Notice of Privacy Practices

Our Duties

Aevum Longevity and Aesthetic Surgery is required by law to maintain the privacy of protected health information, to give you this notice of our legal duties and privacy practices with respect to that information, and to notify you following a breach of unsecured protected health information.

We are required to follow the terms of the notice currently in effect. Protected health information means information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health, to the health care you receive, or to payment for that care.

How We May Use and Disclose Your Health Information Without Your Authorization

We may use and disclose your health information without your written authorization for the following purposes.

Treatment

We may use your health information to provide, coordinate or manage your care, and we may disclose it to other health care providers involved in your treatment. For example, we may share information with a physician you are referred to, with a pathology laboratory examining a specimen removed during a procedure, or with a pharmacy filling a prescription.

Payment

We may use and disclose your health information so that treatment you receive may be billed and payment collected, from you, from an insurance company or from a third party. For example, we may need to give a health plan information about a procedure so that it will pay us or reimburse you.

Health Care Operations

We may use and disclose your health information for our own operations, which include quality assessment, reviewing the competence and qualifications of our staff, training, licensing, business planning, and general administrative activities.

Appointment Reminders and Related Communications

We may contact you to remind you of an appointment, to give you follow up or aftercare instructions, or to tell you about treatment alternatives or health related benefits and services that may interest you. You may ask us to contact you at a particular telephone number or address, or by a particular method, and we will accommodate reasonable requests.

As Required by Law and for Public Health and Safety

We will disclose your health information when required to do so by federal, state or local law. We may also use or disclose it:

• For public health activities, including reporting disease, injury, births, deaths and reactions to medications or problems with products
• To report suspected abuse, neglect or domestic violence as required or permitted by law
• For health oversight activities such as audits, investigations, inspections and licensure
• In response to a court or administrative order, a subpoena, a discovery request or other lawful process
• To law enforcement officials in the limited circumstances the law permits
• To a coroner, medical examiner or funeral director as necessary for them to carry out their duties
• For organ and tissue donation purposes
• To avert a serious and imminent threat to the health or safety of you or another person
• For specialized government functions, including military, national security and protective services
• For workers' compensation purposes as authorised by law

Research

We may use or disclose your health information for research purposes only where that research has been approved through a process that reviews the research proposal and establishes protocols to protect the privacy of your information, or where the information has been de-identified.

Business Associates

We may share your health information with third parties who perform services on our behalf, such as billing, laboratory, information technology or records services. Each of those business associates is required by written agreement to safeguard your information and to use it only for the purpose for which it was shared.

Individuals Involved in Your Care

Unless you object, we may disclose to a family member, a relative, a close friend or any other person you identify the health information directly relevant to that person's involvement in your care or in payment for your care. If you are not present or are unable to agree or object, we will use our professional judgment to determine whether disclosure is in your best interest.

Uses and Disclosures That Require Your Written Authorization

The following always require your written authorization:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures for marketing purposes
• Disclosures that constitute a sale of protected health information
• Use of your photographs, images or testimonial on our website, in print or on social media
• Any other use or disclosure not described in this notice

If you give us an authorization, you may revoke it in writing at any time. Revoking an authorization stops any further use or disclosure under it. It does not undo a use or disclosure we already made while the authorization was in effect.

Photographs and Before and After Images

Clinical photography is often part of good care and we may take photographs for your medical record. Using any photograph of you publicly, including on this website, on social media or in any printed material, requires your separate written authorization, which is entirely voluntary and which you may revoke at any time.

Your Rights Regarding Your Health Information

You have the following rights.

Right to Inspect and Copy

You have the right to inspect and to receive a copy of the health information that may be used to make decisions about your care, in the form and format you request if it is readily producible, including an electronic copy where we hold it electronically. We may charge a reasonable, cost based fee. In limited circumstances we may deny a request, and where the law allows, you may ask for that denial to be reviewed.

Right to Request an Amendment

If you believe health information we hold about you is incorrect or incomplete, you may ask us to amend it. Your request must be in writing and must state the reason for the amendment. We may deny a request if the information was not created by us, is not part of the information we keep, is not part of the information you would be permitted to inspect and copy, or is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we made of your health information, other than disclosures for treatment, payment and health care operations and certain other exceptions. Your request must state a time period, which may not be longer than six years.

Right to Request Restrictions

You have the right to request a restriction on the health information we use or disclose about you for treatment, payment or health care operations, or to someone involved in your care. We are not required to agree to a request, with one exception: if you pay in full, out of pocket, for a service and ask us not to disclose information about that service to your health plan for payment or operations purposes, we must agree.

Right to Request Confidential Communications

You have the right to ask that we communicate with you about medical matters in a certain way or at a certain location, for example only by telephone or only at a particular address. We will accommodate all reasonable requests and we will not ask you why you are making the request.

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 it electronically. Ask us at the front desk or call us and we will give you one.

Right to Be Notified of a Breach

You have the right to be notified if there is a breach of your unsecured protected health information.

Changes to This Notice

We reserve the right to change this notice and to make the revised notice effective for health information we already hold as well as for information we receive in the future. The current notice will be posted on this website and a copy will be available at the practice, with the effective date shown.

How to Exercise a Right or Make a Complaint

To exercise any of the rights described above, or to raise a concern about how your health information has been handled, contact us at Aevum Longevity and Aesthetic Surgery, 4211 N. Buffalo Road, Suite 15, Orchard Park, NY 14127, or call or text 716-392-2608. We would far rather hear about it directly and put it right.

You may also file a complaint with the Secretary of the United States Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/privacy/hipaa/complaints.

You will not be retaliated against in any way for filing a complaint, and it will not affect the care you receive from us.