NOTICE OF PRIVACY PRACTICES

(Effective March 23, 2013)
Please review carefully
This notice describes how protected health information about you may be used and disclosed and how you can get access to this information.

Valley Plastic Surgery takes the responsibility to safeguard your protected health information very seriously. This notice is intended to inform you of how we protect, use and disclose your information as well as to explain your right to control these disclosures.

Your Privacy Rights:

To inspect and copy your health information
To request an amendment to your records
To request restrictions on use and disclosure of your information
To request confidential communications
To receive a paper copy of our Notice of Privacy Practices
To an accounting of disclosures
To file a complaint about how we have used and disclosed your information
To be notified following a breach of your information by Valley Plastic Surgery

We may use and disclose information about you without your permission for:

Treatment purposes and alternatives
Payment
Health care operations
Appointment reminders

Special Situations your information may be used and disclosed:

To avert a serious threat to your health or safety
As required by law
For research if you are involved in a research project
To an organ/tissue donation organization if you are a donor
If required by armed forces, national security or intelligence if you were or are a member
To Workers Compensation if you are being treated under this program
For public health reporting purposes
For health oversight audits
For court order/subpoena
To law enforcement
To coroner/medical examiner/funeral directors
To family/friends if we can infer from the circumstances based on our professional judgment that you will not object. (You have the right to object)
To family or others involved in a deceased person’s care or payment for care

Note: We will not use or disclose your information for any purpose other than described without your written authorization. (You may revoke that authorization at any time)

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with our facility or with the secretary of the department of Health and Human Services. To file a complaint with our office, contact:

The VPS Privacy Officer
Valley Plastic Surgery
280 S. Pacific Hwy
Talent, OR 97540
541-512-4771

**You will not be subjected to any negative consequences for filing a complaint

A more detailed version of this Notice may be obtained at the Registration Desk