Effective Date: May 19, 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 template notice should be reviewed by counsel and finalized before the practice begins patient care.
Our Responsibilities
Ambani Aesthetics is committed to protecting your health information. We are required by law to maintain the privacy and security of protected health information, provide this Notice, follow the terms of the Notice currently in effect, and notify affected individuals if a breach occurs that may have compromised protected health information.
Your Rights
You have the right to request access to your medical records, ask us to correct your records, request confidential communications, ask us to limit certain uses or disclosures, receive a list of certain disclosures, receive a paper copy of this Notice, choose someone to act for you, and file a complaint if you believe your privacy rights have been violated.
Some requests must be made in writing and may be subject to legal limitations. We will respond to requests as required by applicable law.
Your Choices
You may tell us your preferences for sharing information with family, close friends, or others involved in your care. In certain situations, such as marketing communications or sale of protected health information, we will ask for written authorization when required by law.
How We May Use and Share Health Information
We may use and share health information to treat you, run our practice, bill for services, coordinate care, communicate with you about appointments or treatment, support quality improvement, comply with law, respond to public health or safety issues, work with health oversight agencies, respond to lawsuits and legal actions, and support other uses permitted or required by law.
Uses That May Require Authorization
We will obtain your written authorization for uses and disclosures not otherwise permitted by law, including certain marketing communications, sale of protected health information, and other situations where authorization is legally required. You may revoke an authorization in writing, except to the extent we have already relied on it.
Complaints
You may file a complaint with Ambani Aesthetics if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Contact
Questions about this Notice may be sent to concierge@shoshanamd.com.