Please review this notice carefully. Your information. Your rights. Our responsibilities.
Your rights
When it comes to your health information, you have certain rights. This section explains those rights and some of NuSelf's responsibilities.
Get an electronic or paper copy of your medical record
You may ask to inspect or receive an electronic or paper copy of your medical record and other health information NuSelf maintains about you. We generally will provide a copy or summary within the time required by law and may charge a reasonable, cost-based fee where permitted.
Ask us to correct your medical record
You may ask NuSelf to correct health information you believe is incorrect or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing within the time required by law.
Request confidential communications
You may ask NuSelf to contact you in a specific way, such as at a particular telephone number, or to send mail to a different address. We will accommodate reasonable requests.
Ask us to limit what we use or disclose
You may ask us not to use or disclose certain health information for treatment, payment or healthcare operations. We are not required to agree to most requests. If you pay for a service or healthcare item in full out of pocket, you may ask us not to disclose information about that item or service to your health plan for payment or operations, and we will agree unless a law requires disclosure.
Get a list of certain disclosures
You may request an accounting of certain disclosures of your health information made during the period allowed by law. The list will not include all disclosures, such as most disclosures for treatment, payment and healthcare operations. One accounting in a 12-month period is generally provided without charge; a reasonable fee may apply to additional requests.
Get a copy of this notice
You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide one promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information as authorized by law. We will verify that the person has this authority before acting.
File a complaint
You may complain if you believe your privacy rights have been violated by contacting NuSelf at NuSelf Aesthetics & Longevity, Attn: Privacy Officer, 1335 E Whitestone Blvd, Ste V-205, Cedar Park, TX 78613; 512-456-0475; Info@nuselfaesthetics.com. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. NuSelf will not retaliate against you for filing a complaint.
Your choices
For certain health information, you may tell us your preferences about what we disclose. If you have a clear preference in the situations below, tell us what you want us to do and we will follow your instructions when reasonably possible and permitted by law.
- Include or exclude family, close friends or others involved in your care or payment for your care.
- Disclose information in a disaster-relief situation.
- Contact you about fundraising efforts. You may tell us not to contact you again for fundraising.
When you cannot tell us your preference
If you are unable to communicate, NuSelf may disclose information when we believe it is in your best interest, consistent with professional judgment and applicable law. We may also disclose information when necessary to lessen a serious and imminent threat to health or safety.
Written authorization
NuSelf generally will obtain your written authorization before using or disclosing protected health information for marketing, selling protected health information, or most uses of psychotherapy notes when those rules apply. Other uses and disclosures not described in this notice will be made only with your written authorization unless otherwise permitted or required by law. You may revoke an authorization in writing, except to the extent action has already been taken in reliance on it.
Our uses and disclosures
NuSelf may use or disclose your health information in the following ways without obtaining a separate authorization, as permitted or required by law.
Treatment
We may use and disclose health information to treat you and coordinate or manage your care. For example, a NuSelf clinician may share relevant information with another clinician involved in your treatment.
Payment
We may use and disclose health information to bill and receive payment for services, determine coverage or benefits, obtain prior approval, or support collection activities permitted by law.
Healthcare operations
We may use and disclose health information to operate the practice, improve quality, train and supervise workforce members, conduct compliance and auditing activities, assess performance, manage risk and contact you when necessary for care or operations.
Other activities permitted or required by law
- Public-health and safety activities, including disease prevention, product reporting, suspected abuse or neglect, and preventing or reducing a serious threat to health or safety.
- Health oversight activities such as audits, investigations, inspections, licensure and disciplinary proceedings.
- Research that has received legally required approval or for which your authorization or a permitted waiver applies.
- Organ and tissue donation, when applicable.
- Workers' compensation and similar programs authorized by law.
- Law-enforcement purposes and disclosures to correctional institutions when legal requirements are met.
- Medical examiners, coroners and funeral directors as permitted by law.
- Judicial and administrative proceedings, subpoenas, discovery requests or other lawful process when applicable requirements are satisfied.
- Special government functions, including military, national security and protective services, as authorized by law.
- Compliance with any other law that requires or permits a use or disclosure.
Substance use disorder records
If NuSelf maintains records protected by federal substance use disorder confidentiality law, additional restrictions may apply. Such records generally may be used or disclosed for treatment, payment and healthcare operations as allowed by law and applicable consent, but may not be used against you in a civil, criminal, administrative or legislative proceeding without your written consent or an appropriate court order, as required by law.
Our responsibilities
- NuSelf is required by law to maintain the privacy and security of protected health information.
- We will notify affected individuals as required if a breach occurs that may have compromised the privacy or security of their information.
- We must follow the duties and privacy practices described in the notice currently in effect.
- We will not use or disclose your information other than as described here unless you authorize it in writing or another law permits or requires it.
Changes to this notice
NuSelf may change the terms of this notice, and the changes may apply to all health information we maintain, including information created or received before the change. A revised notice will be available at the practice and on this website with its effective date.
Privacy contact
For questions, requests or complaints regarding health-information privacy, contact NuSelf Aesthetics & Longevity, Attn: Privacy Officer, 1335 E Whitestone Blvd, Ste V-205, Cedar Park, TX 78613; 512-456-0475; Info@nuselfaesthetics.com.