers’ Compensation: For workers’ compensation or similar programs
- Victims of Abuse, Neglect, or Domestic Violence: When required by law to report abuse, neglect, or domestic violence
SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)
If we create or maintain substance use disorder treatment records protected under 42 CFR Part 2:
- These records are protected by federal confidentiality rules (42 CFR Part 2)
- Substance use disorder treatment records received from programs subject to 42 CFR Part 2, or testimony relaying such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless:
- You provide written consent, OR
- A court order is obtained after notice and an opportunity for you to be heard
USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION
Marketing
Most uses and disclosures of protected health information for marketing purposes require your written authorization.
Sale of Protected Health Information
We will not sell your protected health information without your written authorization.
Psychotherapy Notes
Most uses and disclosures of psychotherapy notes (if maintained) require your written authorization.
Other Uses
Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke your authorization at any time by submitting a written notice to our Privacy Officer. The revocation will not affect any uses or disclosures we already made in reliance on your authorization.
PROHIBITED USES AND DISCLOSURES
We will NOT:
Use or disclose genetic information for underwriting purposes.
Example: We will not use your genetic test results to decide whether to provide you with health insurance coverage or to set your insurance premiums.
USES AND DISCLOSURES REQUIRING AN ATTESTATION
For certain uses and disclosures, we may require the requestor to provide a written attestation before we disclose your health information. This helps ensure that protected health information is only disclosed for lawful purposes.
Example: If a law enforcement agency requests your health information for an investigation unrelated to your medical care, we may require them to attest that they are requesting the information for a lawful purpose and not to prosecute you for certain protected activities.
Note: A person may be subject to criminal penalties under 42 U.S.C. 1320d-6 if that person knowingly and in violation of HIPAA obtains or discloses individually identifiable health information relating to an individual.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding the health information we maintain about you:
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.
We are not required to agree to your request unless you are asking us to restrict the disclosure of your protected health information to a health plan for payment or health care operations purposes and the information pertains solely to a health care item or service for which you (or someone on your behalf) have paid us in full out of pocket.
To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us:
- What information you want to limit
- Whether you want to limit our use, disclosure, or both
- To whom you want the limits to apply
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
We will accommodate all reasonable requests. You do not need to give a reason for your request.
Right to Inspect and Copy
You have the right to inspect and obtain a copy of health information that may be used to make decisions about your care, such as medical and billing records. You also have the right to request an electronic copy of electronic health records.
To inspect and copy health information, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies.
We may deny your request in certain limited circumstances. If you are denied access to health information, you may request that the denial be reviewed.
Right to Amend
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice.
To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request.
We may deny your request if:
- The information was not created by us
- The information is not part of the records kept by or for our practice
- The information is not part of the information you would be permitted to inspect and copy
- The information is accurate and complete
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of your health information for purposes other than treatment, payment, or health care operations.
To request an accounting, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years. The first accounting you request within a 12-month period will be free. For additional requests within the same 12-month period, we may charge you for the costs of providing the list.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. You may request a copy of this notice at any time by contacting our Privacy Officer.
Right to be Notified of a Breach
You have the right to be notified in the event that we (or a Business Associate) discover a breach of your unsecured protected health information.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with our practice, contact: Privacy Officer AIVI Aesthetics Skin Health Clinic 28720 Roadside Drive, Suite 373 Agoura Hills, CA 91301 Phone: (818) 851-9900 Email: info@aiviaesthetics.com
To file a complaint with the Secretary of HHS: Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be penalized or retaliated against for filing a complaint.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.
We will post a copy of the current notice in our facility and on our website at www.aiviaesthetics.com. The notice will contain the effective date on the first page.
FACILITY OWNERSHIP OF MEDICAL RECORDS
You acknowledge that you are receiving medical services from healthcare professionals at AIVI Aesthetics Skin Health Clinic. AIVI Aesthetics Skin Health Clinic has a contractual relationship with the healthcare professionals (and their professional entities, if applicable). To the extent permitted by law, you agree that your medical record shall be maintained in accordance with law by AIVI Aesthetics Skin Health Clinic and is the property of AIVI Aesthetics Skin Health Clinic. AIVI Aesthetics Skin Health Clinic shall permit you access to your records upon request as described in this notice.
CONTACT INFORMATION
AIVI Aesthetics Skin Health Clinic
28720 Roadside Drive, Suite 373
Agoura Hills, CA 91301
Phone: (818) 851-9900
Email: info@aiviaesthetics.com
Website: www.aiviaesthetics.com
