Notice of Privacy Practices

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have the right to:

• ✦Get an electronic or paper copy of your medical record. We may charge a reasonable, cost-based fee.
• ✦Ask us to correct your medical record if you think it is incorrect or incomplete.
• ✦Request confidential communications — for example, that we contact you at a specific phone number or address.
• ✦Ask us to limit what we use or share. We are not required to agree if it would affect your care.
• ✦Get a list of those with whom we have shared your information (an accounting of disclosures).
• ✦Get a copy of this privacy notice, including a paper copy, at any time.
• ✦Choose someone to act for you, such as a person with medical power of attorney or a legal guardian.
• ✦File a complaint if you feel your privacy rights have been violated.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, talk to us. You have both the right and the choice to tell us to:

• ✦Share information with your family, close friends, or others involved in your care.
• ✦Share information in a disaster relief situation.

In the following cases we never share your information unless you give us written permission: marketing purposes, sale of your information, and most sharing of psychotherapy notes.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

• ✦To treat you — we can use your health information and share it with other professionals who are treating you.
• ✦To run our organization — to manage and improve the practice, and contact you when necessary.
• ✦To bill for your services — to bill and get payment from you, insurers, or other entities.

We are also allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research — but we have to meet many conditions in the law before we can share your information for these purposes:

• ✦Help with public health and safety issues.
• ✦Do research, subject to applicable protections.
• ✦Comply with the law, including state and federal requirements.
• ✦Respond to organ and tissue donation requests.
• ✦Work with a medical examiner or funeral director.
• ✦Address workers' compensation, law enforcement, and other government requests.
• ✦Respond to lawsuits and legal actions.

Our Responsibilities

• ✦We are required by law to maintain the privacy and security of your protected health information.
• ✦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 give you 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. If you tell us we can, you may change your mind at any time by letting us know in writing.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Complaints and Contact

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

Ageless Aura MD
10301 Democracy Lane, Suite 300
Fairfax, VA 22030
Phone: 703-885-1600
Email: support@agelessauramd.com