THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

If you have questions, please contact: De La Shey Lingerie c/o Compliance Officer, 14099 E. Exposition Ave, Aurora, CO 80012, or by calling (303) 993-8725 and asking for the Compliance Officer.

This Notice describes how we may use/disclose your protected health information (“PHI”) to carry out treatment, payment or healthcare services and for other purposes that are permitted or required by law.  It also describes your right to access and control your PHI.  “PHI” is information about you, that may identify you, and that relates to your past present or future physical or mental health or condition and related healthcare services or the past, present or future payment for your healthcare services. 

We are required to abide by the terms of this Notice. We may change the terms of our Notice at any time. The new Notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice.

Uses and Disclosures of PHI: De La Shey Lingerie may use/disclose your health information as described below:

Treatment — PHI may be used/disclosed to provide, coordinate or manage your healthcare and any related services. For example, we may disclose your PHI to another healthcare provider if it is necessary for treatment of your condition.

Payment – We may disclose your PHI to another party, such as an insurance carrier, an HMO, a PPO, or collection agency in order to obtain payment. This may include activities such as: making a determination of eligibility or coverage of insurance benefits, reviewing services provided to you for medical necessity, and performing utilization reviews.

Healthcare Operations – In order for the De La Shey Lingerie to operate in accordance with applicable law and insurance requirements and to continue to provide quality and efficient services, it may be necessary for De La Shey Lingerie to compile, use/disclose your PHI. For example, we may use your information in order to evaluate the performance of our personnel.

Uses and Disclosures of PHI Based Upon Your Written Authorization: Other uses/disclosures of your PHI will be made only with your written authorization, unless permitted or required by law as described below. You make revoke this authorization at any time by sending written notice of the revocation to our office, except to the extent that we have taken an action. You may obtain a form for this purpose from our office by calling us at the number listed above.

Required or Permitted Uses and Disclosures That May Be Made Without Your Authorization:

Others Involved In Your Healthcare: If you agree, or we can reasonably infer from the circumstances that you agree, De La Shey Lingerie may disclose to individuals identified by you such as your family, a close personal friend, or any other person identified by you, your PHI directly relevant to such person’s involvement with your care or payment of your care. If you are not present or unable to agree or object to the use or disclosure of your PHI, De La Shey Lingerie may use its professional judgment to determine whether the disclosure is appropriate and act accordingly. In most cases, De La Shey will only disclose PHI information with written informed consent. De La Shey Lingerie may also use/disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. We may use or disclose the information to an authorized public or private entity to assist in disaster efforts.

Appointment Reminders: De La Shey Lingerie may contact you to remind you of an upcoming appointment with our boutique.

Treatment Alteratives: We may contact you about treatment alteratives or health-related benefits/services that may be of interest to you.

Required By Law: We may use/disclose your PHI to the extent that it is required by law. You will be notified, as required or permitted by law, of any such use or disclosure.

Communication Barriers: We may use/disclose your PHI if De La Shey Lingerie attempts to communicate with you but is unable to do so due to substantial communication barriers, such as unconsciousness, and we determine that you would permit the use/disclosure.

Public Health Activities: We may disclose your PHI for public health activities, which may include, for example, information collected by a public health authority to collect the information to prevent or control disease.

Abuse. Neglect. or Domestic Violence: We may use or disclose your PHI to a public health authority that is authorized by law to receive reports of abuse or neglect.

Health Oversight: We may disclose your PHI for health oversight activities required by law, such as to government agencies including criminal investigations, audits, or general oversight activities relating to the community’s healthcare.

Communicable Diseases: We may use or disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceedings, or in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized).

Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or biologic product deviations; to track products; to enable product recalls, to make repairs and replacements; or to conduct post marketing surveillance, as required.

Research: At this time De La Shey Lingerie does not participate in research studies and will not release information for that purpose.  However, De La Shey Lingerie reserves ther right to change its policy regarding research.  If this should change in the future, a written notice will be sent out future appointments or given at your next in-person visit.

Coroner or Medical Examiner: De La Shey Lingerie may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or if it is necessary for law enforcement authorities to identify or apprehend an individual.

Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes to include but are not necessarily limited to the reporting of certain types of wounds or physical injury, in response to a request to locate or identify a suspect, fugitive or missing person, or to comply with the requirements of a court order.

Workers’ Compensation: Your PHI may be disclosed by us as authorized to comply with Workers’ Compensation laws and other similar legally-established programs.

Military Activity and National Security: Your PHI may be disclosed as required by the military command authorities or for the purposes of determining eligibility for benefits by the Department of Veterans Affairs or for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Business Associate: To a business associate if De La Shey Lingerie obtains satisfactory written assurance, in accordance with the applicable law, that the business associate will appropriately safeguard your PHI.

Inmates: We may use or disclose your PHI if you are an inmate and we created or received your PHI in providing care to you.

Your Rights: We require that you exercise each right described below by completing a form for this purpose. You may obtain the appropriate form by calling our office. We will be happy to mail you the appropriate form.

Inspect and copy your PHI that is included in a designated record set. A designated record set contains medical and billing records and any other records that we use to make healthcare decisions about you. Your request for access to your medical records must be made on a written form provided by our office. We have thirty (30) days to respond to your request to either grant or deny you access. There are limited circumstances where we may deny you access to the information. Depending on the circumstances, a decision to deny access may be reviewed. If you are denied access, you will receive written notice listing the reason for denial and your rights.

Request a restriction on your PHI. You may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes. Your request must be in writing on a form we provide. and must state the specific restriction requested and to whom you want the restriction to apply. You may obtain the form from our Compliance Officer. We will respond to this request within thirty (30) days of receipt. De La Shey Lingerie is not required to agree to a restriction if De La Shey Lingerie believes it is in your best interest to permit the use/disclosure of your PHI. If De La Shey Lingerie does agree to the request, we may not use/disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment.

Receive confidential communications from us by alternative means or at an alternative location. You may request on a form we provide communication with you be by alternative means or at an alternative location. De La Shey Lingerie will accommodate all reasonable requests.

Amend your PHI. You may request in writing on our form an amendment of your PHI in a designated record set for as long as we maintain the information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We will respond to your written request for amendment within sixty (60) days of receiving your request.

Receive an accounting of disclosures of your PHI as provided by law. This request applies to disclosures made for purposes other than treatment, payment, or healthcare operations as described in this Notice. It excludes disclosures we have made to you, disclosures you have authorized, disclosures to family and friends involved in your healthcare, and disclosures for notification purposes. To request an accounting, you must submit a written request on a form used for this purpose that you may obtain by requesting the form from our Compliance Officer. The request must state a time period, which may not be longer than six years and may not include dates before April 15, 2023.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with De La Shey Lingerie’s Compliance Officer. All complaints must be in writing on a form designed for this purpose that you may obtain from our Compliance Officer. You may contact our Compliance Officer at (303) 993-8725 for further information about the complaint process. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services at: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201 or email OCRComplaint@hhs.gov. You have the right to file a complaint with the Board of Certification (BOC) at 877-776-2200, during normal business hours, Mon — Fri. 8am to 5pm.