HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

MedGlo Aesthetic Medicine & Wellness ("MedGlo") is committed to protecting the privacy of your health information. Federal law requires us to maintain the privacy and security of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices.

We are required by law to follow the practices described in this Notice. We reserve the right to change our privacy practices and the terms of this Notice at any time, and to make the new provisions effective for all PHI we maintain. A copy of the current Notice will be available at our office and on our website.

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your health information to provide, coordinate, or manage your health care and related services. For example, Dr. Recalde may share your medical history and treatment plan with other health care providers involved in your care.

Payment

We may use and disclose your health information to obtain payment for services provided to you. This may include providing information to your health insurance company, credit card processor, or financing provider (such as CareCredit or Cherry).

Health Care Operations

We may use and disclose your health information for our own health care operations, such as quality improvement activities, training, business management, and administrative activities.

Other Permitted Uses

We may also use or disclose your health information as required or permitted by law for:

• Public health activities and reporting
• Health oversight activities
• Judicial and administrative proceedings
• Law enforcement purposes
• To prevent a serious threat to health or safety
• Workers' compensation as required by law

Uses Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your health information for:

• Marketing purposes
• Sale of your health information
• Use of before-and-after photographs for promotional materials
• Most other purposes not described in this Notice

You may revoke your authorization in writing at any time, except to the extent that we have already acted in reliance upon it.

Your Rights Regarding Your Health Information

You have the following rights regarding your health information:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information maintained by MedGlo, with limited exceptions. We may charge a reasonable fee for copies.

Right to Amend

You have the right to request that we amend your health information if you believe it is incorrect or incomplete. We may deny your request in certain circumstances.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your health information.

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request, except in certain circumstances involving self-pay patients.

Right to Confidential Communications

You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at a specific phone number.

Right to a Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with MedGlo or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

To file a complaint with the Office for Civil Rights, visit www.hhs.gov/ocr/privacy/hipaa/complaints or call 1-877-696-6775.

Contact Information

For questions about this Notice or to exercise your rights, contact our Privacy Officer: