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This notice describes how your medical information may be used and disclosed and your individual rights.

An individual has the right to protected health information (PHI) that is safeguarded from unlawful use or disclosure and the right to access and review that PHI.

Please do not disclose your medical information through the website. 

Certain health and medical information is protected under the Health Insurance Portability and Accountability Act ("HIPAA") and applicable state law. This information may be provided by you online in a secured Electronic Health System or in person to your provider.

Your medical information is important to me and I am committed to maintaining privacy and confidentiality of your medical information. In the office your records are kept in a secured electronic database that allows me to provide quality care to you. The health information you provide is required by law to be protected. I am also required to notify you if there is a breach of your health information. The following information outlines how your medical information may be used, your rights and my legal obligates with respect to your PHI. 

Uses and Disclosures of Protected Health Information (PHI)

Your protected health information may be used and disclosed by the Nurse Practitioner and others outside of the office that are involved in your care and treatment for the purpose of providing health care services to you to support business operations of this office, if requested by you to a finance company to pay for your care, and any other use required by law. 


I will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, I would disclose your PHI, as necessary, if, as a result of my services, you require treatment by another physician or specialist. Your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. 


Your PHI will be used, if requested, to obtain payment for your services. For example, if you desire to finance the costs of your treatments, this may involve disclosing relevant protected private information in order to obtain approval. 

Healthcare Operations: 

I may use or disclose, as needed, your PHI in order to support the business activities of this office. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. In addition, I may use a sign-in sheet at the registration desk where you will be asked to sign your name. I may also call you by name in the waiting room when I am ready to see you. I may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. 

I may use or disclose your PHI in the following situations without your authorization. These situations include: as required by law; public health issues as required by law, communicable diseases; health oversight; abuse or neglect; Food and Drug Administration requirements; legal proceedings; law enforcement; coroners, funeral directors and organ donation; research; criminal activity and national security; workers compensation; inmates; required uses and disclosures. Under the law, we must make disclosure to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500. 

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law. 

You may revoke this authorization, at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization.

You will be required to sign a HIPAA consent form on your first visit to the office. 

Your Rights

Following is a statement of your rights with respect to your PHI.

You have the right to inspect and copy your PHI. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

You have the right to require a restriction of your PHI. This means you may ask me not to use or disclose any part of your PHI for the purposes of treatment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. 

I am not required to agree to a restriction that you may request. If the Nurse Practitioner believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another service provider. 

You have the right to request to receive confidential communications from me by alternative means or at an alternative email. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e., electronically. 

You may have the right to amend your PHI. If I deny your request for amendment, you have the right to file a statement of disagreement with me and we may prepare a rebuttal to our statement and will provide you with a copy of any such rebuttal. 

You have the right to receive an accounting of certain disclosures I have made, if any, of your PHI. 

I reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice. 


You may complain to Illuminate Skin Health, LLC, or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with Illuminate Skin Health, LLC, by notifying our privacy contact of your complaint. Illuminate Skin Health, LLC will not retaliate against you for filing a complaint.

 Illuminate Skin Health, LLC, is required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please contact Illuminate Skin Health, LLC. 

This notice was published and becomes effective on/or before September 21, 2020.

HIPAA Privacy Policy: Text
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