La Belle Medspa Notice of Privacy Practices
**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.**

This Notice of Privacy Practices (“Notice”) describes how La Belle Medspa (“we,” “our,” “the Practice”) may use and disclose your Protected Health Information (“PHI”) and how you may access this information. We are required by federal law—the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)—to maintain the privacy of your PHI, to provide you with this Notice, and to abide by the terms contained herein.

This Notice applies to all medical records and health information maintained or created by La Belle Medspa.

I. OUR RESPONSIBILITIES
La Belle Medspa is required by law to:

• Maintain the privacy and security of your Protected Health Information (“PHI”).
• Provide you with this Notice of our legal duties and privacy practices.
• Follow the terms of this Notice currently in effect.
• Notify you in the event of a breach of your unsecured PHI.
• Disclose only the minimum necessary PHI as required for permitted uses and disclosures.

II. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

HIPAA permits La Belle Medspa to use and disclose PHI for Treatment, Payment, and Health Care Operations ("TPO") without obtaining additional written authorization from you.

A. Treatment

• We may use or disclose your PHI to provide, coordinate, or manage your health care. For example:
• A provider may review your medical history to determine treatment suitability.
• We may consult with another health care professional involved in your care.

B. Payment
We may use and disclose your PHI to obtain payment for services provided. This may include:

• Submitting claims to your insurance carrier.
• Verifying eligibility or coverage.
• Billing and collection activities.

C. Health Care Operations
We may use and disclose your PHI for internal administrative and quality assurance purposes, including:

• Quality assessment and improvement activities
• Licensing and certification reviews
• Internal audits
• Staff training and evaluation
• Compliance and risk management functions

These uses help ensure that we maintain high standards of care.

III. OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
La Belle Medspa may disclose PHI without your authorization under specific circumstances permitted by law, including:

A. Public Health Activities

• We may disclose PHI to authorized public health authorities for purposes including:
• Disease reporting
• Preventing or controlling disease
• Reporting adverse events to the FDA
• Notifications regarding product recalls

B. Victims of Abuse, Neglect, or Domestic Violence
We may disclose PHI to government authorities authorized by law to receive reports of abuse, neglect, or domestic violence.

C. Health Oversight Activities
We may disclose PHI to governmental agencies responsible for oversight activities, such as:

• Audits
• Inspections
• Compliance investigations

D. Judicial and Administrative Proceedings
We may disclose PHI:

• In response to a court order
• Under certain conditions in response to a subpoena, discovery request, or legal demand

E. Law Enforcement Purposes
We may disclose PHI to law enforcement officials for purposes such as:

• Identifying or locating a suspect, fugitive, or missing person
• Responding to a court order, warrant, or subpoena
• Reporting certain injuries or threats as required by law

F. Medical Examiners, Coroners, and Funeral Directors
We may disclose PHI to facilitate:

• Identifying the deceased
• Determining cause of death
• Funeral-related duties

G. Organ and Tissue Donation
We may disclose PHI to organizations involved in organ procurement or tissue donation.

H. Research
We may disclose PHI for approved research projects, provided appropriate safeguards and protocols are in place to protect your privacy.

I. Serious Threat to Health or Safety
We may disclose PHI when necessary to prevent or lessen a serious and imminent threat to your health or the health and safety of others.

J. Workers’ Compensation
We may disclose PHI as authorized by workers’ compensation laws or similar programs providing benefits for work-related injuries or illness.

K. Specialized Government Functions
We may disclose PHI for activities related to:

• Military personnel
• National security
• Presidential or official protective services

IV. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
We will obtain your written authorization before using or disclosing your PHI for any purpose not described in this Notice, including:

• Most marketing communications
• Sale of PHI
• Psychotherapy notes (if applicable)

You may revoke an authorization in writing at any time, except to the extent we have already relied on it.

V. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your PHI:

1. Right to Inspect and Obtain Copies
You may request to inspect or obtain a copy of your medical and billing records.
Requests must be submitted in writing.

We may charge a reasonable fee for copying, mailing, or preparing your records.

2. Right to Request Restrictions
You may request restrictions on how your PHI is used or disclosed for TPO.
We are not required to agree to most requested restrictions.

To request a restriction, your request must be in writing and describe:

• What information you want restricted
• Whether the restriction applies to use, disclosure, or both
• To whom the restriction applies

3. Right to Confidential Communications
You may request to receive communications of PHI by alternative means or at alternative locations (e.g., only by mail or only at work).
We will accommodate reasonable requests.

Requests must be submitted in writing.

4. Right to Amend Your Records
If you believe your PHI is incorrect or incomplete, you may request an amendment.
Requests must be in writing and must include a reason.

We may deny a request under certain conditions.

5. Right to an Accounting of Disclosures
You may request a list (“accounting”) of certain disclosures of your PHI made by La Belle Medspa during the previous six (6) years, excluding disclosures for TPO.

Requests must be submitted in writing.

6. Right to a Paper or Electronic Copy of This Notice
You may request a paper or electronic copy of this Notice at any time.

This Notice is also available on our Website at:
https://labelleoc.com/notice-of-privacy-practices-hipaa

VI. CHANGES TO THIS NOTICE
We reserve the right to revise or amend this Notice at any time.
Revised notices will apply to all PHI we maintain.

The effective date is listed at the top of this Notice.
The current version will always be available on our Website.

VII. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with:

La Belle Medspa — Privacy Officer
17400 Irvine Blvd Suite M
Tustin, CA 92780
Phone: (714) 486-1107

You may also file a complaint with:
U.S. Department of Health and Human Services — Office for Civil Rights
(https://www.hhs.gov/ocr/)

We will not retaliate against you for filing a complaint.

VIII. CONTACT INFORMATION
For questions or more information about this Notice, contact:

La Belle Medspa — Privacy Officer
17400 Irvine Blvd Suite M
Tustin, CA 92780
Phone: (714) 486-1107
Email: vidaforevercosmetica@gmail.com