Campanile Plastic Surgery
Dr. Frank E. Campanile, M.D.
425 S. Cherry Street #321
Denver, CO 80246
Statement of Privacy Notice
Effective December 1st, 2011
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.
Please review the information carefully.
Campanile Plastic Surgery is structured as an organized healthcare arrangement, which allows for the sharing of protected health information among groups and
services listed in this Notice to carry out services for Treatment, Payment or Healthcare Operations.
Your protected health information may be released to other healthcare professionals within Campanile Plastic Surgery or other covered entities for the
purpose of providing you with quality healthcare. Campanile Plastic Surgery might share your health information with other departments in the organization
to assist in coordinating the care you need, such as prescriptions, blood work, meals, and x-rays or other diagnostic tests.
Your protected health information may be released to your insurance provider for the purpose of Campanile Plastic Surgery receiving payment for providing
you with needed healthcare services. Campanile Plastic Surgery might share health information with your physician for payment activities related to the care you received.
Your protected health information may be released in connection with our healthcare operations. Campanile Plastic Surgery might share your health information
to perform evaluation of our quality of services provided to you during your stay. Campanile Plastic Surgery might share information among outside agencies
for review and certification or licensing of our services provided.
Your protected health information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse,
a crime or domestic violence.
Your protected health information may be released to other healthcare providers in the event you need emergency care.
insurance/demographic information or inform you of test results. You have the right to request a more confidential way of providing you protected health
information or alternative communication method at time you are seen at Campanile Plastic Surgery. Campanile Plastic Surgery will honor all reasonable requests.
You may be contacted by Campanile Plastic Surgery by phone, email, text message or mail to offer healthcare treatment options or other health services that
may be of interest to you. Campanile Plastic Surgery will provide in its’ marketing information on how to opt out of receiving future marketing communications.
You may be contacted by Campanile Plastic Surgery for the purposes of raising funds to support the operations of Campanile Plastic Surgery. Campanile Plastic
Surgery will provide in its’ fundraising material information on how to opt out of receiving future fundraising communications.
You have the right to restrict the use of your protected health information. However, Campanile Plastic Surgery may choose to refuse your restriction if it is
in conflict with providing you with quality healthcare or in the event of an emergency situation.
You have the right to receive confidential communication about your health status. Campanile Plastic Surgery might disclose health information to notify,
or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care,
your location or your general health condition or death. Campanile Plastic Surgery will also use our professional judgment and our experience with common practice
to make reasonable decisions when releasing your health information that is directly relevant to the person’s involvement in your healthcare.
You have the right to review and photocopy any/all portions of your health information; Campanile Plastic Surgery
Your protected health information may be released to a public health organization or federal organization in the event of a communicable disease or to report
a defective device or untoward event to a biological product (food or medication).
Your protected health information may be used in our facilities directory; name, location in our facility, general condition and/or religious affiliation to
be provided upon a caller’s specific request by name. Campanile Plastic Surgery will only release your religious affiliation to clergy. Campanile Plastic
Surgery will provide you the opportunity to prohibit disclosure to our facility directories unless emergency circumstances prevent your opportunity to object.
Your protected health information may be released only after receiving written authorization from you other than those listed above or for treatment, payment or
healthcare operations. You may revoke your permission to release protected health information at any time. It must be in writing with effective date and be
specific to the health information being protected. Campanile Plastic Surgery is NOT required to agree to your request.
Your protected health information may be disclosed to an approved research project by Campanile Plastic Surgery in accordance with our policy and protocol
for protecting the patient’s privacy. In most cases, Campanile Plastic Surgery will have the opportunity to obtain your written authorization before any information
is shared for research purposes.
You may be contacted by Campanile Plastic Surgery by phone or mail, email or text message (or leave a message on a voicemail, via email message or via
text message) to remind you of appointments, pre-schedule procedures, verify has the right to assess a fee for the photocopying of the health information.
You have the right to request an amendment to your health information. It must be in writing and explain why the information should be amended. Campanile
Plastic Surgery can deny the amendment and if so, a written explanation will be provided.
You have the right to know who has accessed your protected health information and for what purpose other than for Treatment, Payment, Healthcare Operations,
and other activities by you. Campanile Plastic Surgery requires that the request for accounting of the disclosures be in writing to the Patient Information
Privacy Officer listed below.
You have the right to possess a copy of this Statement of Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
Campanile Plastic Surgery is required by law to protect the privacy of its patients. It will keep protected any and all patient health information and will
provide patients with a list of duties or practices that protect health information upon written request.
Campanile Plastic Surgery will abide by the term of this notice. Campanile Plastic Surgery reserves the rights to make changes to this notice and will
continue to maintain the confidentially of all health information
You have the right to complain to Campanile Plastic Surgery if you believe your rights to privacy have been violated. If you feel your privacy rights have
been violated, please mail your written complaint to: Campanile Plastic Surgery at 425 S. Cherry Street Denver, CO 80246
All complaints will be investigated.
You may also submit a written complaint to:
Secretary of U.S. Department of Health
and Human Services
Office of Civil Rights
200 Independence Ave., S.W.
Washington, DC 20201