New Look Skin Center™ Notice of Privacy Practices

THIS PRIVACY NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS PRIVACY NOTICE CAREFULLY.

Effective Date of this Privacy Notice:  April 20, 2016

This New Look Skin Center™ Notice of Privacy Practices (“Privacy Notice”) has been created by New Look Skin Center, Inc. and New Look Skin LLC (collectively, “New Look Skin Center™,” “we,” “our” or “us”) in compliance with the Standards for Privacy of Individually Identifiable Health Information (the “Privacy Standard”) set forth by the U.S. Department of Health and Human Services (“HHS”) pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”).  As set forth in the Privacy Notice, New Look Skin Center™ is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:

  • New Look Skin Center’s™ uses and disclosures of Protected Health Information (“PHI”);
  • your privacy rights with respect to your PHI;
  • New Look Skin Center’s™ duties with respect to your PHI;
  • your right to file a complaint with New Look Skin Center™ and/or the Secretary of the U.S. Department of Health and Human Services; and
  • the person or office to contact for further information about New Look Skin Center’s™ privacy practices.

PHI includes all “Individually Identifiable Health Information” transmitted or maintained by New Look Skin Center™, regardless of form (oral, written, electronic). The term “Individually Identifiable Health Information” means information that:  

  • Is created or received by a health care provider, health plan, employer or health care clearinghouse.
  • Relates to the: (a) past, present or future physical or mental health or condition of an individual; (b) provision of health care to an individual; or (c) past, present or future payment for the provision of health care to an individual; and
  • Identifies the individual, or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

Section 1:  Notice of PHI Uses and Disclosures

1.1  Required PHI Disclosures

Upon your request, New Look Skin Center™ is required to give you access to certain PHI in order to inspect and copy it and to provide you with an accounting of disclosures of PHI made by New Look Skin Center™.  Disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine New Look Skin Center’s™ compliance with the privacy regulations.  

1.2  Permitted Uses and Disclosures to Carry Out Treatment, Payment and Healthcare Operations

The law allows New Look Skin Center™ and its business associates, and their agents/subcontractors, if any, to use or disclose PHI to carry out Treatment, Payment and Healthcare Operations (as those terms are defined below).  New Look Skin Center™ will disclose PHI to a business associate only if New Look Skin Center™ receives satisfactory assurance that the business associate will appropriately safeguard the information. In addition, New Look Skin Center™ may contact you to provide information about treatment alternatives or other health-related benefits or services that may be of interest to you.

For purposes of this Privacy Notice, “Treatment” shall mean the provision, coordination or management of health care and related services.  It also includes, but is not limited to, consultations and referrals between one or more of your health care providers.  

For purposes of this Privacy Notice, “Payment” shall mean activities undertaken by New Look Skin Center™ to obtain fees in connection with health care services provided.  Payment includes, but is not limited to, all billing functions.  

For purposes of this Privacy Notice, “Healthcare Operations” shall mean activities undertaken by New Look Skin Center™ in connection with its business operations and provision of care, including, where necessary, to contact you, to manage your treatment and to provide you with requested services.

1.3  Uses and Disclosures that Require Your Written Authorization

New Look Skin Center™ does not create or maintain substance abuse treatment records or psychotherapy notes; provided, however, that should you submit same to New Look Skin Center™, we will never share any such records without your written permission.

1.4  Disclosures that Require that You Be Given an Opportunity to Agree or Disagree Prior to the Disclosure

Where authorized by you in advance, New Look Skin Center™ may disclose to a family member, other relatives, your close personal friends or any other person identified by you, PHI directly relevant to such person’s involvement with your care or payment for your health care.

When you are present for or otherwise available prior to a disclosure and you are able to make health care decisions, New Look Skin Center™ will disclose PHI, if:

  • New Look Skin Center™ obtains your agreement;
  • New Look Skin Center™ provides you with the opportunity to object to the disclosure and you fail to do so; or
  • New Look Skin Center™ infers from the circumstances, based upon professional judgment, that you do not object to the disclosure.

New Look Skin Center™ may obtain your oral agreement or disagreement to a disclosure.  However, if you are not present, or the opportunity to agree or object to the disclosure cannot practicably be provided because of your incapacity or emergency circumstance, New Look Skin Center™ may, in the exercise of professional judgment, determine whether the disclosure is in your best interests, and, if so, disclose PHI that is directly relevant to the person’s involvement with your health care.

1.5  Uses and Disclosures for which Consent Authorization or Opportunity to Object Is not Required

Subject to the requirements set forth in the Privacy Regulation, use and disclosure of your PHI is allowed without your authorization or request under the following circumstances:

(a) When required by law, provided that the use or disclosure complies with and is limited to the relevant requirement of such law;

(b) When permitted for purposes of: (i) public health activities, relating to preventing or controlling disease, injury or disability; (ii) reporting child or other abuse or neglect; (iii) reporting domestic violence; and/or (iv) reporting to the Food and Drug Administration (“FDA”): (A) problems with FDA-regulated products or activities; and/or (B) reactions to medications.  PHI may also be disclosed to a person who may have been exposed to a communicable disease or is at risk of spreading a disease or condition, if authorized by law;

(c) New Look Skin Center™ may disclose your PHI to a public health oversight agency for oversight activities authorized by law, such as: (i) audits, civil, administrative or criminal investigations; (ii) inspections; (iii) licensure; and/or (iv) disciplinary actions;

(d) New Look Skin Center™ may disclose your PHI in the course of a judicial or administrative proceeding in response to an order of the court or administrative tribunal, provided that New Look Skin Center™ discloses only the PHI expressly authorized by such order in response to a subpoena or discovery request provided or other lawful process, that is not accompanied by an order of a court or administrative tribunal if certain conditions are met;

(e) New Look Skin Center™ may disclose your PHI to a law enforcement official when required for law enforcement purposes such as identifying or locating a suspect , fugitive, material witness or missing person.  In addition, New Look Skin Center™ may disclose PHI in compliance with: (i) a court order, court-ordered warrant or subpoena or summons issued by a judicial officer; (ii) a grand jury subpoena; or (iii) an administrative request, including an administrative subpoena or summons, a civil or authorized investigative demand, provided certain conditions are satisfied.  Further New Look Skin Center™ may disclose your PHI if it believes in good faith that the PHI constitutes evidence of criminal conduct that occurred on New Look Skin Center’s™ premises;                   

(f) New Look Skin Center™ may disclose PHI of a deceased person to a coroner or medical examiner or funeral directors;

(g) New Look Skin Center™ may use or disclose PHI for research, subject to conditions;

(h) When consistent with applicable law and standards of ethical conduct, New Look Skin Center™ may use or disclose PHI to prevent or lessen a serious and imminent threat to health or safety of a person or the public;

              (i) When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law, New Look Skin Center™ may use or disclose PHI;

              (j) New Look Skin Center™ may disclose PHI for military, national security, prisoner and government benefit purposes; and

              (k) New Look Skin Center™ may disclose PHI to organizations involved in procuring, banking or transplanting organs and tissues.

Section 2: Rights of Individuals

2.1 Right to Request Restrictions on PHI Uses and Disclosures

You may request that New Look Skin Center™ restrict its uses and disclosures of your PHI to carry out Treatment, Payment or Health Care Operations, or to restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care.  However, New Look Skin Center™ is not required to agree to your requested restriction(s).

If New Look Skin Center™ agrees to a requested restriction, New Look Skin Center™ may not use or disclose PHI in violation of such restriction, except that, if you requested a restriction and later are in need of emergency treatment and the restricted PHI is needed to provide the emergency treatment, New Look Skin Center™ may use the restricted PHI, or it may disclose such information to a health care provider, to provide such treatment to you.  If restricted PHI is disclosed to a health care provider for emergency treatment, New Look Skin Center™ must request that such health care provider not further use or disclose the information.

A restriction agreed to by New Look Skin Center™ is not effective to prevent uses or disclosures when required by the Secretary of HHS to investigate or determine New Look Skin Center’s™ compliance with the Privacy Standard or uses or disclosures that are otherwise required by law.

New Look Skin Center™ may terminate its agreement to a restriction if:

  • You agree to or request the termination in writing;
  • You orally agree to the termination and the oral is documented; or
  • New Look Skin Center™ informs you that it is terminating its agreement to a restriction, except that such termination is only effective with respect to PHI created or received after New Look Skin Center™ has informed you of termination.

If New Look Skin Center™ agrees to a restriction, it will document the restriction by maintaining a written or electronic record of the restriction.  The record of the restriction will be retained for six (6) years from the date of its creation or the date when it last was effective, whichever is later.

You or your personal representative will be required to request restrictions on uses and disclosures of your PHI in writing. Such requests should be addressed to the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.2 Right to Request Confidential Communications of PHI

You may request to receive communications of PHI from New Look Skin Center™ by alternative means or at alternative locations if you clearly state that the disclosure of all or part of the information to which the request pertains could endanger you.  New Look Skin Center™ will accommodate all such reasonable requests.  However, New Look Skin Center™ may condition the provision of a reasonable accommodation on:

  • When appropriate, information as to how payment, if any, will be handled; and
  • Specifications by you to an alternative address or other method of contact.

You or your personal representative will be required to request confidential communications of your PHI in writing. Such requests should be made to the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.3 Right to Inspect and Copy PHI

You have a right to inspect and obtain a copy of your PHI contained in a Designated Record Set (as defined below) for as long as New Look Skin Center™ maintains the PHI.

For purposes of this Privacy Notice, “Designated Record Set” means a group of records maintained by or for New Look Skin Center™ that is related to payment and medical records.

New Look Skin Center™ will act on requests for access no later than thirty (30) days after receipt of each such request.  However, if the request for access is for PHI that is not maintained or accessible to New Look Skin Center™ on-site, New Look Skin Center™ must take action no later than sixty (60) days from receipt of such requests.  If New Look Skin Center™ cannot take action within the required time, New Look Skin Center™ may extend the time for such action by no more than thirty (30) days if New Look Skin Center™, within the applicable time limit, provides you with a written statement of the reasons for the delay and the date by which it will complete its action on the request.

If New Look Skin Center™ provides access to PHI, it will provide the access requested, including inspection or obtaining a copy, or both, of your PHI in a Designated Record Set.  New Look Skin Center™ will provide you with access to the PHI in the form or format as agreed to between you and New Look Skin Center™.  New Look Skin Center™ may provide you with a summary of the PHI requested, in lieu of providing access to the PHI or may provide an explanation of the PHI to which access has been provided in certain circumstances.  New Look Skin Center™ will arrange with you for a convenient time and place to inspect or obtain a copy of the PHI, or mail a copy of the PHI at your request.  If you request a copy or PHI or agree to a summary or explanation of PHI, New Look Skin Center™ may impose a reasonable, cost-based fee.

Under very limited circumstances, New Look Skin Center™ may deny your request.  If New Look Skin Center™ denies access to PHI in whole or in part, New Look Skin Center™ will, to the extent possible, give you access to any other PHI requested, after excluding PHI as to which New Look Skin Center™ has grounds to deny access.  If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, if applicable, a statement of your review rights, including a description of how you may exercise those review rights and a description of how you may complain to New Look Skin Center™ or to the Secretary of the HHS.  If you request review of a decision to deny access, New Look Skin Center™ will refer the request to a designated licensed health care professional for review. The reviewing official will determine, within a reasonable period of time, whether to deny the access requested.  New Look Skin Center™ will promptly provide you with written notice of that determination.

If New Look Skin Center™ does not maintain the PHI that is the subject of your request for access, and New Look Skin Center™ knows where the requested information is maintained, New Look Skin Center™ will inform you of where to direct the request for access.

You or your personal representative will be required to request access to your PHI in writing.  Such requests should be addressed to the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.4 Right to Amend PHI

You have the right to request that New Look Skin Center™ amend your PHI or a record about you in a Designated Record Set for as long as the PHI is maintained in the Designated Record Set.  

New Look Skin Center™ may deny your request for amendment if it determines that the PHI or record that is the subject of the request:

  • Was not created by New Look Skin Center™, unless you provide a reasonable basis to believe that the originator of  PHI is no longer available to act on the requested amendment;
  • Is not part of the Designated Record Set; or
  • Is accurate and complete.

New Look Skin Center™ has sixty (60) days after the request is made to act on the request.  A single thirty (30) day extension is allowed if New Look Skin Center™ is unable to comply within that deadline provided that New Look Skin Center™, within the original sixty (60) day time period, provides you with a written statement of the reasons for the delay and the date by which it will complete its action on the request.  If New Look Skin Center™ accepts the requested amendment, New Look Skin Center™ will make the appropriate amendment to the PHI or record that is the subject of the request by, at a minimum, identifying the records in the Designated Record Set that are affected by the amendment and appending or otherwise providing a link to the locations of the amendment.  New Look Skin Center™ will timely inform you that the amendment is accepted and obtain your identification of, and your agreement to have New Look Skin Center™ notify, the relevant person(s) with which the amendment needs to be shared as provided in the Privacy Standard.

If you request is denied in whole or in part, New Look Skin Center™ must provide you with a written denial that explains the basis for the denial.  You have the right to have certain information related to your requested amendment included in your records.  For example, if you disagree with New Look Skin Center’s™ decision, you have the right to submit a written statement explaining your disagreement with the denial, which New Look Skin Center™ will include in your records.  New Look Skin Center™ will provide a description of how you may complain to New Look Skin Center™ or to the Secretary of HHS.  These procedures will be explained in more detail in any written denial notice sent to you by New Look Skin Center™.

You or your personal representative will be required to request amendment to your PHI in your Designated Record Set in writing. Such requests for amendment of PHI in a Designated Record Set should be made to the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.5 The Right to Receive an Accounting of PHI Disclosures

At your request, New Look Skin Center™ will provide you with an accounting of disclosures by New Look Skin Center™ of your PHI during the six (6) years prior to the date of your request. However, such accounting need not include PHI disclosures made: (a) to carry out Treatment, Payment or Health Care Operations; (b) to individuals about their own PHI; (c) incident to a use or disclosure otherwise permitted or required by the Privacy Standard; (d) pursuant to an authorization from you; (e) to certain persons involved in your care or payment for your care; (f) to notify certain persons of your location, general condition or death; (g) as part of a “Limited Data Set’ (as defined in the Privacy Standard), which largely relates to research purposes; or (h) prior to the compliance date of April 14, 2004.  You may request an accounting of disclosures for a period of time less than six (6) years from the date of the request.  

If the accounting cannot be provided within sixty (60) days after receipt of the request, an additional thirty (30) days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.

If you request more than one accounting within a twelve (12) month period, New Look Skin Center™ will charge a reasonable, cost-based fee for each subsequent accounting.  We will notify you of any fees involved so that you may decide whether to withdraw or modify the request for a subsequent accounting to avoid or reduce the fee.

You or your personal representative will be required to request an accounting of your PHI disclosure in writing.  Such requests should be made to the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.6 The Right to Receive a Paper Copy of this Privacy Notice upon Request

You have a right to obtain a paper copy of this Privacy Notice upon request.  To request a paper copy of this Privacy Notice, contact the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

2.7 A Note about Personal Representatives

You may exercise your rights through a personal representative.  Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you.  Proof of such authority may take one of the following forms:

  • a power of attorney for health care purposes, notarized by a notary public;
  • a court order of appointment of the person as the conservator or guardian of the individual; or
  • an individual who is the parent of a minor child.

New Look Skin Center™ retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minors.

Section 3:  New Look Skin Center’s™ Duties

3.1 Notice

New Look Skin Center™ is required by law to maintain the privacy of PHI and to provide individuals with notice of New Look Skin Center’s™ legal duties and privacy practices with respect to PHI.

This Privacy Notice is effective beginning on the effective date set forth on Page 1 of this Privacy Notice. New Look Skin Center™ is required to comply with the terms of this Privacy Notice; provided, however, that New Look Skin Center™ reserves the right to change the terms of this Privacy Notice and to make the new revised Privacy Notice provisions effective for all PHI that it maintains, including any PHI created, received or maintained by New Look Skin Center™ prior to the date of the revised Privacy Notice.  If a privacy practice is changed, a revised version of this Privacy Notice will be provided to all individuals then affected.  If agreed upon between New Look Skin Center™ and you, New Look Skin Center™ will provide you with a revised Privacy Notice electronically.  Otherwise, New Look Skin Center™ will mail a paper copy of the revised Privacy Notice to your most current address of record.  In addition, the revised Privacy Notice will be maintained on any website and in any mobile app maintained by New Look Skin Center™ to provide information about its benefits.

Any revised version of this Privacy Notice will be distributed within sixty (60) days of the effective date of any material change to the uses or disclosures, the individual’s rights, the duties of New Look Skin Center™ or other privacy practices stated in this Privacy Notice.  Except when required by law, a material change to any term of this Privacy Notice may not be implemented prior to the effective date of the revised Privacy Notice in which such material change is reflected.

If the manner in which we use your PHI changes, you will have a choice as to whether or not we use your PHI in this different manner, and we will only use your PHI in this different manner where you opt-in to such use.

3.2 Minimum Necessary Standard

When using or disclosing PHI or when requesting PHI from another covered entity, New Look Skin Center™ will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.

However, the minimum necessary standard will not apply in the following situations:

  • disclosures to or requests by a health care provider for treatment;
  • uses or disclosures made to the individual;
  • disclosures made to the Secretary of  HHS;
  • uses or disclosures that are required by law;
  • uses or disclosures that are required for New Look Skin Center’s™ compliance with the Privacy Standard; and/or
  • uses or disclosures made pursuant to an authorization.

This Privacy Notice does not apply to information that has been de-identified. De-identified information is information: (a) that does not identify an individual: (b) with respect to which there is no reasonable basis to believe that the information can be used to identify an individual; and (c) that is not Individually Identifiable Health Information.                                                

Section 4:  Your Right to File a Complaint with New Look Skin Center™ or the HHS Secretary

If you believe that your privacy rights have been violated, you may complain to New Look Skin Center™ in care of the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. 20201. You may also address your compliant to one of the regional Offices for Civil Rights.  A list of these offices can be found at http://www.hhs.gov/ocr/reqmail.html.  

New Look Skin Center™ will not retaliate against you for filing a complaint.

Section 5: Whom to Contact at New Look Skin Center™ for More Information                                                                                

If you have any questions regarding this Privacy Notice or the subjects addressed in it, you may contact the following individual: Maria Hambarsoonian, Privacy Officer, 1219 West Glenoaks Blvd. Glendale, CA 91201, (818) 662-5005, maria@newlookskincenter.com

Conclusion

PHI use and disclosure by New Look Skin Center™ is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act).  You may find these rules at 45 Code of Federal Regulations Parts 160 and 164.  This Privacy Notice attempts to summarize the regulations.  The Privacy Standard will supersede any discrepancy between the information in this Privacy Notice and the Privacy Standard.