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.
7th Element Medical Aesthetics, PLLC (“7th Element,” “we,” “us,” or “our”), located at 4203 Montrose Blvd, Suite 400, Houston, TX 77006, is required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice describing our legal duties and privacy practices, and abide by the terms currently in effect. This Notice applies to all PHI created, received, or maintained by 7th Element, including our medical director, Dr. Asim Merchant, MD, our licensed clinical staff, and our business associates acting on our behalf.
1. Our Commitment to Your Privacy
We are committed to protecting the privacy of your health information. We create a record of the care and services you receive from us in order to provide you with quality care and to comply with legal requirements. This Notice applies to all records of your care generated by 7th Element, whether made by our staff or by our medical director.
2. How We May Use and Disclose Your Health Information
We may use and disclose your PHI for the following purposes without your written authorization:
- Treatment — to provide, coordinate, or manage your care and any related services, including consultation between providers and referrals for care.
- Payment — to bill and collect payment for services, including verifying insurance or payment eligibility where applicable and processing payments through our billing and scheduling systems.
- Health Care Operations — for activities such as quality assessment, staff training, licensing, and administrative functions necessary to run our practice.
- Appointment Reminders and Treatment Alternatives — to contact you regarding appointments or to tell you about treatment options or health-related services that may be of interest to you.
- As Required by Law — including public health reporting, health oversight activities, judicial or administrative proceedings, and to avert a serious threat to health or safety.
Any use or disclosure of your PHI for purposes other than those listed above — including most uses of PHI for marketing purposes — requires your specific written authorization, which you may revoke at any time in writing.
3. Your Rights Regarding Your Health Information
You have the following rights with respect to your PHI:
- Right to Inspect and Copy — you may request access to your medical and billing records.
- Right to Amend — you may request that we amend your PHI if you believe it is incorrect or incomplete.
- Right to an Accounting of Disclosures — you may request a list of certain disclosures we have made of your PHI.
- Right to Request Restrictions — you may request restrictions on certain uses or disclosures of your PHI, which we are not always required to agree to.
- Right to Request Confidential Communications — you may request that we communicate with you in a specific way or at a specific location.
- Right to a Paper Copy — you may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
- Right to be Notified of a Breach — you will be notified in the event of a breach of unsecured PHI as required by law.
4. Our Responsibilities
- We are required by law to maintain the privacy and security of your PHI.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this Notice and provide you with a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing, and you may revoke that permission in writing at any time.
5. Complaints
If you believe your privacy rights have been violated, you may file a complaint with 7th Element directly, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
- 7th Element Medical Aesthetics, PLLC — 4203 Montrose Blvd, Suite 400, Houston, TX 77006
- S. Dept. of Health and Human Services, Office for Civil Rights — www.hhs.gov/ocr/privacy/hipaa/complaints/
6. Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. A copy of the current Notice will be posted in our office and available on our website, and you may request a copy at any time.
7. Contact Us
If you have questions about this Notice or would like to exercise any of the rights described above, please contact us:
- 7th Element Medical Aesthetics, PLLC
- 4203 Montrose Blvd, Suite 400, Houston, TX 77006
- Website: 7thelementaesthetics.com
