NOTICE OF PRIVACY PRACTICES
Chesapeake Center for Cosmetic and Plastic Surgery
Ms. Tabitha Bostwick 757-673-5900
Effective Date: January 1, 2015
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care that we provide and may receive similar records from other providers. We use these records to provide or enable other healthcare providers to deliver quality medical care, to obtain payment for services provided to you as allowed by your health insurance plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of your protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals in the event that a breach of unsecured protected health information occurs. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.
TABLE OF CONTENTS
A. How this medical practice may use or disclose your protected health information
B. When this medical practice may not use or disclose your protected health information
C. Your protected health information rights
1. Right to request special privacy protections
2. Right to request confidential communications
3. Right to inspect and copy medical records
4. Right to amend or supplement medical records
5. Right to an accounting of disclosures
6. Right to a paper or electronic copy of this notice
D. Changes to this Notice of Privacy Practices.
A. How this medical practice may use or disclose your protected health information
This medical practice collects health information about you and stores it in a chart (medical record) and for certain other information, on a computer. This constitutes your medical record. The medical record is the property of this medical practice, but the information contained within the medical record belongs to you. The law permits us to use or disclose your protected health information for the following purposes:
1. Treatment. We use medical information about you to provide medical care to you. We disclose medical information to our employees and to others who are involved in providing the medical care which you need. For example, we may share your medical information with other physicians or other health care providers who will in turn provide medical services that we do not provide. Or we may share this information with a pharmacist who needs it in order to dispense a prescription to you, or to a laboratory which performs tests. We may also disclose medical information to members of your family or to other individuals who can help you when you are sick, injured or after you die.
2. Payment. We use and disclose medical information about you in order to obtain payment for some of the services which we provide. For example, we give your health plan the information which it requires before it will pay us. We may also disclose information to other healthcare providers in order to assist them in obtaining payment for the services which they have provided to you.
3. Health Care Operations. We may use and disclose medical information about you to operate this medical practice. For example we may use and disclose this information in order to review and improve the quality of care which we provide, or to evaluate the competence and qualifications of our professional staff. Or, we may use and disclose this information in order to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for the purpose of medical reviews, legal services and audits, including but not limited to fraud and abuse detection as well as compliance programs and business planning and management. We may also share your medical information with our “business associates”, such as our billing service, or other entities whose businesses perform administrative services for our practice. We have a written contract with each of these business associates which contains the terms which require them and their subcontractors to protect your confidentiality and security of your protected health information. We may also share your information with other healthcare providers, healthcare clearinghouses or health insurance plans that have a relationship with you when they request this information in order to help them with their quality assessment and improvement activities, their patient safety activities, their population-based efforts to improve health or to reduce healthcare costs, their protocol development, case management or care coordination activities, their review of competence, qualifications and performance of healthcare professionals, their training programs, there accreditation, certification or licensing activities or their health care fraud and abuse detection and compliance efforts, many of which are mandated by law.
4. Appointment Reminders. We may use and disclose medical information in order to contact you and remind you about your future appointments. If you do not answer, we may leave this information in a voicemail or in a message left with the person answering the phone.
5. Sign In Sheet. We may use and disclose medical information about you by requesting that you sign in when you arrive at our office for your appointment. We may also call out your name in the presence of other individuals when you are invited into the treatment area.
6. Notification and Communication with Family. We may disclose your health information including your location, your general condition or, unless you have instructed us otherwise, in the event of your death when notifying a family member, your personal representative or any other designated person who is responsible for your care. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or who helps to pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe that it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object to the release of information, our health professionals will use their best judgment when communicating with your family and others.
7. Marketing. Provided that we do not receive any payment for making these communications, we may contact you in order to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care which may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle and get recommended tests, participate in a disease management program, provide you with small gifts, tell you about government-sponsored health programs or encourage you to purchase a product or service when we see you, from which we may be paid. Finally we may receive compensation which covers our cost of reminding you to take and refill your medication, or otherwise communicate about a drug or biological product that is currently prescribed for you. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without first obtaining your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity which you authorize and we will stop any future marketing activity to the extent that you revoke such authorization.
8. Sale of Health Information. We will not sell your health information without your prior written authorization. The authorization will disclose that we will receive compensation for your health information if you authorize to sell it, and we will stop any future sales of your information to the extent that you revoke that authorization.
9. Required by Law. As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or to respond to judicial or administrative proceedings or to law enforcement officials, we will further comply with the requirements set forth below concerning those activities.
10. Public Health. We may, and are sometimes required by law, to disclose your health information to public health authorities for various purposes related to such instances as the following: prevention or control of disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the food and drug administration any problems with products and or reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we would form you or your personal representative promptly unless in our best professional judgment, we believe that the notification would place you at risk of serious harm or would require informing a personal representative which we believe is responsible for the abuse or harm.
11. Health Oversight Activities. We may, as we are sometimes required by law, disclose your health information in the course of any administrative or judicial proceeding to the extent each is expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or other administrative order.
13. Law Enforcement. We may, as we are sometimes required by law, disclose your health information to a law enforcement official for purposes such as identifying or locating a criminal suspect, fugitive, material witness or missing person, and or comply with a court order, warrant, grand jury subpoena or other law enforcement purposes.
14. Coroners. We may, as we are sometimes required by law, disclose your health information to corners in connection with their investigations of deaths.
15. Organ or Tissue Donation. We may disclose your health information to organizations which are involved in procuring, banking or transplanting organs and tissues.
16. Public Safety. We may, as we are sometimes required by law, disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
17. Proof of Immunization. We will disclose proof of immunization to a school that is required to have it prior to admitting a student when you have agreed to the disclosure on behalf of yourself or your dependent.
18. Specialized Government Functions. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
19. Workers’ Compensation. We may disclose your health information as necessary in order to comply with Workmen’s Compensation laws. For example, to the extent that your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
20. Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
21. Breach Notification. In the event of a breach of unsecured protected health information, we will notify you as required by law. If you have provided with us with a current e-mail address, we may use e-mail to communicate information related to such a breach. In some circumstances, our business associate may provide the notification. We may also provide notification by other methods as appropriate.
22. Research. We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.
B. When this medical practice may not use or disclose your health information
Except as described in this notice of privacy practices, this medical practice will, consistent with its legal obligations, not use or disclose any health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
C. Your health information rights
1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out of pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you in that event of our decision.
2. Write to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests which are submitted in writing and which specify how or where you wish to receive these communications.
3. Right to Inspect and Copy. You have the right to inspect and copy your health information with limited exceptions. To access your medical information, you must submit a written request detailing what information you would like access to, whether you want to inspect it at our premises or obtain a copy of it. If you want a copy of the record, you will need to indicate your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will produce for you an alternative format which you find acceptable. If we cannot agree and we maintain the record in an electronic format, we will offer you a choice of readable electronic or hard copy format. We will also send a copy to any other person whom you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage and, if requested and agreed to in advance, the cost of preparing the next ovulation or summary. We may deny your request under limited circumstances. If we deny your request to access your child’s records or the records of an incapacitated adult whom you are representing because we believe that allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision.
4. Right to Amend or Supplement. You have a right to request that we amend your health information which you believe is incorrect or incomplete. You must make a request to amend in writing and include the reasons that you believe the information is inaccurate or incomplete. We are not required to change your health information and will provide you with information about this medical practices denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If we deny your request, you may submit a written statement of your disagreement with that decision and we may, in turn, prepare a written rebuttal. All information related to any request to amend the medical records will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice except that this medical practice does not have to account for the disclosures provided to you or personal and to your written authorization or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 18 (specialized government functions) of section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to or use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent that this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
6. Right to a Paper or Electronic Copy of This Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information including a right to a paper copy of this notice of privacy practices, even if you have previously requested its receipt by e-mail. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.
D. Changes to this notice of privacy practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this notice currently in effect. After an amendment is made, the revised notice of privacy protections will apply to all protected health information which we maintain, regardless of when it was created or when it was received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. We will also post the current notice on our website.
Complaints about this notice of privacy practices or how this medical practice handles your health information should be directed to our privacy officer listed at the top of this Notice of Privacy Practices.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to the following individual:
Office for Civil Rights, U.S. Department of Health and Human Services
150 S. Independence Mall West
Suite 372, Public Ledger Building
Philadelphia, PA 19106-9111
Main line (800) 368-1019 or OCRM@hhs.gov
The complaint form may be found at the following web address:
www.hhs.gov/privacy/hipaa/complaints/hipcomplaint.pdf You will not be penalized in any way for filing a complaint.
CHESAPEAKE CENTER for COSMETIC and PLASTIC SURGERY
I, ______________________________, have received a copy of the Chesapeake Center for Cosmetic and Plastic Surgery Notice of Privacy Practices.
Signature of Patient or Legal Guardian Date
The HIPAA regulations are intended to protect your personal health information. However frequently the practice encounters patients who appoint others to call the office to arrange appointments and to take care of the financial aspects of their care.
Please indicate below if there are any persons whom you may provide the practice an authorization to release information regarding your appointments, financial and/or other medical information:
Circle which choice(s) apply
___________________________________ Appointments Financial Medical All
___________________________________ Appointments Financial Medical All
If you have any additional questions regarding this notice or our health information privacy policies, please contact the office administrator at 757-673-5900.
When I first considered breast enlargement, I wasn't sure that it was the thing for me. I just wanted to restore the breasts that I had before bearing my two children.
After the kids came, I gradually lost about two cup sizes. Thanks to you, I have been pleased to have my figure back. This has made me very glad that I made the decision to go ahead with the operation.
I cannot say enough good things about my entire experience with Dr. Grenga and his staff. Dr. Grenga has made a difference in my looks ( 10 years+ younger ). His expertise as well as his bedside manner have made a positive difference in my life.
I know that you get thank you’s everyday but I want to let you know how much I appreciate the extent that you went to yesterday to help me. I will always be thankful for your extreme kindness you are truly the most caring Doctor a girl could ask for.
Thank you for the wonderful kindness and politeness you all show each and every time I have come to or called the office. You all ROCK !
Your attention to detail and expertise exceeded all of our expectations. You have a true passion for your work and it shines with your wonderful bedside manner. Words cannot express how truly thankful we are for what you have done for us and our daughter.
AL and SL
They say pictures can say a thousand words but the first one that came to mind after looking at these before & after’s is wow. You have made such a difference in how I look and feel about myself. I look forward to a continued relationship with you and your staff at the Chesapeake Center for Cosmetic and Plastic Surgery. Many thanks!
You performed a tummy tuck on me three months ago and the results are terrific! I personally want to thank him for the job well done. His staff and Dr. Grenga take the time with you and make your whole surgery experience wonderful. If I ever need anything else done to my body, Dr. Grenga will be doing it.
I feel now that I wished that I had my breast reduction operation a long time ago. I cannot believe that I waited so long for this and suffered for so many years. I feel so much better and have enjoyed exercising again because my back and breasts no longer hurt. My clothes fit so much better as well. You were right-it has made a remarkable difference in my appearance but I want you to know that it has made a difference in my outlook as well. I feel years younger!
Dr. Grenga has practiced in Hampton Roads since 1987. He is board-certified by the American Board of Plastic Surgery, and is a Fellow of the American College of Surgeons. He has dedicated his practice to the specialty of cosmetic and plastic surgery.
As one of the most experienced plastic surgeons
in Southeastern, Dr. Grenga offers his patients a
diverse selection of plastic surgery options for enhancing your figure and rejuvenating your appearance.