inject skincare

HIPAA Notice

Inject Skincare

Medical Aesthetics & Wellness

HIPAA Notice of Privacy Practices

Provider: Amelia Robles, MSN, APRN, ANP-C

Effective Date: October 10, 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.

Inject SkinCare is committed to protecting your health information. This Notice explains how

your Protected Health Information (PHI) may be used and disclosed, your privacy rights, and

our legal responsibilities.

How We Use and Disclose Your Health Information

We may use and disclose your health information without additional authorization when

permitted by law for:

● Treatment: Providing and coordinating your healthcare. For example, we may share

relevant medical information with a pharmacy filling your prescription.

● Payment: Billing and collecting payment for healthcare services. For example, we may

provide necessary information to a health plan to process a claim.

● Healthcare Operations: Managing our practice, improving patient care, conducting

quality reviews, and performing administrative activities. For example, we may review

patient records to evaluate the quality of our services.

We may also use or disclose information when permitted or required by law for:

● Public health reporting and safety activities, including product recalls and reporting

adverse medication reactions.

● Reporting suspected abuse, neglect, or domestic violence.

● Health oversight activities and legally authorized government investigations.

● Workers' compensation matters.

● Certain law enforcement requests and judicial or administrative proceedings.

● Medical examiners, coroners, funeral directors, and organ or tissue donation

organizations, when applicable.

● Research activities permitted by law.

● Preventing or reducing serious threats to health or safety.

● Special government functions, including certain military or national security activities.

● Compliance with federal or state laws, including disclosures to the U.S. Department of

Health and Human Services when required to demonstrate compliance with privacy

laws.

These disclosures are subject to applicable legal requirements and limitations.

Your Choices and Authorizations

You may express your preferences regarding sharing information with family members, friends,

caregivers, or others involved in your care or payment for your care, including during disaster

relief situations.

We will follow your preferences when required by law. If you cannot communicate your wishes,

we may share relevant information when permitted by law and determined to be in your best

interest.

Certain uses and disclosures require your written authorization, including most uses for

marketing, sales of PHI, and most disclosures of psychotherapy notes, if applicable.

Other uses and disclosures not described in this Notice will require written authorization when

required by law. You may revoke an authorization in writing at any time, except to the extent we

have already acted in reliance on it.

Inject SkinCare does not currently use PHI for fundraising. If this changes, applicable notice and

opt-out rights will be provided.

Health information disclosed to a recipient may, in some circumstances, be redisclosed and no

longer protected by HIPAA. Other applicable confidentiality laws may continue to protect certain

records.

Substance Use Disorder Information

Information about substance use documented during routine medical care is protected under

HIPAA and other applicable privacy laws.

If Inject SkinCare receives or maintains records protected under 42 CFR Part 2, additional

federal confidentiality protections apply. Such records generally cannot be used or disclosed in

civil, criminal, administrative, or legislative investigations or proceedings against you without

your written consent or an appropriate court order and subpoena, as required by law.

Additional State Privacy Protections

Inject SkinCare provides healthcare services in Arizona and Oregon and complies with

applicable federal and state medical privacy laws.

Arizona law protects the confidentiality of medical and payment records and limits their

disclosure to circumstances authorized by law or by the patient.

Oregon law provides additional protections for certain sensitive health information, including

HIV-related information, mental health records, genetic testing information, and substance use

disorder treatment records, when applicable.

We will obtain written authorization when required and follow whichever applicable law provides

greater privacy protection. Information will be disclosed without authorization only when

permitted or required by law.

Your Privacy Rights

You have the right to:

● Access your records: Request an electronic or paper copy of your medical records. We

generally respond within 30 days, subject to permitted extensions. Reasonable,

cost-based fees may apply.

● Request corrections: Ask us to amend information you believe is incorrect or

incomplete. We may deny certain requests but will explain the reason in writing,

generally within 60 days, subject to permitted extensions.

● Request confidential communications: Ask us to contact you through a specific

method or at an alternative location. We will accommodate reasonable requests.

● Request restrictions: Ask us to limit certain uses or disclosures of your health

information. We are not required to agree to every request. If we agree, exceptions may

apply, including for emergency treatment.

● Restrict health plan disclosures: Request that information about services paid for in

full out-of-pocket not be disclosed to your health plan for payment or healthcare

operations, unless disclosure is required by law.

● Request an accounting: Obtain a list of certain disclosures of your health information

for the preceding six years. Disclosures for treatment, payment, healthcare operations,

and certain other purposes are generally excluded. One accounting per 12-month period

is provided without charge.

● Obtain this Notice: Request a paper copy at any time, even if you previously agreed to

receive it electronically.

● Designate a representative: Have a legally authorized personal representative exercise

your rights on your behalf.

● File a complaint: Submit a privacy complaint without retaliation.

To exercise your rights, contact Inject SkinCare using the information below.

Our Legal Responsibilities

Inject SkinCare is required by law to:

● Maintain the privacy and security of your protected health information.

● Notify affected individuals following a breach of unsecured PHI when required by law.

● Provide notice of our legal duties and privacy practices.

● Follow the terms of the Notice currently in effect.

We will not use or disclose your information other than as described in this Notice or as

otherwise permitted or required by law without obtaining authorization when required.

We reserve the right to update this Notice and apply revised terms to information previously

collected. The current Notice will be available upon request, in our office, and on our website.

Privacy Questions or Complaints

Inject SkinCare Privacy Contact: Amelia Robles

Phone: 928-251-0631

Email: amelia@injectskincare.com

You may also file a complaint with the 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: https://www.hhs.gov/hipaa/filing-a-complaint/

Inject SkinCare will not retaliate against you for filing a complaint.