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NOTICE OF PRIVACY PRACTICES

Last modified: june 19, 2025

A LEGAL DISCLAIMER

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.

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This Notice of Privacy Practices (this “Notice”) explains how Provocative Plastic Surgery LLC (“we” or “us”) may use and disclose medical information and how you can gain access to this information. This Notice is being provided to you as a requirement of federal law, the Health Insurance Portability and Accountability Act (HIPAA). Please review this policy carefully.

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During your treatment with us, doctors, nurses, and other caregivers may gather information about your medical history and current health. Each time you are treated at our facility, we make a record of your visit. This record usually contains your health history, current symptoms, examination, test results, diagnoses, treatment, and plan for future care. This information is referred to as “Protected Health Information” (PHI). PHI includes identifiable information that relates to your physical or mental health and healthcare services.

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This Notice explains how we may use and disclose your PHI for treatment, payment, and healthcare operations, and other purposes allowed by law. It also outlines your rights regarding your PHI.

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We are required by federal law to:

  • Comply with this Notice.

  • Maintain the privacy & security of your PHI.

  • Notify you promptly of any breaches affecting your PHI.

  • Provide you with this Notice and any updates.

 

We will not use or share your PHI beyond what is stated in this Notice unless you expressly authorize it in writing.

 

We may update this Notice periodically. A current version is available:

I. Uses and Disclosures

Below are examples of how we may use or disclose your PHI:

 

A. For Treatment


We may share PHI with healthcare providers—such as physicians, nurses, labs, and pharmacies—to coordinate your treatment and services.

 

B. For Payment


Your PHI may be used to bill and receive payment for services, and shared with insurers or other providers as necessary to obtain payment.

 

C. For Healthcare Operations


We may use PHI for internal activities like quality review, staff training, accreditation, certification, compliance, and legal consultations.

 

D. Other Uses


We may use PHI to remind you of surgery dates, discuss treatment alternatives or benefits, or contact you for fundraising. To opt out of fundraising communications, please notify our Privacy Officer.

II. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Object

Federal privacy rules allow us to use or disclose your PHI without your permission in the following situations:

 

A. When Legally Required

 

We will disclose your PHI when required by any federal, state, or local law.

 

B. When There Are Risks to Public Health

 

We may disclose your PHI to:

  • Prevent or control disease, injury, or disability.

  • Report births and deaths.

  • Conduct public health surveillance or investigations.

  • Report adverse events, product defects, or enable recalls to the FDA.

  • Notify individuals exposed to communicable diseases.

  • Report to employers information about work-related illness or injury (if legally permitted).

 

C. Suspected Abuse, Neglect, or Domestic Violence

 

We may report PHI to government authorities if we suspect a patient is a victim of abuse, neglect, or domestic violence, only as allowed by law or with patient agreement.

 

D. Health Oversight Activities

 

We may share PHI with agencies conducting audits, inspections, or investigations as authorized by law. We will not share PHI under this authority if you are the subject of the investigation unless the PHI directly relates to your care.

 

E. Judicial and Administrative Proceedings

 

We may share PHI if ordered by a court or administrative tribunal. In some cases, we may share information in response to a subpoena, provided legal conditions are met.

 

F. Law Enforcement Purposes

 

We may disclose PHI to law enforcement officials when:

  • Required by law (e.g., reporting wounds or injuries).

  • In response to a court order or subpoena.

  • To identify or locate a suspect, fugitive, witness, or missing person.

  • When you are a crime victim.

  • If your condition appears to be related to criminal conduct.

  • To report a crime occurring on our premises or in an emergency.

 

G. Coroners, Funeral Directors, and Organ Donation

 

We may disclose PHI:

  • To coroners or medical examiners for identification or determining cause of death.

  • To funeral directors for lawful duties.

  • For organ, eye, or tissue donation purposes.

 

H. Research

 

We may use or disclose PHI for research if approved by an Institutional Review Board that ensures appropriate safeguards are in place.

 

I. Serious Threat to Health or Safety

 

We may disclose PHI to prevent or reduce a serious threat to your health and safety or that of others, consistent with law and professional ethics.

 

J. Specified Government Functions

 

Federal law allows disclosure of PHI for:

  • Military and veterans activities.

  • National security and intelligence.

  • Protection of the President and others.

  • Medical suitability determinations.

  • Correctional institutions and law enforcement custodial situations.

 

K. Workers’ Compensation

 

We may release your PHI as required to comply with workers’ compensation laws and similar programs.

III. Uses and Disclosures Permitted Without Authorization but With Opportunity to Object

We may disclose your PHI to a family member, close friend, or personal representative involved in your care or payment, unless you object.

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You may object verbally or in writing. If you do not object—or if we infer it’s in your best interest—we may proceed with the disclosure.

IV. Uses and Disclosures Which You Authorize

Other than as described in this Notice, we will not use or disclose your PHI without your written authorization. This includes:

  • Psychotherapy Notes: We will not disclose them unless necessary for your treatment, in training programs, or to defend ourselves legally.

  • Marketing: We will not use your PHI for marketing without your authorization, unless it’s a face-to-face conversation or a gift of nominal value. If we receive financial compensation for marketing, we will disclose that.

  • Sale of PHI: We will not sell your PHI without your written permission.
     

You may revoke your authorization at any time in writing, except to the extent that we have already relied on it.

V. Your Rights Regarding PHI

You have the following rights concerning your Protected Health Information:

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A. Right to Inspect and Copy

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You can request to see or get a copy of your PHI, including medical and billing records. You must submit your request in writing to our Privacy Officer. We may charge a fee for copying and mailing. Access may be denied in certain legal or safety situations.

 

B. Right to Request Restrictions

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You may ask us not to use or share your PHI for treatment, payment, or health care operations. We are not required to agree unless:

  • You pay for the service in full out-of-pocket, and

  • You request that we not share it with your health plan.

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You must make restriction requests in writing to our Privacy Officer.

 

C. Right to Request Confidential Communications

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You can request that we communicate with you by specific methods (e.g., phone, email) or at specific locations. Requests must be in writing and must state that you could be endangered otherwise. We will accommodate reasonable requests.

 

D. Right to Amend

 

You may request changes to your PHI if you believe it is incorrect or incomplete. Requests must be made in writing and state why the change is needed. We may deny the request, but you can submit a statement of disagreement.

 

E. Right to an Accounting of Disclosures

 

You can request a list of times we’ve shared your PHI (excluding those for treatment, payment, and operations) in the past 6 years. The first list each year is free; additional requests may incur a fee.

 

F. Right to a Paper Copy of This Notice

 

You can request a paper copy of this Notice at any time, even if you’ve agreed to receive it electronically.

 

G. Additional HITECH Rights

 

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, you also have the right to:

  • Be notified in the event of a data breach involving your PHI.

  • Request a copy of your electronic medical records.

  • Prevent disclosure of your PHI to a health plan if you pay in full out-of-pocket.

VI. Our Duties

We are required by law to:

  • Maintain the privacy of your PHI.

  • Provide you with this Notice of our privacy practices.

  • Notify you if a breach of unsecured PHI occurs.

  • Abide by the terms of this Notice currently in effect.

 

We reserve the right to change the terms of this Notice. If we do, the new Notice will apply to all PHI we maintain and will be posted on our website at https://provocativeps.com. You may also request a copy from our office at any time.

VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint.

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To file a complaint with us, contact:

Privacy Officer
Provocative Plastic Surgery
3701 SW 87th Ave
Miami, FL 33165
Phone: (305) 402-9111
Email: info@provocativeps.com

VIII. Contact Person

For more information about this Notice, your rights, or if you have questions, you may contact our Privacy Officer:

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Provocative Plastic Surgery
Attn: Privacy Officer
3701 SW 87th Ave
Miami, FL 33165
Phone: (305) 402-9111
Email: info@provocativeps.com

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