Welcome to Avalon Plastic Surgery Center. Our staff
welcomes the opportunity to be involved in your health
care. We strive to provide you with the best medical care
possible in a friendly and comfortable environment.
“Plastic” comes from the Greek word “Plastikos”, which
means to mold or shape. Plastic surgery is the surgical
specialty which deals with reconstructive and cosmetic
surgical procedures. Reconstructive surgery is performed on
abnormal or damaged structures of the body to improve
function and restore a more normal appearance. Aesthetic or
cosmetic surgery is performed to reshape normal structures
of the body to improve one’s appearance and self
Avalon, we also offer an individualized skin care program.
The SkinMedica program is a complete skin care line that
aids in reducing the signs of aging and promotes healthy
skin texture and appearance. We want to make your visit as
comfortable and pleasant as possible. Our in-office
surgical suite allows us to perform many cosmetic
procedures in a private and comfortable environment.
Our Promise to you...
is to provide you with the information needed to make a
plastic surgery health care decision. This will include
diagnosis, treatment options, expected outcomes, post
operative care, and recovery pertaining to your procedure.
We encourage you to ask questions.
Barnard is on staff at Allen Memorial Hospital and Covenant
Medical Center, both in Waterloo, IA.
accept Medicare and many other insurance plans. We will
file your primary and secondary insurances at no cost to
you. Simply provide us with all policy information and a
copy of your insurance card. A copy of the card must be on
file for us to submit your claim. We will notify your
insurance carrier if surgery is to be scheduled. It is your
responsibility to let us know if a second opinion or pre
certification is required. Ultimately, you are responsible
to know your plan. We deal with many plans and can provide
only the basic information to you. Most cosmetic surgical
procedures are done in our office suite. This allows the
finest care to you at the most reasonable cost. Fees for
cosmetic procedures are due three weeks prior to the
scheduled surgery. Account statements are sent out once a
month. You are responsible for the balance not covered by
your insurance. We ask that you keep your account current.
of Information/Privacy Practices
notice of Privacy Practices describes how medical
information about you may be used and disclosed and how you
can get access to this information. Please review it
carefully. Avalon Plastic Surgery Center is required by law
to follow the terms of this Notice as long as it is in
effect. If you have any questions about this notice,
contact Dr. Mark A. Barnard at 2710 St Francis Dr #310,
Waterloo, IA 50702.
Your Rights under the Federal Privacy
Although your health records are the physical property of
the health care provider who completed the records, you
have the following rights with regard to the information
1. Request restriction on uses and disclosures of your
health information for treatment, payment and health care
operations. Avalon Plastic Surgery Center is not required
to agree to a requested restriction.
2. The right to receive confidential communication of
protected health information.
3. Obtain a copy of this notice of information; you have a
right to a hard copy upon request.
4. Inspect and copy your health information upon request.
Again, this right is not absolute. In certain situation
such as if access would cause harm, we can deny access.
A. Request amendment/correction of your health information,
We do not have to grant the request if the following
a. We did not create the record. If, as in the case of a
consultation report from another provider, we did not
create the record, we cannot know whether is it accurate or
Thus, in such cases, you must seek amendment correction
from the party creating the record. If the party amends or
corrects the record, we will put the corrected record into
b. The record is accurate and complete.
5. Obtain an accounting of non-routine uses and
disclosures, those other than for treatment, payment, and
health care operations until a date that the federal
Department of Health and Human Services will set after
January 1, 2011. After that date, we will have to provide
an accounting to you upon request for uses and disclosures
for treatment, payment, and health care operations.
A. To receive confidential communications of protected
B. Revoke your consent or authorization to use or disclose
health information except to the extent that we have taken
action in reliance on the consent or authorization.
Responsibilities under the Federal Privacy
In addition to providing you your rights, as detailed
above, the federal privacy standard requires us to take the
1. Maintain the privacy of your health information,
including implementing reasonable and appropriate physical,
administrative, and technical safeguards to protect the
2. Provide you this notice as to our legal duties and
privacy practices with respect to individually identifiable
health information that we collect and maintain about you.
3. Abide by the terms of this notice.
4. Train our personnel concerning privacy and
5. Implement a sanction policy to discipline those who
breach privacy/confidentiality or our policies with regard
6. Mitigate (lessen the harm of) any breach of
7. We may contact you to provide appointment reminders or
information about treatment and services.
8. We may disclose health information to your health
insurance, insurance issuer. We will not use or disclose
your health information without your consent or
authorization except as described in this notice or
otherwise required by law.
notice must contain a statement that individuals may
complain to the covered entity and to the Secretary of
Health and Human Services if they believe their privacy
rights have been violated, a brief description of how the
individual may file a complaint with the covered entity,
and a statement that the individual will not be retaliated
against for fining a complaint.
to Get More Information or to Report a Problem
have questions and/or would like additional information,
you may contact Mark A. Barnard, MD at (319(-272-8488 or
2710 St Francis Dr #310, Waterloo, IA 50702. Individuals
may bring complaints to Avalon Plastic Surgery Center
without fear of retaliation by the practice, if they
believe their privacy rights have been violated.
of Disclosures for Treatment, Payment and Health Care
will use your health information for treatment.
giving radiology department/surgery your diagnosis and
summary of problems when scheduling/ordering tests/surgery)
will use your health information for health care
of your medical record for quality control purposes.)
will use your health information for payment
giving your insurance company your diagnosis /operations)
provide some services through contracts with business
use or disclose information to notify or assist in
notifying a family member, a personal representative, or
another person responsible for your care, location and
with family: Unless
you object, health professionals, using their best
judgment, may disclose to a family member, another
relative, a close personal friend, or any other person that
you identify health information relevant to that person’s
involvement in your care or payment related to your care.
disclose information to researchers when their research has
been approved by an institutional review board that has
reviewed the research proposal and established protocols to
ensure the privacy of your health information.
directors: We may
disclose health information to funeral directors consistent
with applicable law to enable them to carry out their
of care: 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.
and Drug Administration (“FDA”): We may
disclose to the FDA health information relative to adverse
effects/events with respect to food, drugs, supplements,
product or product defects, or postmarking surveillance
information to enable product recalls, repairs, or
compensation: We may
disclose health information to the extent authorized by and
to the extent necessary to comply with laws relating to
workers compensation or other similar programs established
required by law, we may disclose your health information to
public health or legal authorities charged with preventing
or controlling disease, injury, or disability.
institution: If you
are an inmate of a correctional institution, we may
disclose to the institution or agents thereof health
information necessary for your health and the health and
safety of other individuals.
enforcement: We may
disclose health information for law enforcement purposes as
required by law or in response to a valid subpoena.
oversight agencies and public health
embers of our work force or business associates believe in
good faith that we have engaged in unlawful conduct or
otherwise violated professional or clinical standards and
are potentially endangering one or more patients, workers,
or the public, they may disclose your health information to
health oversight agencies and/or public health authorities,
such as the department of health.
federal Department of Health and Human Services
the privacy standards, we must disclose your health
information to DHHS as necessary to determine our
compliance with those standards.
WE RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE
THE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY
IDENTIFIABLE HEALTH INFORMATION THAT WE MAINTAIN. IF WE
CHANGE OUR INFORMATION PRACTICES, WE WILL OFFER/GIVE A
REVISED NOTICE TO YOU AT YOUR NEXT OFFICE VISIT.
Effective date: 2-2-04/revised 8-5-13