THIS NOTICE DESCRIBES HOW DERMATOLOGY, P.L.C. MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
When it comes to your health information you have certain rights.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy of a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home or office phone) or send mail to a different address. We will say “yes” to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all of the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one with 12 months.
You can ask for a copy of this notice at any time,
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
Your can complain if you feel we have violated your rights by contacting our Privacy Officer.
You can file a complaint with the U.S. Dept. of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
For certain health information you can tell us your choices about what we share, by completing the PHIR form. You have right right and choice to tell us to:
Share information with your family, close friends, or others involved in your care.
Share information in a disaster relief situation
Include your information in a hospital directory.
If you are not able to tell us your preference for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to address a serious and imminent threat to your health or safety.
In these cases we never share your information unless you give us written permission:
Sale of your information
Most sharing of psychotherapy notes
In the case of fundraising: we may contact you for fundraising efforts, but you can tell us not to contact you again.
OTHER USES AND DISCLOSURES
We typically use or share your health information in the following ways.
Treat you- We can use your health information and share it with professionals who are treating you.
Run our Organization- We can use and share your health information to run our practice, improve your care and contact you when necessary.
Bill for your services; We can use and share your health information to bill and get payment from health plans or other entities.
We are allowed or required to share your information in other ways-usually in ways that contribute to the public good such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
HELP WITH PUBLIC HEALTH AND SAFETY ISSUES
We can share health information about you for certain situations such as:
Helping with Product recalls
Reporting adverse reactions to medications
Preventing or reducing a serious threat to anyone’s health or safety
Reporting suspected abuse, neglect, or domestic violence
We can use or share your information for health research
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
We can share health information about you with organ procurement organizations. Also with a coroner, medical examiner or funeral director when an individual dies
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services,
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena
We are required by law to maintain the privacy and security of your protected health information
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
We must follow the duties and privacy practices described in this notice and give you a copy of it at your request.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
CHANGES TO THE TERMS OF THIS NOTICE
We can change the terms of this notice, and the changes will apply to all information that we have about you will be available upon request, in our office and on our web site.
TO FILE A COMPLAINT WITH DERMATOLOGY, P.L.C., please contact the Privacy Officer at the following:
320 Winding River Lane, Suite 301
Charlottesville, VA 22911-3569