Notice of Privacy Practices
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.
What is your protected Health Information:
Protected Health Information (PHI) refers to any information that relates to a
person’s physical or mental health, health care services received, or payment for
health care services. PHI can include things like medical records, test results,
treatment plans, and insurance information. Under the Health Insurance
Portability and Accountability Act (HIPAA), PHI is considered sensitive information
that must be kept confidential and secure by health care providers, insurance
companies, and other organizations that handle health information.
Ways in Which We May Use and Disclose Your Protected Health Information:
The following paragraphs describe different ways that we use and disclose your protected health information. We have provided an example for each category, but these examples are not meant to be exhaustive. We assure you that all of the ways we are permitted to use and disclose your health information fall within one of these categories.
Treatment
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. We will also disclose your health information to another provider who we have requested to be involved in your care. For example — we would disclose your health information to a specialist to whom we have referred you for a diagnosis to help in your treatment.
Payment
We will use and disclose your protected health informationrelated to payment for the health care services we provide you. For example — we may include information to a bookkeeper that identifies you, your diagnosis, procedures performed, and supplies used in rendering the service. It is the patient responsibility to mark Venmo (or similar) as “private”.
Health Care Operations
We will use and disclose your protected health information to support the business activities of our practice. We may disclose your health information to third-party business associates who perform billing, consulting, transcription services, or marketing services for our practice.
Other Ways We May Use and Disclose Your Protected Health Information:
– Appointment Reminders
We may use and disclose your protected health information to contact you as a reminder about scheduled appointments or treatment.
– Treatment Alternatives
We may use and disclose your protected health information to tell you about or to recommend possible alternative treatments or options that may be of interest to you.
– Others Involved in Your Care
We may use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identify that is involved in your medical care or payment for care.
– Research
We may use and disclose your protected health information to researchers provided the research has been approved by an institutional review board that has reviewed the research proposal and established
protocols to ensure the privacy of your health information.
– As Required by Law
We may use and disclose your protected health information when required by federal, state or local law. You will be notified of any such disclosures.
– To Avert a Serious Threat to Public Health or Safety
We may use and disclose your protected health information to a public health authority that is permitted to collect or receive the information for the purpose of controlling disease, injury, or disability. If directed by that health authority, we will also disclose your health information to a foreign government agency that is collaborating with this public health authority. We will share your health information about adverse events with appropriate entities.
– Worker’s Compensation
We may use and disclose your protected health information for worker’s compensation or similar programs that
provide benefits for work-related injuries or illness.
Your Health Information Rights
Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to:
– A Paper Copy of This Notice
You have the right to receive a paper copy of this notice upon request. You may obtain a copy by asking Refine By Farrell, LLC, known as Refine Medical Aesthetics, at your next visit or by emailing us a request to mail you a copy.
– Inspect and Copy
You have the right to inspect and copy the protected health information that we maintain about you in our designated record set for as long as we maintain that information. This designated record set includes your medical and billing records, as well as any other records we use for making decisions about you. We may charge you a fee for the costs of copying, mailing, or other supplies used in fulfilling your
request. If you wish to inspect or copy your medical information, you must submit your request in writing to Refine By Farrell, LLC, 49 Cromwell Place, Old Saybrook, CT 06475. You may mail in your request, or bring it
to our office. We will have 30 days to respond to your request for information that we maintain at our practice site. If the information is stored off-site, we are allowed up to 60 days to respond but must inform you of this delay.
If you wish to inspect or copy your medical information, you must submit your request in writing to our Suzanne Arcuni, APRN, Refine By Farrell, LLC, 49 Cromwell Place, Old Saybrook, CT 06475. You may mail in your request, or bring it to our office. We will have 30 days to respond to your request for information that we maintain at our practice site. If the information is stored off-site, we are allowed up to 60 days to respond but must inform you of this delay.
– Request Amendment
You have the right to request that we amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to Refine By Garrell LLC, known as Refine Medical Aesthtetics stating exactly what information is incomplete or inaccurate and your reasoning that supports your request. We are permitted to deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if:
- The information was not created by us, or the person who created it is no longer available to make the amendment.
- The information is not part of the record which you are permitted to inspect and copy;
- The information is not part of the designated record set kept by this practice; or if it is the opinion of the health care provider that the information is accurate and complete
Request Restrictions
You have the right to request a restriction or limitation of how we use or disclose your medical information for treatment, payment, or health care operations. For example—you could request that we not disclose information about a prior treatment to a family member or friend who might be involved in your care or payment for care. Your request must be made in writing to Refine By Farrell, LLC known as Refine Medical Aesthetics. We are not required to agree to your request if we feel it is in your best interest to use or disclose that information. However, if we do agree, we will comply with your request unless that information is needed for emergency treatment.
An Accounting of Disclosures
You have the right to request a list of the disclosures of your health information we have made outside of our practice that were not for treatment, payment, or health care operations. Your request must be made in writing and must state the time period for the requested information. You may not request information for any dates prior to April 14, 2003 (the compliance date for the federal regulation) nor for a period of time greater than six years (our legal obligation to retain information). We may charge you a fee for the costs of providing the copy. We will notify you of such costs and afford you the opportunity to withdraw your
request before any costs are incurred.
Request Confidential Communications
You have the right to request how we communicate with you to preserve your privacy. For example— you may request that we call you only at your work number, or by mail at a special address or postal box. Your request must be made in writing and must specify how or where we are able to contact you. We will
accommodate all reasonable requests.
File a Complaint
If you believe we have violated your medical information privacy rights, you have the right to file a complaint with Suzanne Arcuni, APRN at Refine By Farrell, LLC know as Refine Medical Aesthetics or directly to the Secretary of Health and Human Services. To file a complaint with Suzanne Arcuni, APRN, you must make it in writing within 180 days of the suspected violation. Provide as much detail as you can about the suspected violation and send it to Refine By Farrell, LLC 49 Cromwell Place Old Saybrook, CT 06475.
Uses of Disclosure Not Covered
Uses or disclosures of your health information not covered by this notice or by the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time
and we will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by
the revocation.
For More Information
If you have questions or would like additional information, you may contact us at:
info@refinect.com
860-287-3360
Refine By Farrell, LLC
49 Cromwell Place
Old Saybrook, CT 06475
or:
Refine Medical Aesthetics
1587 Boston Post Rd., Suite A3
Westbrook, CT 06498
Effective Date: 05/02/2023
