NOTICE OF PRIVACY PRACTICES
—Zuri Plastic Surgery Miami—

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.

Last Updated: August 20, 2024

This Notice of Privacy Practices (“Notice”) describe how Zuri Plastic Surgery, LLC (“Zuri Plastic Surgery”, “we”, “us”, or “our”) may use and disclose your Protected Health Information (“PHI”) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Zuri Plastic Surgery is required by law to maintain the privacy and security of your PHI. to provide individuals with notice of their legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice.

USES AND DISCLOSURES OF PHI

We may use and disclose your PHI for the purposes treatment, payment and health care operations, described in more detail below. 

FOR TREATMENT: We may use and disclose your PHI so that we can provide, coordinate, and/or manage your treatment. For example, we may use your past medical information in order to diagnose your present condition or we may provide your PHI to another physician to whom we refer you for additional care to ensure that the health care professional has the necessary information to diagnose or treat you. 

FOR PAYMENT: We may use and disclose your PHI so that we may be paid for the medical treatment or other health care services we provide you. For example, we will submit PHI about you to your insurance company in order to receive payment for services we have provided to you. We may also tell your insurance company about a service you are going to receive in order to obtain prior approval or to determine whether your health insurance will cover the service.

FOR HEALTHCARE OPERATIONS: We may also use and disclose your PHI for our health care operations, including quality assessment and improvement, such as evaluating the treatment and services you receive and the performance of our staff in caring for you. For example, we may use your PHI to evaluate how we can better meet your needs or we may provide your PHI to an auditor who reviews our books so that we can keep our license to provide medical services. These disclosures help make sure that we are complying with all applicable laws and continue to provide quality health care to our patients.

OTHER USES AND DISCLOSURES OF YOUR PHI

In addition to using or disclosing your PHI for treatment, payment and health care operations, we may use and disclose PHI without your written authorization under the following circumstances. Although not every use or disclosure within a category is listed, we are only permitted to use or disclose your PHI without your authorization if it falls within one of these categories.

BUSINESS ASSOCIATES: We may use or disclose your PHI with outside companies that perform services for us such as accreditation, legal, computer, or auditing services. These outside companies are called “Business Associates” and are required by HIPAA and by contract to keep your PHI confidential.

FOR HEALTH OVERSIGHT ACTIVITIES: We may disclose your PHI to to a health oversight agency for oversight activities required by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws. For example, if necessary, we will disclose your PHI in licensure proceedings by the American Board of Plastic Surgery.

FOR APPOINTMENT REMINDERS: We may use and disclose your PHI to contact and remind you that you have an appointment with us. If you request that such communications be made confidentially, please contact our office in writing at 7540 SW 61 Ave., South Miami, FL 33143. We will accommodate all reasonable requests.

USES AND DISCLOSURES TO INDIVIDUALS INVOLVED IN YOUR CARE: We may disclose your PHI to a member of your family, a relative, a guardian, personal representative, close friend, or any other person you identify, that directly relates to that person’s involvement in your medical care. If you are unable to agree or object to this disclosure, or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may disclose such PHI as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose your PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition, or death. 

USES AND DISCLOSURES IN EMERGENCY SITUATIONS: We may use or disclose your PHI in an emergency treatment situation. If this happens, your physician will attempt to obtain your acknowledgment of this Notice as soon as reasonably practicable after the delivery of treatment.

USES AND DISCLOSURES FOR HEALTH-RELATED BENEFITS OR SERVICES: From time to time, we may use and disclosure your PHI to tell you about certain health related benefits or services that may be of interest to you.

USES AND DISCLOSURES REQUIRED BY LAW: We will use or disclose your PHI when required to do so by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if the law requires us to do so, of any such uses or disclosures. We must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the law.

USES AND DISCLOSURES RELATED TO COMMUNICABLE DISEASES: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

DISCLOSURES OF ABUSE OR NEGLECT: We may disclose your PHI to a public health authority authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to a governmental entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with state law.

DISCLOSURES TO THE FOOD AND DRUG ADMINISTRATION: We may disclose your PHI to a person or company required by the Food and Drug Administration (FDA) to report adverse events, product defects or other problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements; or to conduct post-market surveillance, as required.

DISCLOSURES FOR LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court order or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

DISCLOSURES TO LAW ENFORCEMENT: We may disclose your PHI if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process.

Other related disclosures may include disclosures relating to individuals who are Armed Forces personnel, to national security and intelligence agencies, as well as disclosures to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.

DISCLOSURES TO CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATION: We may disclose your PHI to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties required by law. We may also disclose PHI about you to a funeral director in order to permit the funeral director to carry out legal duties and may do so if death is reasonably anticipated. Your PHI may also be disclosed for certain organ donations to which you may have agreed.

DISCLOSURES FOR RESEARCH: In certain circumstances, we may disclose your PHI for medical research purposes. A researcher may have access to information that identifies you when their research has been approved and protocols have been established to ensure the privacy of your information. We may also disclose a limited set of your information, as allowed under the law, for research purposes.

DISCLOSURES RELATED TO CRIMINAL ACTIVITY: We may disclose your PHI, consistent with federal and state laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public, or if it is necessary for law enforcement authorities to identify or apprehend an individual.

DISCLOSURES FOR WORKERS’ COMPENSATION: We may release your PHI for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

OTHER USES AND DISCLOSURES OF PHI FOR WHICH AUTHORIZATION IS REQUIRED

Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which you have the limited right to revoke in writing. Your PHI may not be used or disclosed for marketing purposes or sold by Zuri Plastic Surgery without your prior written authorization. If you sign a written authorization permitting uses and disclosures of your PHI other than those described in this Notice, you may revoke your authorization by submitting a written request to Zuri Plastic Surgery’s Privacy Officer at any time. However, we are unable to retract or invalidated any uses or disclosures that were made with your permission before you revoked your authorization.

HIPAA provides additional protection for psychotherapy notes, and most uses or disclosures of psychotherapy notes require your written permission. Psychotherapy notes are the personal notes of a mental health professional about a private or group counseling session.

In addition, other types of information may have greater protection under federal or state law, such as certain drug and alcohol information, HIV/AIDS and other communicable disease information, genetic information, mental health information, or information about developmental disabilities. For this type of information, we may be required to get your written permission before disclosing it to others; we may seek that permission in Zuri Plastic Surgery’s intake forms if permitted by law. If you have any questions about this, contact Zuri Plastic Surgery’s Privacy Officer, whose contact information is provided at the end of this Notice.

YOU HAVE THE FOLLOWING RIGHTS REGARDING YOUR PHI

You have the following rights regarding your PHI. All requests must be submitted in writing to Zuri Plastic Surgery’s Privacy Officer. Please contact the Privacy Officer for additional information regarding any of these rights. The contact information for the Privacy Officer can be found at the end of this Notice.

RIGHT TO INSPECT AND COPY: You have the right to inspect and copy your PHI that may be used to make decisions about your medical care. Usually this right includes both medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances, such as information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access, and you have a right to request that any such denial be reviewed.

RIGHT TO REQUEST RESTRICTIONS: You have the right to request that we restrict the use and disclosure of your PHI for the purposes of treatment, payment and health care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes described in this Notice. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to 7540 SW 61 Ave., South Miami, FL 33143. 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 confidential communications

You also have the right to request to receive private health information communications (such as appointment confirmations) by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to 7540 SW 61 Ave., South Miami, FL 33143. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

RIGHT TO AMEND: If you feel that the PHI we have about you is incorrect or incomplete, you have the right to request that your PHI be amended. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your PHI is responsible for amending it. For more information regarding the procedures for submitting such a request, contact 7540 SW 61 Ave., South Miami, FL 33143. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of such rebuttal.

RIGHT TO AN ACCOUNTING OF DISCLOSURES: You have a right to an accounting of disclosures of your PHI, for purposes other than: (a) treatment, payment or healthcare operations; (b) pursuant to an authorization; (c) incident to a permitted use or disclosure; or (d) for certain other limited disclosures defined by law.

To request this list of disclosures we made of PHI about you, you must submit a request in writing to 7540 SW 61 Ave., South Miami, FL 33143. Your request must state a time period which may not be longer than six (6) years prior to the date of your request and may not include dates before August 1, 2005. Your request should indicate the form in which you want the list (for example, on paper or electronically). You will be charged for photocopying. 

RIGHT TO RECEIVE A PAPER COPY OF THIS NOTICE: Even if you have agreed to receive this Notice electronically, you have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.

You may obtain a copy of this Notice at our website: https://www.zuriplasticsurgery.com

To obtain a paper copy of this Notice, contact: 786.804.1603

To learn more about these procedures, or to make any of these requests, you should contact our Office Manager at 786.804.1603.

CHANGES TO THIS NOTICE

Zuri Plastic Surgery reserves the right to change this notice. We reserve the right to make the revised or changed Notice effective for phi we already have about you, as well as any information we create or receive in the future. We will post a copy of the current Notice on Zuri Plastic Surgery website: https://www.zuriplasticsurgery.com. The Notice will contain a “Last Updated” date near the top of the page.

COMPLAINTS

If you believe your privacy rights have been violated and/or that Zuri Plastic Surgery has not followed this policy, you may file a complaint with our Office Manager.

You may also file a complaint with the Secretary of the Department of Health and Human Services at http://www.hhs.gov/ocr/privacy/hipaa/complaints.

To file a complaint with our office at 7540 SW 61 Ave., South Miami, FL 33143. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF PROTECTED HEALTH INFORMATION

Other uses and disclosures of your protected health information not covered by this notice or the laws that apply to Zuri Plastic Surgery will be made only with your written permission (“Authorization”). If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical treatment or other services that we have provided to you.

QUESTIONS?

If you have any questions regarding this notice, please contact the Office Manager at Zuri Plastic Surgery at 786.804.1603 or email [email protected].