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PLEASE REVIEW THIS INFORMATION CAREFULLY.
This notice details and applies to the practices of Elite Plastic Surgery and the practices followed by all of Elite Plastic Surgery workforce members who handle your medical information.
Elite Plastic Surgery acknowledges that your medical information is personal and Elite Plastic Surgery is committed to protecting it. Elite Plastic Surgery maintains records and conducts treatments with aim of giving the highest level of protection to your medical and personal information, while still giving you the highest level of medical care. This notice applies to all records of your medical care received or created by Elite Plastic Surgery.
Other medical treatment providers (i.e. physicians, hospitals, home health agencies, etc.) may have differing policies or notices pertaining to the use and disclosure of your medical information. Those statements, policies, and guidelines do not apply to the policy provided in this notice.
The ways in which Elite Plastic Surgery may use and disclose medical information regarding you is detailed in this notice. Your medical information, also referred to as “protected health information,” includes your demographic information, or any other information that could identify you and that relates to your past, present or future physical or mental health and related health care services.
In this notice, your rights, as well as certain obligations Elite Plastic Surgery has regarding the use and disclosure of your protected health information, will be detailed. Elite Plastic Surgery are required by name to:
As a patient at Elite Plastic Surgery, you provide consent for Elite Plastic Surgery to utilize your protected health information for specific activities, such as treatment, payment and other health care operations.
Your protected health information may be disclosed by Elite Plastic Surgery so that Elite Plastic Surgery and its medical professionals can provide treatment to you. Including but not limited to:
For example, Elite Plastic Surgery will submit protected health information regarding you to your insurance company in order to receive payment for services Elite Plastic Surgery has provided you. Elite Plastic Surgery may also use and disclose protected health information regarding you for Elite Plastic Surgery’s health care operations.
Elite Plastic Surgery may use your protected health information to evaluate how Elite Plastic Surgery can better meet your needs or Elite Plastic Surgery may provide protected health information regarding you to an auditor who reviews books/files so that Elite Plastic Surgery may keep current licensing to provide medical services.
Other uses and disclosures of your protected health information
The following uses and disclosures of patient protected health information may be made without any additional authorization from you. (While not every use or disclosure is detailed, but rest assured that all uses and disclosures by Elite Plastic Surgery are only those permitted under the law).
Uses and disclosures for appointment reminders
To remind you of an appointment at the office we may use and disclose your medical information to contact you. Please contact our office in writing at 10910 N. Tatum Blvd
Suite B #100
Phoenix, AZ 85028 to request that such communications be made confidentially. Elite Plastic Surgery will accommodate all reasonable requests.
Uses and disclosures to others involved in your healthcare
We may disclose your protected health information that directly relates the involvement of the following in your medical care:
In the event you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment.
Your protected health information may also be used or disclosed by us to notify or assist in notifying a family member, personal representative or any other person responsible for your care of your location, general condition, or death.
Lastly, your protected health information may be used or disclosed by us to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Uses and disclosures in emergency situations
If at any time emergency treatment is needed, we may provide your protected health information to necessary parties. In this event we will attempt to obtain your permission and acknowledgement of this event where and when possible, which may occur after the treatment has been administered.
Uses and disclosures for health-related benefits or services
Time to time, we may use and disclose protected health information to inform you about certain health related benefits or services that may be of interest to you.
Uses and disclosures required by law
Your protected health information may be used or disclosed by Elite Plastic Surgery when required to do so by federal, state, or local law. This will be made in compliance with the law and will be limited to the relevant requirements of the law. If the law requires us to do so you will be notified of any such uses or disclosures. Elite Plastic Surgery 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
If authorized by law your protected health information may be used or disclosed, 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 for health oversight activities
Elite Plastic Surgery may disclose protected health information to a health oversight agency for activities authorized by law. Such activities include, for example:
Such activities are necessary for the government to monitor the health care system, the delivery of healthcare, government benefit programs, other government regulatory programs and civil rights laws.
Disclosures of abuse or neglect
Your protected health information may be disclosed to a public health authority authorized by law to receive reports of child abuse or neglect. Moreover, we may disclose your protected health information 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 practice state law.
Disclosures to the food and drug administration
Your protected health information may be disclosed to a person or company required by the Food and Drug Administration (FDA) to report:
As the agency is required to do.
Disclosures for lawsuits and disputes
In the event you are involved in a lawsuit or a dispute, your protected health information may be disclosed in response to a court order or administrative order. We may also disclose protected health information regarding you in response to:
But this is 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
Your protected health information may be disclosed by Elite Plastic Surgery if asked to do so by a law enforcement official, in response to:
Other related disclosures may include disclosures relating to individuals or organizations such as:
Disclosures to coroners, funeral directors, and organ donation
Your protected health information may be disclosed by Elite Plastic Surgery to a coroner or medical examiner for:
We may also disclose protected health information regarding 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 protected health information may also be disclosed for certain organ donations to which you may have agreed.
Disclosures for research
Disclosures for research
Your protected health information may be disclosed by Elite Plastic Surgery to researchers when their research has been approved and protocols have been established to ensure the privacy of your information. For research purposes, we may also disclose a limited set of your information, as allowed under the law.
Disclosures related to criminal activity
Consistent with federal and state laws, we may disclose your protected health information should we believe that the use or disclosure is necessary to:
Disclosures for Workers’ Compensation
Your protected health information may be disclosed for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Right to inspect and copy
You have the right to inspect and copy protected health information that may be used to make decisions regarding your medical care. Both medical and billing records are usually included in this right. Requests must be submitted in writing. Should 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. Requests to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.
Right to request restrictions
You have the right to request that Elite Plastic Surgery restrict the use and disclosure of your protected health information for treatment, payment and health care operations. However, Elite Plastic Surgery are not required to agree to your request. If Elite Plastic Surgery does 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 10910 N. Tatum Blvd
Suite B #100
Phoenix, AZ 85028. And in your request, you must provide:
Right to confidential communications
You have the right to request to receive private health information communications (such as appointment confirmations) by alternative means or at alternative locations. For instance: you can ask that Elite Plastic Surgery only contact you at work or by mail. For such requests, you must make your request in writing to 10910 N. Tatum Blvd
Suite B #100
Phoenix, AZ 85028. Elite Plastic Surgery will not ask you the reason for your request. Elite Plastic Surgery will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to amend
You have the right to request that your protected health information be amended in the event that you feel that the protected health information Elite Plastic Surgery has regarding you is incorrect or incomplete. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your protected health information is responsible for amending it. For more information pertaining to the procedures for submitting such a request, contact 10910 N. Tatum Blvd
Suite B #100
Phoenix, AZ 85028.
Right to an accounting of disclosures
You have a right to an accounting of disclosures of your protected health information, for reasons other than treatment, payment or health care operations by Elite Plastic Surgery or any of the people or companies who perform treatment, payment or health care operations on our behalf.
You must submit a request in writing to 10910 N. Tatum Blvd
Suite B #100
Phoenix, AZ 85028 in order to request this list of disclosures Elite Plastic Surgery made of protected health information regarding you. 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 May 12, 2021. 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 a paper copy of this notice
You have the right to 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://eliteplasticsurgeryaz.com/
To obtain a paper copy of this Notice, contact (480) 291-6895.
To learn more about these procedures, or to make any of these requests, you should contact our Office Manager at (480) 291-6895.
Changes to this notice
We reserve the right to change this notice. Elite Plastic Surgery also reserves the right to make the revised or changed Notice effective for protected health information Elite Plastic Surgery already has regarding you, as well as any information Elite Plastic Surgery may create or receive in the future. Elite Plastic Surgery will post a copy of the current Notice on Elite Plastic Surgery website: https://eliteplasticsurgeryaz.com/. The Notice will contain the effective date.
You may file a complaint with Dr. Rozbeh Torabi and Dr. Radbeh Torabi Office Manager or with the Secretary of the Department of Health and Human Services in the event you believe your privacy rights have been violated and/or that Elite Plastic Surgery or Dr. Rozbeh Torabi and Dr. Radbeh Torabi has not followed this policy.
To submit a complaint with Dr. Rozbeh Torabi and Dr. Radbeh Torabi contact our Office Manager, 10910 N. Tatum Blvd
Suite B #100 Phoenix, AZ 85028. All complaints must be filed in writing. You will not be penalized for filing a complaint.
Other uses of protected health information
Your written permission (“authorization”) is required for other uses and disclosures of your protected health information not covered by this notice or the laws that apply to Dr. Rozbeh Torabi and Dr. Radbeh Torabi. Should you provide us permission to use or disclose protected health information regarding you, you may revoke that permission, in writing, at any time. Should you revoke your permission, Elite Plastic Surgery will no longer use or disclose protected health information regarding you for the reasons covered by your authorization. Please understand that Elite Plastic Surgery is unable to take back any disclosures Elite Plastic Surgery may have already made with your permission, and that Elite Plastic Surgery is required to retain records of the medical treatment or other services that Elite Plastic Surgery provided to you.
For any questions or concerns regarding this notice, feel free to reach out to the Office Manager at Elite Plastic Surgery.
Contact us today and let us know how we can help you. Looking to book a consultation? Our team is currently scheduling consultations for all procedures. Please fill out the form or give us a call today.