HIPAA Privacy Policy

Effective April 14, 2003

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review the information carefully.

• La Bellezza is structured as an organized healthcare arrangement, which allows for the sharing of protected health information among groups and services listed in this Notice to carry out services for Treatment, Payment or Healthcare Operations.
• Your protected health information may be released to other healthcare professionals within La Bellezza or other covered entities for the purpose of providing you with quality healthcare. La Bellezza might share your health information with other departments in the organization to assist in coordinating the care you need, such as prescriptions, blood work, meals, and x-rays or other diagnostic tests.
• Your protected health information may be released to your insurance provider for the purpose of La Bellezza receiving payment for providing you with needed healthcare services. La Bellezza might share health information with your physician for payment activities related to the care you received.
• Your protected health information may be released in connection with our healthcare operations. La Bellezza might share your health information to perform evaluation of our quality of services provided to you during your stay. La Bellezza might share information among outside agencies for review and certification or licensing of our services provided.
• Your protected health information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
• Your protected health information may be released to other healthcare providers in the event you need emergency care.
• Your protected health information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Your protected health information may be used in our facilities directory; name, location in our facility, general condition and/or religious affiliation to be provided upon a caller’s specific request by name. La Bellezza will only release your religious affiliation to clergy. La Bellezza will provide you the opportunity to prohibit disclosure to our facility directories unless emergency circumstances prevent your opportunity to object.
• Your protected health information may be released only after receiving written authorization from you other than those listed above or for treatment, payment or healthcare operations. You may revoke your permission to release protected health information at any time. It must be in writing with effective date and be specific to the health information being protected. La Bellezza is NOT required to agree to your request.
• Your protected health information may be disclosed to an approved research project by La Bellezza in accordance with our policy and protocol for protecting the patient’s privacy. In most cases, La Bellezza will have the opportunity to obtain your written authorization before any information is shared for research purposes.
• You may be contacted by La Bellezza by phone or mail (or leave a message on an automated answering device) to remind you of appointments, pre schedule procedures verify insurance/demographic information or inform you of test results. You have the right to request a more confidential way of providing you protected health information or alternative communication method at time you are seen at La Bellezza. La Bellezza will honor all reasonable requests.
• You may be contacted by La Bellezza by phone or mail to offer healthcare treatment options or other health services that may be of interest to you. La Bellezza will provide in its’ marketing information on how to opt out of receiving future marketing communications.
• You may be contacted by La Bellezza for the purposes of raising funds to support the operations of La Bellezza. La Bellezza will provide in its’ fundraising material information on how to pot out of receiving future fundraising communications.
• You have the right to restrict the use of your protected health information. However, La Bellezza may choose to refuse your restriction if it is in conflict with providing you with quality healthcare or in the event of an emergency situation.
• You have the right to receive confidential communication about your health status. La Bellezza might disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, your location or your general health condition or death. La Bellezza will also use our professional judgment and our experience with common practice to make reasonable decisions when releasing your health information that is directly relevant to the person’s involvement in your healthcare.
• You have the right to review and photocopy any/all portions of your health information; La Bellezza has the right to assess a fee for the photocopying of the health information.
• You have the right to request an amendment to your health information. It must be in writing and explain why the information should be amended. La Bellezza can deny the amendment and if so, a written explanation will be provided.
• You have the right to know who has accessed your protected health information and for what purpose other than for Treatment, Payment, Healthcare Operations, and other activities by you. La Bellezza requires that the request for accounting of the disclosures be in writing to the Patient Information Privacy Officer listed below.
• You have the right to possess a copy of this Statement of Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
• La Bellezza is required by law to protect the privacy of its patients. It will keep protected any and all patient health information and will provide patients with a list of duties or practices that protect health information upon written request.
• La Bellezza will abide by the term of this notice. La Bellezza reserves the rights to make changes to this notice and will continue to maintain the confidentially of all health information.

You have the right to complain to La Bellezza if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your written complaint to:

La Bellezza Cosmetic Center and Day Spa

Attention: Patient Information Privacy Officer
13691 Metro Parkway Suite 110
Fort Myers, Fl. 33912

All complaints will be investigated. No personal issue will be raised for filing a complaint with La Bellezza.

You may also submit a written complaint to:

Region IV, Office of Civil Rights
U.S. Dept. of Health & Human Services
Atlanta Federal Center, Ste 3B70
61 Forsyth Street, S.W.
Atlanta, GA 3030-8909