Policies. Plainly Stated.

Our Commitment to Your Privacy

Shoreline Aesthetics, LLC ("we," "us," or "our") is committed to protecting the privacy of your protected health information ("PHI"). PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services. This Notice describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI.

We are required by law to maintain the privacy of your PHI, provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI.

How We May Use and Disclose Your PHI

The following categories describe the ways we use and disclose your PHI. For each category, we will explain what we mean and provide examples. Not every use or disclosure will be listed; however, all permitted uses and disclosures will fall within one of these categories.

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes coordinating care with other providers (such as your primary care physician or pharmacist) and providing you with prescriptions, treatments, or follow-up care.

For Payment

We may use and disclose your PHI to obtain payment for services we provide to you. This includes activities such as making determinations of eligibility or coverage, billing, claims management, and collection activities.

For Health Care Operations

We may use and disclose your PHI to support our business activities, including quality assessment, employee training and review, licensing, and conducting or arranging for medical reviews. We may also use your information to contact you about appointment reminders, treatment alternatives, or health-related products and services.

Other Permitted Uses and Disclosures

• As required by law: We may disclose PHI when required to do so by federal, state, or local law.
• Public health activities: We may disclose PHI for public health activities, including reporting disease and injury, vital events, and conducting public health surveillance.
• Health oversight: We may disclose PHI to a health oversight agency for activities authorized by law.
• Judicial and administrative proceedings: We may disclose PHI in response to a court or administrative order, subpoena, or other lawful process.
• Law enforcement: We may disclose PHI for law enforcement purposes as permitted by law.
• Specialized government functions: We may disclose PHI for military, national security, or correctional purposes as authorized by law.
• Workers' compensation: We may disclose PHI for workers' compensation programs as authorized by law.

Authorized Disclosures

Other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. You may revoke any authorization in writing at any time, except to the extent that we have already taken action in reliance on it.

The following uses and disclosures require your written authorization:

• Marketing communications (other than face-to-face communications or promotional gifts of nominal value)
• Sale of your PHI
• Most uses and disclosures of psychotherapy notes (if applicable)
• Use of your photographs or before/after images for marketing or social media

Your Rights Regarding Your PHI

You have the following rights regarding the PHI we maintain about you:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your PHI in a designated record set. We may charge a reasonable, cost-based fee for copies. Requests should be made in writing.

Right to Request Amendment

You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances. Amendment requests must be in writing and include a reason supporting the request.

Right to Request Restrictions

You have the right to request that we restrict how we use or disclose your PHI for treatment, payment, or health care operations, or to a family member or friend involved in your care. We are not required to agree to your request, except in the limited case where you (or someone on your behalf, other than a health plan) pays in full for a service or item out-of-pocket and request that we not disclose information about that service to your health plan for payment or operations purposes.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your PHI in a specific way or at a specific location (for example, by mail to a particular address rather than by phone). We will accommodate reasonable requests.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your PHI. The first accounting in any 12-month period is free; we may charge a reasonable, cost-based fee for additional requests.

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Right to Be Notified of a Breach

You have the right to be notified following a breach of unsecured PHI in accordance with applicable law.

Our Duties

We are required by law to maintain the privacy of your PHI and to provide you with this Notice describing our legal duties and privacy practices. We are required to abide by the terms of this Notice currently in effect. We reserve the right to change the terms of this Notice and make the new provisions effective for all PHI we maintain. If we make a material change to this Notice, we will post the revised Notice in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, please contact:

You will not be retaliated against for filing a complaint.

Effective Date: [To be set on attorney review]