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HIPPA Policy


Policy Effective 3/30/22



This notice describes the practices of Skin Design Aesthetics, its providers and staff, and that of any provider with staff privileges with respect to your protected health information. Skin Design Aesthetics, providers, staff and personnel authorized to have access to your medical chart are subject to this notice.

Skin Design Aesthetics understands that medical information is personal. We are committed to protecting medical information about you. We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care. This notices applies to all of the records of your medical care, which are received or created by Skin Design Aesthetics.

This notice will tell you about the ways in which Skin Design Aesthetics may use and disclose medical information about you. Your medical information, also referred to as “protected health information”, is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health and related health care services. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by name to:

  • Maintain the privacy of your health information;
  • Subject to certain exceptions under the law, provide notice of any unauthorized acquisition, access, use or disclosure of your protected health information, to the extent it was not otherwise secured;
  • Provide you with a notice as to our legal duties and privacy practices with respect to information we maintain about you;
  • Abide by the terms of this notice; and
  • Notify you if we are unable to agree to a requested restriction on certain uses and disclosures.


By becoming a patient at Skin Design Aesthetics, you are giving consent for Skin Design Aesthetics to use your protected health information for certain activities, including treatment, payment and other health care operations ("TPO"). 

We may use and disclose protected health information about you so that Skin Design Aesthetics and its medical providers can treat you. For example, we may use your past medical information in order to diagnose your present condition or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you.  We may also use and disclose protected health information about you for Skin Design Aesthetic's health care operations, in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs or we may provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services in.


The following categories describe different ways that we may use and disclose medical information without your authorization. We will explain what we mean for each category of uses or disclosures, but not every use or disclosure in a category will be listed. Be assured that all uses and disclosures made by Skin Design Aesthetics are only those which are permitted under the law.

We will use your health information for treatment.

  • For example: We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We also may provide your physician or a subsequent health care provider with copies of various reports to assist in treating you once you are discharged from care at Practice.

We will use your health information for payment.

  • For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

We will use your health information for regular health care operations.

  • For example: We may use the information in your health record to assess the care and outcome in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.

We will use and disclose your health information as otherwise allowed by law. Examples of those uses and disclosures follow:

  • Business associates: There are some services provided in our organization through agreements with business associates. Examples include answering services and copy services. To protect your health information, however, we require business associates to appropriately safeguard your information.
  • Notification: Unless you object, we may use or disclose information to notify or assist in notifying a family member, a personal representative or another person responsible for your care about your location and general condition.
  • Individuals involved in your care: Unless you object, we may disclose to a family member, another relative, a close personal friend or another person you identify the health information that is directly relevant to that person's involvement in your health care or payment for your health care. If you are not able to agree or object to such disclosure, we may disclose the information as necessary if we determine it is in your best interest in our professional judgment.
  • In emergency situations: We may use or disclose your health information to public or private emergency medical services, hospitals to coordinate your care or to notify your family or friends of your location or condition in an emergency. We will provide you with an opportunity to agree or object to these disclosures when practical.
  • Research: We may disclose information to researchers when their research has been approved by an institutional review board that has established protocols to protect the privacy of your health.
  • Communications regarding treatment alternatives and appointment reminders: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
  • Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.
  • Worker's compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs established by law.
  • Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
  • Abuse, neglect or domestic violence: As required by law, we may disclose health information to a governmental representative authorized by law to receive reports of abuse, neglect or domestic violence.
  • Judicial, administrative and law enforcement purposes: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes.
  • Health oversight activities: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure.
  • Threats to health or safety: We may use or disclose health information as allowed by law if we believe in good faith that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or for law enforcement authorities to identify or apprehend an individual involved in a crime.
  • Special government functions: We may disclose health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, or for protective services to the President of the United States or certain other government officials. If you are a member of the military, we may disclose health information to military authorities under some circumstances. If you are an inmate of a jail, prison or other correctional facility or in the custody of law enforcement personnel, we may disclose health information necessary to maintain your health and the health and safety of others.
  • Required or allowed by law: We will disclose medical information about you when required or allowed to do so by federal, state or local law.
  • Electronic Health Information Exchange: Skin Design Aesthetics uses a third party (Aesthetic Record) to maintain our electronic medical records (EMR). Skin Design Aesthetics stores electronic health information about you in the EMR. Skin Design Aesthetics monitors who can view your EMR.

When We Need Your Written Authorization

We will not use or disclose your health information without your written authorization, except as described in this notice. Additional circumstances that might require your additional written authorization are not common, but an example would be uses and disclosures for marketing purposes.


You have the rights to: 

  • Request a restriction on certain uses and disclosures of your information for treatment, payment and health care operations, and as to disclosures permitted to persons, including family members involved with your care and as provided by law. However, we are not required by law to agree to a requested restriction, unless the request relates to a restriction on disclosures to your health insurer regarding health care items or services for which you have paid out of pocket and in full;
  • Obtain a paper copy of this notice of information practices;
  • Inspect and request a copy of your health record as provided by law;
  • Request that we amend your health record as provided by law. We will notify you if we are unable to grant your request to amend your health record;
  • Obtain an accounting of disclosures of your health information as provided by law; and
  • Request communication of your health information by alternative means or at alternative locations. We will accommodate reasonable requests.

You may exercise your rights set forth in this notice by providing a written request to: Skin Design Aesthetics, 31 Schoosett Street, Unit 202, Pembroke, MA 02359.  We may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.


We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain, including information created or received before the change. Should our information practices change, we are not required to notify you, but we will have the revised notice available at the office of each practice location  and on our website.

If you have questions and would like additional information, you may contact Kristina Borrelli at: 781-924-5173.


If you believe your privacy rights have been violated, you can send a complaint to the Founder/Manager of Skin Design Aesthetics or to the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Notice of Privacy Practices Acknowledgement

I, the undersigned, understand that under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:

  • Conduct, plan and direct my treatment and follow-up among the multiple health care providers who may be involved in that treatment directly and indirectly;
  • Obtain payment from third-party payers; and
  • Conduct normal health care operations, such as quality assessments and physician certifications. 

I acknowledge that I have been provided the Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I understand that this organization has the right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time at the address above to obtain a current copy of the Notice of Privacy Practices.

I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree, then you are bound to abide by such restrictions.

I acknowledge that my medical information/records will be released to Skin Design Aesthetics. I further acknowledge that my medical information/records will be released from Skin Design Aesthetics to my primary care provider and referring/consulting providers.