Patient Privacy Notice

This Notice of Health Information Practices describes your personal information that is collected and how or when that information is used or disclosed. It also describes your rights related to your Protected Health Information (PHI). Please be assured that the staff at Contemporary Cosmetic Surgery, Inc. (CCS, Inc.) are committed to using your protected health information responsibly.

What information about you is collected?

During each consultation, a record is made of your symptoms, physical examination, test results, diagnoses and proposed treatment plan. The purpose of this health record is to track your medical care, provide a means of communication with your family physician and other health care professionals. It is a legal document describing the care you received and is a means by which you or a third-party payer can verify that services billed were actually provided. Occasionally, it may be used as a tool in educating heath professionals, a source of data for medical research, a source of information for public health officials in charge of improving the health of this state and the nation, a source of data for our planning and marketing or a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

How may your information be used and disclosed?

Your health information may be used for one or more of the following purposes: for your treatment; to communication with your family; on bills for payment by third-party payers; for medical research that has been approved by an IRB; for marketing of new or alternative regimens to you.

Your health information may be disclosed to your third-party payer; our business associates; Federal Drug Administration (FDA); The Bureau of Workers Compensation; Public Health Authorities to prevent or control disease, injury, or disability and Law Enforcement, as may be required by law. Federal law makes provision for your health information to be released to an appropriate agency, public health authority or attorney.

What are your health information rights?

You have the right to request a obtain a copy of this notice of our information practices upon request, inspect and copy your health record at a mutually convenient time, as stated in 45 CFR 164.524. You may Amend your health record as provided in 45 CFR 164.528, obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528, request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and revoke your authorization to use or disclose health information except if that action has already been taken.

Please understand that although your health record is the physical property of CCS. Inc., the information within the record belongs to you.

How may you gain access to your health information?

You may request to view your health information at a time that is mutually convenient. You may also request that changes be made in your record to clarify any ambiguity.

What are the responsibilities of CCS Inc.?

CCS Inc. will strive to maintain the privacy of your health information, provide you with this notice and privacy practices with respect to information we collect and maintain about you, abide by the terms of this notice, notify you if we are unable to agree with a requested restriction, and accommodate reasonable requests you may have to exchange PHI by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our practices change, we will send a revised notice to the address you've supplied us, or if you want, we will email the revised notice to you.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

How may you obtain more Information or report a problem?

You may obtain more information by contacting the practice's Privacy Officer, at 216-595-6800. If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer or with the
Office for Civil Rights; U.S. Department of Health and Human Services. There will be no retribution for filing a complaint with either of these.