The Patients’ “Bill of Rights”

As a patient and a consumer, you should be aware of certain rights. Take a few moments to educate yourself of those rights.

A.         Patients are to be treated with respect, consideration, and dignity.  

B.          Patients should be provided appropriate privacy.

C.          Patient disclosures and records are to be treated confidentially, and, except when required by law, patients should be given the opportunity to approve or refuse their release.

D.         Patients are to be provided, to the degree known, with complete information concerning their diagnosis, evaluation, treatment, and prognosis. When it is medically inadvisable, such information should be given to a person designated by the patient or to a legally authorized person.

E.          Patients are to be given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.

F.          Patients are expected to conduct themselves in an appropriate, responsible manner. Instructions from your doctor and his staff should be adhered to.

G.         This is a cosmetic surgery facility. Facial cosmetic surgery, tumescent liposuction, tummy tucks, and breast augmentation are performed here. We are not providers for any insurance companies.

H.         Dr. McMenamin will provide his home phone number for you after surgery. Our “after hours” voice mail greeting will also provide you with his beeper number. In his absence, the physician assistant will have his beeper and another MD will be available for emergencies.

I.            Fees for services will be quoted to you. Consultation fees are payable at the time of service. A deposit of 1/3 of your surgery fee is due at the time your surgery is scheduled. The balance is due at your pre-operative visit.

J.           We accept cash, checks, and most major credit cards for payment. We also offer financing through reputable companies for those who qualify.

K.         We occasionally conduct non-funded research projects in our facility. Your participation in such research will be discussed with you and is totally voluntary.

L.          If you are unhappy with any aspect of your care, please let us know so that we can take steps to make corrections in that area. All post-operative patients will receive a confidential satisfaction questionnaire approximately 3 months after surgery. Please express your opinions. Compliments are appreciated too!

M.        You have a right to question or refuse any mode of treatment. We will assist you in getting a second opinion from another physician at your request.

N.         You have a right to chose and/or change your treating physician.

O.         Dr. McMenamin advertises his services by several different modalities including the newspaper, the phone book, educational seminars, and radio/TV broadcasts. His goal is to present his work in an honest, forthright fashion that is not misleading to patients.

P.          Dr. McMenamin is insured for medical malpractice.

Q.         If you have a suggestion or grievance, please request a form or submit a confidential letter outlining your concerns. We will do our best to remedy the situation to your satisfaction. The California Medical Board is the governing body for physicians in this state.

R.          An Advance Directive document gives a designated person the ability to make health related decisions for you if and when you are incapacitated. It also outlines your wishes under certain circumstances. If you want more information, or wish to complete this document for future health care needs, please ask us. However, because of the nature of Dr. McMenamin's services, we do not honor Advance Directives.

S.           Dr. McMenamin and his staff are required to have the proper licensure, certifications, and/or training to provide the care given to you in this facility. We would be happy to provide you with that information when requested.

                                                                                                                                                                                                      Rev. 11/02/07

NOTICE OF PRIVACY PRACTICES  

Our Pledge Regarding Medical Information:

The privacy of your medical information is important to us.  We understand that your medical information is personal, and we are committed to protecting it.  We create a record of the care and services you receive in our office.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice will tell you about the ways we may use and share medical information about you.  We also describe your rights and certain duties we have regarding the use and disclosure of medical information.

Our Legal Duty:

LAW REQUIRES US TO: 

1.        Keep your medical information private.

2.        Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.

3.        Follow the terms of the notice that is now in effect.

WE HAVE THE RIGHT TO:

1.        Change our privacy practices and the terms of this notice at any time, provided that law permits the   changes.

2.        Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

NOTICE OF CHANGE TO PRIVACY PRACTICES:

1.        Before we make an important change in our privacy practices, we will change the notice and make the new notice available upon request.

Use and Disclosure of Your Medical Information:

This is how we use and disclose medical information.  Note:  We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization.  Any specific written authorization you provide may be revoked at any time by writing to us.

FOR TREATMENT:

We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people who are taking care of you.  We may also share medical information about you with your other health care providers to assist them in treating you.

FOR PAYMENT:

We may use and disclose your medical information for payment purposes.

Example:  The laboratory or mammography center may ask us for your diagnosis  

   in order to bill your insurance for their services.        

FOR HEALTH CARE OPERATIONS:

We may use and disclose your medical information for our health care operations.  This may include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.

ADDITIONAL USES AND DISCLOSURES:

In addition to using and disclosing your medical information for treatment, payment and health care operations, we may use and disclose medical information for the following purposes.

TO PROVIDE INFORMATION TO BUSINESS ASSOCIATES:

There are some services provided in our office through contacts with business associates.  Examples include anesthesiologists or transcriptionist.  To protect your health information, however, we require the business associate to appropriately safeguard your information.

TO PROVIDE NOTIFICATION:

We may use or disclose information to notify or assist in notifying a person chosen by you (family member, personal representative, or another person responsible for your care), your location and general condition.

TO COMMUNICATE WITH FAMILY:

Health professionals may, using their best judgment, disclose to a person chosen by you (family member, other relative, close personal friend, or any other person you identify), health information relevant to that person’s involvement in your care or payment related to your care.

FOR APPOINTMENT REMINDERS:

We may contact you to provide appointment reminders.

FOR RESEARCH IN LIMITED CIRCUMSTANCES:

Medical information for research purposes in limited circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.

FUNERAL DIRECTOR, CORONER, MEDICAL EXAMINER:

We may share the medical information about a person who has died with a coroner, medical examiner, funeral director, or an organ procurement organization to help them carry out their duties.

SPECIALIZED GOVERNMENT FUNCTIONS:

Subject to certain requirements, we may disclose or use health information for military personnel or veterans, for national security and intelligence activities and protection of the President and other authorized persons or foreign heads of state, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.

COURT ORDERS AND JUDICIAL AND ADMINISTRATIVE PROCEEDINGS:

We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances.  Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials.  We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim, or missing person.

PUBLIC HEALTH ACTIVITIES:

As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect.  We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the Food and Drug Administration.  We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE:

We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health or safety of others.  We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.

WORKERS COMPENSATION:

We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.

HEALTH OVERSIGHT ACTIVITIES:

We may disclose medical information to an agency providing health oversight for oversight activities authorized by law, including audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure, or disciplinary actions, or other authorized activities.

LAW ENFORCEMENT:

Under certain circumstances, we may disclose health information to law enforcement officials.  These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.

YOUR INDIVIDUAL RIGHTS:

Although your health record is the physical property of the healthcare practitioner (Patrick McMenamin, MD) who compiled it, the information belongs to you.  You have the right to:

1.                    Look at or get copies of your medical information.  You must make your request in writing.  You may ask the receptionist for the form needed to request access. There may be charges for copying and postage if you want the copies mailed to you. 

2.                    Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment or health care operations and other specified exceptions.

3.                    Request that we place additional restrictions on our use or disclosure of your medical information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in case of an emergency).

4.                    Request that we communicate with you about your medical information by different means or to different locations.  Your request must be made in writing to our Privacy Officer.

5.                    Request that we change your medical information.  We may deny your request if we did not create the information you want changed or for certain other reasons.  If we deny your request, we will provide you with a written explanation.  You may respond with a statement of disagreement that will be added to the information you want changed.  If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

6.                    Obtain a paper copy of the Notice of Privacy Practices upon request.

QUESTIONS AND COMPLAINTS:

If you have any questions about this notice, please ask the receptionist for help or ask to speak to our Privacy Officer,  Gina Heckeroth.

If you think that we may have violated your privacy rights, contact the person named above.  You may also submit a written complaint to the U.S. Department of Health and Human Services.  We will not retaliate in any way if you choose to file a complaint.

These privacy practices are effective April 14, 2003 and will remain in effect until further notice.