Effective Date: 08/13/2025
Adlakha Plastic Surgery
Notice of Privacy Practices

I. 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.

II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)
Pursuant to the Privacy Rules established by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), we are legally required to protect the privacy of your health information. We call this information “protected health information” or “PHI” for short. PHI includes information that can be used to identify you and that we’ve created or received about your past, present, or future health condition, the provision of health care to you, or the payment for this health care. We are required to provide you with this notice about our privacy practices, which explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices described in this notice. We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Whenever we make an important change, we will promptly update this notice and post it in public areas of our office. You can also request a copy of this notice from the contact person listed in Section VI below or view it on our website at www.adlakhaplasticsurgery.com.

III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We use and disclose health information for many different reasons. For some, we do not need your specific authorization; for others, we do.

A. Uses and Disclosures That Do Not Require Your Authorization

We may use and disclose your PHI without your authorization for purposes including, but not limited to:

1. Treatment – Sharing PHI with physicians, nurses, hospitals, or other providers involved in your care.

2. Payment – Using PHI to bill and collect payment for services.

3. Health Care Operations – Using PHI for quality assessments, compliance, and administrative purposes.

4. Required by Law – Disclosing PHI when mandated by federal, state, or local law, court orders, or law enforcement.

5. Public Health Activities – Reporting diseases, injuries, births, deaths, and other public health concerns.

6. Health Oversight Activities – Assisting government oversight agencies with audits, investigations, and inspections.

7. Coroners, Funeral Directors, and Organ Donation – Providing necessary information to facilitate donation or related services.

8. Research – Sharing PHI for approved medical research under specific conditions.

9. To Avoid Harm – Disclosing PHI to prevent a serious threat to health or safety.

10. Specific Government Functions – Such as national security or military activities.

11. Workers’ Compensation – Sharing PHI to comply with workers’ compensation laws.

12. Appointment Reminders & Health-Related Benefits – Contacting you about appointments or services.

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B. Uses and Disclosures Where You Have the Opportunity to Object
We may share PHI with family members, friends, or others involved in your care unless you object.

C. All Other Uses Require Your Written Authorization
Any other use or disclosure of PHI not covered above will require your written authorization. You may revoke that authorization in writing at any time.

D. Authorization for Marketing Communications
We will obtain your written authorization before using PHI for marketing, except in certain in-person communications or when providing nominal promotional gifts.

E. Sale of PHI
We will only sell PHI with your prior written authorization.

F. Fundraising Activities
We may use limited information to contact you for fundraising efforts. You may opt out by contacting our Privacy Officer.

G. Incidental Disclosures
Minor, unavoidable disclosures (e.g., being overheard by others) may occur despite safeguards.

H. Business Associates
We may share PHI with third-party vendors performing services for us, provided they agree in writing to protect your information.

IV. YOUR RIGHTS REGARDING YOUR PHI
You have the right to:

1. Request Restrictions – Ask us to limit uses or disclosures.

2. Request Confidential Communications – Ask us to contact you at an alternative address or method.

3. Access Your PHI – Review or request copies of your medical records, including in electronic form.

4. Receive an Accounting of Disclosures – Get a list of certain disclosures made in the past six years.

5. Receive Notice of a Breach – Be informed if your unsecured PHI is compromised.

6. Amend Your PHI – Request corrections to your health information.

7. Obtain a Copy of This Notice – Receive it by email or paper.

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V. HOW TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer (see Section VI) or with the U.S. Department of Health and Human Services at:
200 Independence Ave., S.W.; Room 509F; HHH Bldg., Washington, DC 20201
Email: OCRMail@hhs.gov
We will not retaliate against you for filing a complaint in good faith.

VI. CONTACT INFORMATION
Privacy Officer
Adlakha Plastic Surgery

3951 Convenience Cir NW,

Suite 101, Canton, OH 44718

Phone: (234) 458-2010
Website: www.adlakhaplasticsurgery.com

VII. EFFECTIVE DATE OF THIS NOTICE
Revised Notice – Effective August 13, 2025