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Rights & Responsibilities
  In accordance with the Federal Privacy Law (HIPAA), mesotherapy offices keep medical information and records confidential and will only use them for patient treatment, health care operations, and billing purposes.

Treatment: Physicians, clinicians, and staff will use your medical information to give you the best possible care.

Health Care Operation: Mesotherapy offices will use this information for appropriate follow-up care, patient notification, statistical & regulatory requirements, and internal quality assurance programs.

Billing Purposes: Mesotherapy offices will use your medical information to bill the appropriate third party(ies) for your care.


1. Health information will be given to family members in case of an emergency or under other circumstances with proper authorization and documentation.

2. Health information may be given to other physicians or institutions under emergency situations.

3. Information may be given to proper authorities when neglect or abuse is alleged or suspected.

4. Information may be provided to courts or other agencies when a subpoena is given to this office.

Patient Rights

Effective April 14, 2003
In accordance with the Federal Privacy Law (HIPAA):

Right to Access Records

Patients have the right to see and get copies of their records within thirty (30) days of request. The patient has a right to see anything in the record. Copies may be made and will be charged at the going rate of fifteen (15) cents per page plus any postage costs for mailing records.

Right to Request Restrictions

Patients have the right to request restrictions on who sees their records. Any request that is unreasonable will be dealt with on an individual basis.

Right to Confidential Communication

Patients have the right to receive communications about their record in a confidential manner. In this office patients will be given a form to fill out stating how they would like to be contacted.

Right to Amend the Record

Patients have the right to amend their records when they disagree with the content but physicians have the right to deny these requests. A record cannot be changed but a line may be drawn through the disputed entry. The physician may then write an addendum.

Right to an Accounting of Disclosures

Patients have the right to know everyone to whom the office discloses record information for purposes other than treatment, payment, and health care operation.

A log, as required by HIPAA, will be kept showing each disclosure and the person to whom it is made. This will also show what information is provided and the purpose. This office will only long in the releases for which the patient's authorization is required.

Any questions about this policy can be directed to a Mesotherapy office's Privacy Officer.

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