MEMBERS ONLY MEDSPA, LLC
Members Only MedSpa, LLC (COMPANY) is committed to respecting the privacy of our Members and maintaining the confidentiality of their protected health information. When you consent to treatment at Members Only MedSpa, LLC, you consent to the use of your information as outlined in our Notice of Privacy Practices. If we decide to change our Notice, such changes will be posted on our website: membersonlymedspa.com. You may visit our website and browse without giving us any personal information.
If you have any questions or comments regarding our Privacy Policies or the security of your information, contact the clinic and ask for the office manager.
Notice of Privacy Practices (Effective November 2, 2021)
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.
You may request a paper copy of this Notice of Privacy Practices
Our Pledge to You
Members Only MedSpa, LLC creates a detailed record of the treatments and services you receive at our facilities. By law, we must keep this record private. We must also give you this summary of our legal duties and privacy practices, and follow them. Our policies apply to all of the records of your treatments that the COMPANY maintains.
Who Will Follow These Privacy Practices
Members Only MedSpa, LLC provides treatments and services in partnership with other agencies. These privacy practices will be followed by:
Any nurse and/or staff member who treats you at any of our locations
All board members, employees, staff and volunteers of our organization
All members of our medical staff and allied health practitioners such as Member Liaisons
Any business associate or partner who agrees to maintain your privacy
Some Ways Your Medical Record May Be Used or Shared
We may use or share medical information about you:
To conduct, plan and direct your treatment and follow-up among the multiple healthcare
providers who may be involved in your treatment directly andindirectly
For treatment, such as a referral to a specialist or other health care agency
For health care functions, such as to improve our services
For regulatory agencies, such as during an audit or survey of our facilities
With those whom you designate to be involved in your care
In an emergency or disaster so that your family or friends can be told where you are and
how you are
When required for public health reports, abuse or neglect reports, funeral arrangements and organ donation
When required by law such as a request from law enforcement or a legal order
When required by military authorities if you are a member of the military or a veteran
For national security and intelligence activities, or for the protection of the President or others
Other Ways That Information About you May Be Used
Unless you tell us not to, we may use information that we have about you to:
Remind you of an appointment
Recommend possible treatment options
Tell you about promotions and services
Uses and Disclosures That Require Your Authorization
In any other situation not covered by this notice we will get your written authorization before using or sharing your health information, including release of psychotherapy records. You may revoke any authorization in writing.
Your Rights Regarding Medical Information About You
In most cases, you may review and obtain a copy of your medical record. There may be a fee for the cost to copy and mail it. Your request must specify how or where you wish to receive your medical record. We will honor all reasonable requests.
You may ask us to correct your record if you think that it is incorrect or that key information is missing. You must put your request in writing and state the reason for your request. We cannot revise your record if the information was not created by us; or is not part of the medical record we maintain; or is not part of the record that you can review or copy or if we find out that the record is accurate.
You may get a list of when and whom we gave your medical information. Such a list would not include the permitted disclosures outlined within this notice. Your written request for such a list must state a time period; it must start after November 2, 2021 and be within six years. The first list in a 12-month period is free; other requests will include a fee for our cost to produce the list. We will inform you of the cost before we process your request.
You may ask that we communicate medical information about you in a confidential way, such as sending mail to an address other than your home. We will honor all reasonable requests. Our waiting areas and some of our treatment areas are shared with other Members. Please tell us if you object to this type of waiting or treatment areas. We will do our best to accommodate your request for privacy.
You may ask that we not use or disclose a certain part of your information as allowed by this notice unless you sign a consent form to release the information. By law, we do not have to accept such a request but we will seriously consider it and inform you of our decision. Your request must tell us what specific information you want to limit and to whom the limits apply. You may make any of these requests in writing to the COMPANY Privacy Officer.
Changes to COMPANY Privacy Notice
We may change our privacy policies at any time. Changes will apply to prior and new medical information. Before we make major changes in our policies we will change our Notice of Privacy Practice and post the new notice in our facilities and on our website. You can get a copy of the current privacy notice at any time. The effective date is listed just below the title.
Complaints and Appeals
You may contact the COMPANY Privacy Officer if:
You think that your privacy rights may have been violated
You disagree with our decision about access to your records
You disagree with our decision not to correct your record
We will not punish you in any way for filing a complaint. You may also send a written complaint to the U.S. Department of Health and Human Services’ Office of Civil Rights
Members Only MedSpa, LLC
320 Ward Ave Suite 101
Honolulu, HI 96814
Office of Civil Rights
US Department of Health and Human Services 1961 Stout Street #1428
Denver, CO 80294 (Cannot phone)