HIPAA Privacy Notice

1. Our Legal Duties to Maintain Privacy

FEMME MODERN MEDICINE INC is required by law to:

• Maintain the privacy and security of your Protected Health Information (PHI) in compliance with HIPAA, the HITECH Act, and applicable Florida law.
• Provide you with this Notice detailing our legal duties and privacy practices regarding your PHI.
• Abide by the terms of the Notice currently in effect.
• Notify you promptly in the event of a breach of your unsecured PHI.

 

2. How We May Use and Disclose Your Protected Health Information (PHI)

We may use and disclose your PHI for the following purposes without your prior written authorization:

Treatment: We use your PHI to provide, coordinate, or manage your healthcare services. For example, our providers share clinical notes to coordinate facial aesthetic treatments, medical skincare regimens, or wellness protocols.

Payment: We use and disclose your PHI to bill and collect payment from you, your health plan, or third-party payment processors for services rendered.

Healthcare Operations: We use your PHI to support our business operations, including quality assessment, compliance reviews, licensing, staff evaluations, and operational audits.

As Required by Law: We will disclose PHI when required to do so by federal, state, or local law, including public health reporting, oversight audits, court orders, or judicial subpoenas.

Uses and Disclosures Requiring Your Written Authorization:

Any other uses or disclosures not described in this Notice—including the sale of PHI, marketing communications, or clinical photo disclosures—will be made only with your explicit written authorization. You may revoke such authorization in writing at any time.

3. Your Individual Rights Regarding Your Health Information

Under HIPAA and Florida law, you have the following rights regarding your designated medical record set:

Right to Inspect and Copy: You have the right to inspect and obtain an electronic or paper copy of your medical and billing records. You must submit your request in writing. We will provide access within 30 days and may charge a reasonable, cost-based fee as permitted under Florida law.

Right to Amend Records: If you feel your PHI is incorrect or incomplete, you may request an amendment in writing detailing the reason for the change. We may deny your request under specific circumstances (e.g., if the record was not created by us or is accurate), but we will provide a written explanation.

Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures of your PHI made by us for up to 6 years prior to the date of your request (excluding disclosures made for treatment, payment, healthcare operations, or pursuant to your authorization).

Right to Request Restrictions: You have the right to request restrictions on how we use or share your PHI for treatment, payment, or operations. While we are not required to agree to every request, we must agree if you request that we not send information to your health plan for a service paid out-of-pocket in full.

Right to Request Confidential Communications: You have the right to request that we communicate with you via a specific method (e.g., email, phone, mail) or at an alternate location.

Right to a Paper Copy of This Notice: You may request a physical paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

 

4. How to File a Privacy Complaint

If you believe your privacy rights have been violated, you have the right to file a complaint without fear of retaliation or penalty.

Filing a Complaint with Our Practice:

Send a written complaint to our Privacy Officer at: 

 FEMME MODERN MEDICINE INC

 Attn: Privacy Officer 

 4649 Ponce De Leon Blvd, Suite 406 

 Coral Gables, FL 33146 

 Email: info@pokaesthetic.com 

 

Filing a Complaint with the Federal Government:

You may file a written complaint with the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) by mail, fax, or online at the OCR Complaint Portal (https://www.hhs.gov/hipaa/filing-a-complaint/).