Breast Augmentation

Innovative Women’s Healthcare Solutions and Innovative Surgical Arts & MedSpa

HIPAA PRIVACY NOTICE

THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY. 

• Your confidential healthcare information may be released to other healthcare professionals within the organization for the purpose of providing you with quality healthcare. 
• Your confidential healthcare information may be released to your insurance provider for the purpose of the organization receiving payment for providing you with needed healthcare services. 
• Your confidential healthcare information may be released to the public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
• Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
• Your confidential healthcare information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.
• Your confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.
• You may be contacted by the organization to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
• You may be contacted by the organization for the purpose of raising funds to support the organization’s operations.
• You have the right to restrict the use of your confidential healthcare information. However, the organization may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency. 
• You have the right to receive confidential communication about your health status. 
• You have the right to review and photocopy any/all portions of your healthcare information. 
• You have the right to make changes to your healthcare information. 
• You have the right to know who has accessed your confidential healthcare information and for what purpose.
• You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
• The organization is required by law to protect the privacy of its patients. It will keep confidential all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.
• The organization will abide by the terms of this notice. The organization reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Patients will receive a mailed copy of any changes to this notice within 60 days of making the changes. 
• You have the right to complain to the organization if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the organization: 

ATTN: Innovative Women’s Healthcare Solutions 3200 Highlands Pkwy. Smyrna, GA 30082

• All complaints will be investigated. No personal issue will be raised regarding filing a complaint with the organization. 
• For further information about this Privacy Notice, please contact: 
• Administrator: 678-424-1123 
• This notice is effective as of Date of Effectiveness. This date must not be earlier than the date on which the notice is printed or published.

RSL Healthcare Consulting, LLC 

Phone: 561-213-5125 ▪ Email: Info@RSLHCC.com

Innovative Women’s Healthcare Solutions and Innovative Surgical Arts & MedSpa

CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION

__________________________________________________________________

TO THE PATIENT-PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

Purpose of Consent:  If you agree to this policy and sign upon office arrival, you will consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations. 

Notice of Privacy Practices: You have the right to read out the Notice of Privacy Practices before you decide whether to sign this Consent. Our Notice provides a description of our treatment, payment activities, and healthcare operations, of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. A copy of your Notice accompanies this Consent. We encourage you to read it carefully and completely before signing this Consent.

We reserve the right to change our privacy practices as described in our Notice of Privacy Practices. If we change our practices, we will issue a revised Notice of Privacy Practices, which will contain the changes. Those changes may apply to any of your protected health information that we maintain. 

You may obtain a copy of our Notice of Privacy Practices, including any revisions of Notice, at any time by contacting:

Contact Person: Front Office Staff or Office Manager 

Telephone: 678-424-1123 ext. 107 or 108

Email: info@IWHCS.com

Address: 3200 Highlands Pwky Suite 420, Smyrna, GA 30082

Innovative Women’s Healthcare Solutions and Innovative Surgical Arts & MedSpa

HIPAA PRIVACY NOTICE

THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY. 

• Your confidential healthcare information may be released to other healthcare professionals within the organization for the purpose of providing you with quality healthcare. 
• Your confidential healthcare information may be released to your insurance provider for the purpose of the organization receiving payment for providing you with needed healthcare services. 
• Your confidential healthcare information may be released to the public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
• Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
• Your confidential healthcare information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.
• Your confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.
• You may be contacted by the organization to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
• You may be contacted by the organization for the purpose of raising funds to support the organization’s operations.
• You have the right to restrict the use of your confidential healthcare information. However, the organization may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency. 
• You have the right to receive confidential communication about your health status. 
• You have the right to review and photocopy any/all portions of your healthcare information. 
• You have the right to make changes to your healthcare information. 
• You have the right to know who has accessed your confidential healthcare information and for what purpose.
• You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
• The organization is required by law to protect the privacy of its patients. It will keep confidential all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.
• The organization will abide by the terms of this notice. The organization reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Patients will receive a mailed copy of any changes to this notice within 60 days of making the changes. 
• You have the right to complain to the organization if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the organization: 

ATTN: Innovative Women’s Healthcare Solutions 3200 Highlands Pkwy. Smyrna, GA 30082

• All complaints will be investigated. No personal issue will be raised regarding filing a complaint with the organization. 
• For further information about this Privacy Notice, please contact: 
• Administrator: 678-424-1123 
• This notice is effective as of Date of Effectiveness. This date must not be earlier than the date on which the notice is printed or published.

RSL Healthcare Consulting, LLC 

Phone: 561-213-5125 ▪ Email: Info@RSLHCC.com

Innovative Women’s Healthcare Solutions and Innovative Surgical Arts & MedSpa

CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION

__________________________________________________________________

TO THE PATIENT-PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

Purpose of Consent:  If you agree to this policy and sign upon office arrival, you will consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations. 

Notice of Privacy Practices: You have the right to read out the Notice of Privacy Practices before you decide whether to sign this Consent. Our Notice provides a description of our treatment, payment activities, and healthcare operations, of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. A copy of your Notice accompanies this Consent. We encourage you to read it carefully and completely before signing this Consent.

We reserve the right to change our privacy practices as described in our Notice of Privacy Practices. If we change our practices, we will issue a revised Notice of Privacy Practices, which will contain the changes. Those changes may apply to any of your protected health information that we maintain. 

You may obtain a copy of our Notice of Privacy Practices, including any revisions of Notice, at any time by contacting:

Contact Person: Front Office Staff or Office Manager 

Telephone: 678-424-1123 ext. 107 or 108

Email: info@IWHCS.com

Address: 3200 Highlands Pwky Suite 420, Smyrna, GA 30082