Our Commitment to Your Privacy

Bluebonnet Beauty and Wellness Center PLLC (“we,” “us,” or “Bluebonnet”) is committed to protecting the privacy of your protected health information (“PHI”). PHI is information that identifies you and relates to your past, present, or future physical or mental health, your healthcare treatment, or payment for that healthcare.

We are required by law to:

•    Maintain the privacy of your PHI

•    Provide you with this Notice describing our legal duties and privacy practices regarding your PHI

•    Notify you following a breach of unsecured PHI

•    Follow the terms of the Notice currently in effect

How We May Use and Disclose Your Protected Health Information

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare. For example, our nurse practitioner may share information about your treatment plan with our nursing staff, or we may share your information with another healthcare provider involved in your care, such as your primary care physician, with your consent.

For Payment

We may use and disclose your PHI to obtain payment for the services we provide. For example, we may verify a credit card payment or send a billing statement to you. Most Bluebonnet services are paid in cash; however, if you elect to use a third-party financing provider (such as Cherry or Affirm), we may share information necessary to process the financing.

For Healthcare Operations

We may use and disclose your PHI for activities necessary to run our practice, including quality assessment, employee review, training, accreditation activities, business management, and customer service. For example, we may use your information to evaluate the performance of our staff or to improve the quality of care we provide.

Appointment Reminders and Health-Related Communications

We may contact you to remind you of upcoming appointments, follow up after a visit, or share information about treatment alternatives or health-related services that may interest you. Communications may include voicemail, text message, or email. You have the right to request these communications be sent in a specific way.

With Your Authorization

Most uses and disclosures of PHI for marketing purposes, sale of your PHI, and most uses and disclosures of psychotherapy notes (if any) require your specific written authorization. You may revoke any authorization at any time, in writing, except to the extent we have already acted in reliance on it.

Marketing examples requiring authorization include:

As Required or Permitted by Law

We may use or disclose your PHI without your authorization in the following circumstances:

•    Public health activities: to a public health authority for disease prevention or reporting

•    Health oversight: for audits, investigations, or inspections by a regulator

•    Judicial and administrative proceedings: in response to a court order or subpoena

•    Law enforcement: in response to a lawful request from law enforcement

•    Coroners, medical examiners, funeral directors: as authorized by law

•    Organ and tissue donation: as authorized by law

•    Research: with appropriate review and protections

•    Workers' compensation: as required by law

•    Serious threat to health or safety: to prevent harm

•    Military and veterans: as required by military command authorities

•    National security and intelligence activities: as authorized by law

•    Inmates: to correctional institutions

Disclosures to Family Members and Friends

Unless you object, we may share information about your care with a family member, friend, or other person you indicate is involved in your care or in the payment for your care. We will use professional judgment when sharing information in emergencies.

Your Rights Regarding Your Protected Health Information

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request except in one specific case: if you pay out of pocket in full for a service, you may request that we not disclose that information to your health plan, and we will agree.

Right to Receive Confidential Communications

You have the right to ask that we communicate with you in a specific way or at a specific location. For example, you may ask that we call you only at your work number or that we send mail to a P.O. Box. We will accommodate reasonable requests.

Right to Inspect and Copy Your PHI

You have the right to inspect and obtain a copy of your PHI that we maintain. To request access, submit a written request to our Privacy Officer at the address below. We may charge a reasonable, cost-based fee for copies. We will respond to your request within 30 days.

Right to Request an Amendment

If you believe information we have about you is incorrect or incomplete, you may ask us to amend it. To request an amendment, submit a written request to our Privacy Officer explaining the reason for the amendment. We may deny your request under certain circumstances; if we deny, we will provide a written explanation and you have the right to submit a statement of disagreement.

Right to an Accounting of Disclosures

You have the right to receive a list of certain disclosures we have made of your PHI within the past six years. Some disclosures are excluded, such as those for treatment, payment, healthcare operations, or those you authorized. To request an accounting, submit a written request to our Privacy Officer. The first accounting in any 12-month period is free; we may charge for additional accountings.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice, even if you have agreed to receive it electronically. Ask any staff member or contact our Privacy Officer.

Right to Notification Following a Breach

You have the right to be notified if a breach occurs that involves your unsecured PHI.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us (Privacy Officer, contact information below) or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, SW

Washington, D.C. 20201

Phone: 1-877-696-6775

Website: hhs.gov/ocr

Changes to This Notice

We reserve the right to change this Notice and to make the new Notice apply to information we already have, as well as any information we receive in the future. We will post the new Notice in our office and on our website. You may request a copy at any time.

Contact Information

If you have questions about this Notice or wish to exercise any of your rights, please contact:

Privacy Officer

Bluebonnet Beauty and Wellness Center PLLC

206 S Clay Street

Ennis, TX 75119

Phone: +1 903-600-8358

Email: [email protected]