Effective Date: September 22, 2026
Last Updated: September 22, 2026
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 describes how Iconic Plastic Surgery uses and
discloses protected health information, how we protect your medical information,
and the rights you have regarding your health information.
This Notice applies to Iconic Plastic Surgery and members of our workforce who
have access to protected health information as part of their work for the practice.
Independent hospitals, surgery centers, laboratories, pharmacies, healthcare
professionals, or other organizations involved in your care might maintain their
own privacy practices and notices.
Your Rights
You have rights regarding the health information we maintain about you. These
rights include access to your records, requests for corrections, confidential
communications, certain restrictions on disclosures, an accounting of certain
disclosures, and the right to file a privacy complaint.
Access Your Medical Records
You have the right to inspect or obtain an electronic or paper copy of medical
records and other health information maintained about you, subject to limitations
permitted by law.
California law generally provides patients the right to inspect medical records
within five working days after a qualifying written request and to receive requested
copies within 15 days after receipt of a qualifying written request and any
applicable fees.
Reasonable fees permitted by applicable law might apply to certain record requests.
Contact our Privacy Officer for instructions regarding medical record requests.
Request a Correction or Amendment
You have the right to ask us to correct or amend health information that you
believe is incorrect or incomplete.
We might deny certain requests as permitted by law. If a request is denied, we
will provide information regarding the denial and any additional rights available
to you.
Request Confidential Communications
You have the right to ask us to communicate with you about health matters in a
particular way or at a particular location.
For example, you might request that we contact you only at a specific telephone
number, email address, or mailing address. We will accommodate reasonable requests
as required by law.
Request Restrictions
You have the right to ask us to limit certain uses or disclosures of your protected
health information for treatment, payment, or healthcare operations.
We are not required to agree to every requested restriction. If we agree to a
restriction, we will follow it except where disclosure is permitted or required
by law, including circumstances involving emergency treatment.
If you pay for a healthcare service or item entirely out of pocket, you have the
right to request that information about the service or item not be disclosed to
your health plan for payment or healthcare operations. We will honor the request
unless disclosure is required by law.
Receive an Accounting of Certain Disclosures
You have the right to request a list of certain disclosures of your protected
health information made during the six years before your request.
The accounting generally does not include disclosures made for treatment, payment,
healthcare operations, disclosures made directly to you, disclosures authorized by
you, and certain other disclosures excluded by law.
One accounting during a 12-month period will be provided without charge. A
reasonable cost-based fee might apply to additional requests during the same
12-month period.
Receive a Copy of This Notice
You have the right to request a paper copy of this Notice at any time, including
when you previously agreed to receive it electronically.
Choose Someone to Act for You
If another person has legal authority to act on your behalf, such as a healthcare
agent, personal representative, parent, guardian, or another legally authorized
representative, that person is permitted to exercise applicable privacy rights
on your behalf.
We will verify the person’s legal authority before acting on a request where
verification is required.
Your Choices
For certain uses and disclosures of health information, you have the right to
tell us your preferences.
Family, Friends, and Others Involved in Your Care
You have the right to tell us whether health information should be shared with
family members, close friends, caregivers, or other people involved in your care
or payment for your care.
If you are unable to communicate your preference, we are permitted to share
information when, using professional judgment, the disclosure is in your best
interest and is permitted by law.
Disaster Relief and Emergency Situations
We are permitted to disclose limited health information to organizations assisting
with disaster relief or emergency response when permitted by applicable law.
Marketing
Most uses of protected health information for marketing purposes require your
written authorization.
Certain communications concerning your treatment, treatment alternatives,
appointment reminders, or health-related products or services are permitted by
law without a marketing authorization.
Marketing email and text-message preferences are also governed by applicable
communications laws and our website privacy practices.
Sale of Protected Health Information
Iconic Plastic Surgery does not sell your protected health information.
Any disclosure that legally constitutes a sale of protected health information
requires written authorization unless an exception applies under applicable law.
Psychotherapy Notes
Most uses and disclosures of psychotherapy notes require written authorization
when such records are maintained by the practice, except where an exception
applies under law.
Fundraising
Iconic Plastic Surgery does not currently use protected health information for
fundraising communications. If fundraising communications involving protected
health information are conducted in the future, applicable privacy rights and
opt-out requirements will be honored.
How We Use and Disclose Health Information
Federal and state law permit or require certain uses and disclosures of protected
health information without separate written authorization. The following sections
describe common situations.
Treatment
We use and disclose health information to provide, coordinate, and manage your
healthcare.
For example, information might be shared with physicians, nurses, surgical
facilities, anesthesiology professionals, laboratories, pharmacies, imaging
providers, or other healthcare professionals involved in your treatment.
Payment
We use and disclose health information to obtain payment for healthcare services
and to administer billing activities.
Where applicable, information might be provided to an insurance carrier, health
plan, financing administrator, or another organization involved in processing
payment for covered healthcare services.
Healthcare Operations
We use and disclose health information for healthcare operations necessary to run
our practice and support patient care.
These activities include quality assessment, staff training, credentialing,
compliance activities, auditing, legal services, business management, patient
service activities, and efforts to improve the quality of care.
Business Associates
We work with service providers that perform functions involving protected health
information on our behalf. When required by HIPAA, these organizations operate as
business associates and enter into agreements requiring appropriate safeguards for
protected health information.
Public Health and Safety
We are permitted to disclose health information for public health and safety
activities authorized by law, including:
- Preventing or controlling disease, injury, or disability
- Reporting adverse reactions or problems involving medications or medical devices
- Supporting product recalls
- Reporting suspected abuse, neglect, or domestic violence as required or permitted by law
- Preventing or reducing a serious and imminent threat to health or safety
Health Oversight Activities
We are permitted to disclose health information to health oversight agencies for
activities authorized by law, including audits, investigations, inspections,
licensing activities, and regulatory reviews.
Research
Protected health information might be used or disclosed for research when the
research satisfies applicable legal requirements, including required authorization,
institutional review, waiver, or other permitted processes.
Required by Law
We will disclose health information when federal, California, or other applicable
law requires us to do so.
We are also required to provide information to the U.S. Department of Health and
Human Services when necessary to demonstrate compliance with federal health privacy
requirements.
Organ and Tissue Donation
We are permitted to disclose health information to organ procurement organizations
and similar organizations involved in organ, eye, or tissue donation when permitted
by law.
Coroners, Medical Examiners, and Funeral Directors
We are permitted to disclose health information to coroners, medical examiners,
and funeral directors when permitted or required by law.
Workers’ Compensation
We are permitted to disclose health information as authorized or required for
workers’ compensation programs and similar programs established by law.
Law Enforcement and Government Requests
We are permitted to disclose health information for certain law enforcement or
government purposes when the disclosure satisfies applicable legal requirements.
This includes certain health oversight activities and special government functions
authorized by law.
Lawsuits and Legal Proceedings
Health information might be disclosed in response to a valid court order,
administrative order, subpoena, discovery request, or another lawful process,
subject to applicable federal and California privacy protections.
Substance Use Disorder Records
Federal law provides additional protections for certain substance use disorder
patient records governed by 42 CFR Part 2.
To the extent Iconic Plastic Surgery receives or maintains records protected by
42 CFR Part 2, those records will receive the additional protections required by
federal law.
Part 2 records generally will not be used or disclosed in civil, criminal,
administrative, or legislative investigations or proceedings against you unless
permitted by applicable law, including where appropriate written consent or a
qualifying court order and subpoena are obtained.
Where Part 2 information is involved in fundraising communications, applicable
advance notice and patient choice requirements will be followed.
California Medical Privacy Protections
Iconic Plastic Surgery is located in California and follows applicable California
medical privacy laws in addition to federal HIPAA requirements.
California law provides additional protections for medical information and for
certain categories of sensitive health information. These protections include
restrictions involving certain mental health information, HIV-related information,
and other medical information receiving heightened protection under California law.
California law also treats certain individually identifying immigration-status
information collected or known by a healthcare provider as protected medical
information. We will follow applicable California restrictions governing disclosure
of this information.
Where California law provides stronger privacy protections than federal law, we
will follow the more protective requirement.
Our Responsibilities
Iconic Plastic Surgery is required to:
- Maintain the privacy and security of your protected health information
- Follow the duties and privacy practices described in the current version of this Notice
- Provide you with a copy of this Notice when required or requested
- Notify affected individuals following a breach of unsecured protected health information when notification is required by law
- Use or disclose only the protected health information reasonably appropriate for permitted purposes, subject to applicable law
- Honor valid written authorizations and applicable requests to revoke those authorizations
We will not use or disclose your protected health information for purposes outside
those described in this Notice unless you provide written authorization or the use
or disclosure is otherwise permitted or required by law.
When written authorization is required, you generally have the right to revoke the
authorization in writing. A revocation does not affect actions already taken in
reliance on a valid authorization before the revocation was received.
Privacy and Security Breaches
Iconic Plastic Surgery maintains administrative, technical, and physical safeguards
designed to protect protected health information.
If a breach of unsecured protected health information occurs and applicable law
requires notification, we will provide the required notices within the applicable
legal timeframes.
File a Privacy Complaint
If you believe your privacy rights have been violated, you have the right to submit
a complaint to Iconic Plastic Surgery.
You will not be retaliated against or denied treatment for submitting a privacy
complaint or exercising a privacy right.
Privacy Officer
Iconic Plastic Surgery
3144 El Camino Real, Suite 200
Carlsbad, CA 92008
Phone: 760-637-5288
Email:
dr.dsouza@iconicplasticsurgery.com
File a Complaint With the U.S. Department of Health and Human Services
You also have the right to file a privacy complaint with the U.S. Department of
Health and Human Services Office for Civil Rights.
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-877-696-6775
Website:
File a HIPAA Complaint
Iconic Plastic Surgery will not retaliate against you for filing a complaint with
the practice or the U.S. Department of Health and Human Services.
Changes to This Notice
Iconic Plastic Surgery reserves the right to revise this Notice and our privacy
practices as permitted by law.
A revised Notice will apply to protected health information we already maintain as
well as information created or received after the revised Notice takes effect.
When this Notice is materially revised, the updated version will be available at
our office, upon request, and on our website. The effective date at the top of the
Notice will identify the current version.
Related Privacy Information
This HIPAA Notice of Privacy Practices specifically addresses protected health
information governed by healthcare privacy laws. Information collected through
general website browsing, advertising technologies, cookies, marketing systems,
and other website activities is also addressed in our other privacy disclosures.
Questions About This Notice
Questions regarding this Notice, your medical records, or your health information
privacy rights should be directed to:
Privacy Officer
Iconic Plastic Surgery
3144 El Camino Real, Suite 200
Carlsbad, CA 92008
Phone: 760-637-5288
Email:
dr.dsouza@iconicplasticsurgery.com