The form has information about HIPPA and Email and Texting communication. If you do not wish to sign any part or all of the documents please feel free ask any questions so we can review other options. If you agree then press the read and consent.

Health Insurance Portability and Accountability Act (HIPPA) Privacy Rule

Purpose

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. This notice took effect on April 14 2003 and remains in effect until it is replaced. We are required by the HIPPA privacy rule under federal and state law to protect the privacy of our patient medical information.

Our pledge regarding medical information

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our practice. These records may be created in a physical form (i.e. paper), electronic form (i.e. computer, “cloud”) or other form. These records may include photos.  These records may include video utilizing ipad medical record technology. Video technology helps in recordings discussions between the doctor and patient. Video may also help record complex motion that photos cannot record, such as facial motion, eyelid motion or hand motion. 

The medical record helps us provide you with quality care and assists us in complying with certain medical and legal requirements. The health and billing records we maintain are the physical property of the office and James A. Rieger, M.D. However, you may inspect and obtain a copy for your information. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.

Our legal duty

The office is required to: Maintain the privacy of your health information as required by law

Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you; abide by the terms of this Notice;

Notify you if we cannot accommodate a requested restriction or request; and, accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.

If you use another language besides English please notify our office staff.

How we may use and disclose medical information about you

The following section describes different way that we use and disclose medical information. For each kind of use or disclosure, we will explain what we mean and give examples. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us. However, you may not revoke this authorization for any actions taken before receipt of my written notice to revoke this authorization.

For treatment:

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians or other people who are taking care of you.

Example: You are in the hospital or surgical center having breast reconstruction for breast cancer. A number of health care and support staff need to know about your medical history. The anesthesia doctor for example will need to know about your medical information in order to give your anesthesia. During the course of your treatment, your physician may need to consult with another specialist. He will share the information with such specialist and obtain his/her input.

Example: Medical photography is taken before, during and after a surgical procedure or treatment. Medical photography is required for purposes of documentation. The photography records and images are an important part of the medical record and are the sole property of James A. Rieger, M.D. However, you may inspect and obtain a copy for your information.

For payment:

We may use and disclose your medical information for payment purposes.

Example: We submit requests for payment to your health insurance company. The health insurance company requests information from us regarding medical care given. We will provide information to them about you and the care given. We usually use a business associate to help us file insurance and provide this information to them.

Example: Medical photography is taken before, during and after a surgical procedure or treatment. Medical photography is required for purposes of documentation and insurance authorization /payment.

For payment using Credit cards, debit cards, electronic payments and Financing:

It may become necessary to release your information to financial parties, credit card entities, banks, and financing companies when requested to facilitate your payment.

Services that are performed that are paid with a credit card, electronic payment, debit card or financing third parties are not eligible for payment challenges after services are provided. The patient irrevocably consents to allow our practice to use and disclose my protected health information to a credit card entity, bank or financing company when they request such information to process an account and assist with payment.

For health care operations:

We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you. In some instances we obtain the above services from our insurers or other business associates and will share information about you with such insurers or other business associates as necessary to obtain these services.

Example: Medical information may be required for credentialing purposes at a surgical center or hospital.

We may use and disclose medical information about you without your prior authorization for several other reasons noted below:

We may also contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you.

We may disclose medical information about you to a friend or family member who is involved in your medical care or to disaster relief authorities so that your family can be notified of your location and condition.

Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, funeral arrangements, organ donation, workers’ compensation purposes, and emergencies. We may also disclose medical information when required by law, such as in response to valid judicial or administrative orders.

Other uses of medical information:

In any other situation not involving routine care, treatment, payment, health care operations or matters as noted above in the section entitled how we may use and disclose medical information about you we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision, except to the extent information has been disclosed or action has already been taken.

Example: Authorization for and release of medical photography for purposes of patient education or use during lectures to medical or lay groups or for the doctors’ website use or for advertising would require a written authorization.

Your rights regarding medical information about you

You have a right to:

Look at or get a copy of medical information that we use to make decisions about your care after you submit a written request to our office. Reasonable costs will apply to copying, revival, and supplies. Records are keep at least as long as required by law.

Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office. We may deny your request if you ask us to amend information that was not created by us; is not part of the health information kept by or for the office; is not part of the information that you would be permitted to inspect and copy; or is accurate and complete. If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes.

Request that communication of your health information be made by reasonable alternative means or at an alternative location by delivering the request in writing to our office.

Receive a list of those instances where we have disclosed medical information about you. This accounting will not include uses and disclosures of information for treatment, payment, or health care operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made to family members or friends relevant to that person’s involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location and condition. The request must state the time period desired for the accounting, which must be less than a 6 year period and starting after April 14 2003. You may receive the list in paper or electronic form. The first disclosure list request in a 12 month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any costs.

Appeal a denial of access to your protected health information.

Revoke authorizations that you made previously to use or disclose information by delivering a written revocation to our office, except to the extent information has been disclosed or action has already been taken.

Request a restriction on certain uses and disclosures of your health information by delivering the request to our office — we are not required to grant the request, but we will consider the request.

Receive a paper copy of this notice if this notice was sent electronically.

If you want to exercise any of the above rights, please contact the office in person, in writing, or by phone during regular, business hours.

Questions and Complaints

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the. Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the office.

You may also file a complaint to the Department of Health and Human Services (Department of Health and Human Services, Office of Civil Rights, 200 Independence Ave. S.W., Washington, DC 20201). Under no circumstances will you be penalized or retaliated against for filing a complaint.   

Email and Texting communication consent 

Conditions for the use of your E-mail and Texting Communication

By consenting to the use of e-mail and texting with our practice, you agree that:

A) We may forward e-mails and texts as appropriate for diagnosis, treatment, reimbursement, and other related reasons. As such, staff members, other than the recipient, may have access to e-mails texts that you send. Such access will only be to such persons who have the right to access your e-mail and texts to provide services to you. Otherwise, we will not forward e-mails and texts to independent third parties without your prior written consent, except as authorized or required by law.

B) We reserve the right to save your e-mail and texting or information contained within your e-mail and texting in your medical record.

Patient Acknowledgement and Agreement: We will use reasonable means to protect the privacy of your health information sent by e-mail and texting. However, because of the risks associated with the use of the internet and e-mail and texting, we cannot guarantee that e-mail and texting communications will be confidential. Additionally, we will not be liable in the event that you or anyone else inappropriately uses your e-mail and texting. We will not be liable for improper disclosure of your health information that is not caused by the practice.

I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communications of e-mail and texting between our practice and me, and consent to the conditions outlined herein, as well as any other instructions that our practice may impose to communicate with me by e-mail and texting. Any questions I may have had were answered. We may e-mail and text you for follow-up, including medically related messages and issues.  We may use e-mail and texting as our primary form of communication with you. You may have a copy of this form if you wish.

Legal Statement

By accessing or using this Web site, you acknowledge that you have read, and understand this Privacy Policy and Legal Statement, and are in agreement with these terms. Dr.Rieger and his practices, or its agent for facilitating its Web site, may ask for personal information during a visit to our Web site in order to provide you with information or process a request on your behalf. Dr.Rieger and his practices may also use other information such as your IP address, browser information, the name of the domain from which you accessed the Internet, the date and when you accessed our Web site, the Internet address of any Web site which you linked to, to help diagnose problems with our server and to administer our Web site. Dr.Rieger and his practices does not sell or share information about you with non-affiliated third parties unless we are legally required to do so, or when we are legally permitted to share this information to serve your interests, or to address legitimate business concerns.

Dr.Rieger and his practices reserves the right to modify this Privacy Policy and Legal Statement at any time. We will promptly reflect any such modifications on this Web site.

Aesthetic and Plastic Surgery PA’s Website is designed for educational purposes only. All content, including text, graphics, images, and information available on or through this web site is not engaged in rendering medical advice or professional services. This Site does not constitute a doctor – patient relationship. This Site does not purport to practice medicine in any locality or to provide any other services. The Site does not constitute a recommendation or endorsement with respect to any company, product, treatment or therapy. The photographs used throughout the website are of models not actual patients and not representative of any result or treatment. The information and opinions contained herein are not intended to replace or serve as a substitute for medical or professional consultation or services.

Aesthetic and Plastic Surgery PA and/or  Dr James Rieger and their respective agents, heirs, assigns, contractors, and employees shall not be liable for any claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected to the use of any of the information contained in this Website, including any injuries resulting therefore.

This Web site may contain hypertext links to third party Web sites. Dr.Rieger and his practices has no control of, or responsibility for, the content of such third party Web sites. Such links or references to third parties are provided solely for your convenience and in no way constitute endorsements, or approval of the third party or the material contained on the third party Web site. Information may be gathered by Web sites accessed through a hyperlink. You should read the Privacy Policy and Legal Statement of the Web site that you hyperlinked to.

You agree that your use of this Web site and the content, products, functions or other information available on the pages herein is at your own risk. While Dr.Rieger and his practices intends that the information, content, products, and functions available herein be as accurate and up-to-date as possible, Dr.Rieger and his practices does not guarantee or warrant the accuracy, adequacy, completeness, or reliability of the information, content, functions or products displayed, performed, downloaded or otherwise available herein. Nor does Dr.Rieger and his practices warrant that your access to the Web site will be uninterrupted or that the material accessible from this Web site is virus-free.

The information and services provided on and throughout this site, and the programs and benefits offered by Dr.Rieger and his practices are subject to change without notice.

This web site, including all content, services, functions, hypertext links, and other information made available on or accessed through this site, is provided “as is”, and, without warranties of any kind, either express or implied, including, without limitation, the warranties or non-infringement, merchantability, and of fitness for a particular purpose.

In no event will Dr.Rieger and his practices be liable to you or to any third party for any damages, including without limitation, direct, indirect, special, incidental, consequential, exemplary damages, lost profits, or lost savings, arising out of the use or, inability to use; accuracy, quality or performance of the web site or any hypertext links thereon; or services, or functions, rendered in connection therewith, whether or not Dr.Rieger and his practices has been advised of the possibility of such damages, and whether or not based upon theories of contract, negligence, statutory duty, principles of indemnity or contribution, the failure of any remedy to achieve its essential purpose, or otherwise. Some states do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to you. In no event shall Dr.Rieger’s and his practices total liability to you, or to any third party, for all damages, losses, and causes of action exceed the amount paid by you to access this web site.