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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.
Dermatology Consultants, P.S.C. is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Dermatology Consultant, P.S.C. please contact:
Privacy Officer
859-278-9492
Effective Date of This Notice: April 14, 2003
I. How Dermatology Consultants, P.S.C. may Use or Disclose Your Health Information
Dermatology Consultants, P.S.C. collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of Dermatology Consultants, P.S.C., but the information in the medical record belongs to you. Dermatology Consultants, P.S.C. protects the privacy of your health information. The law permits Dermatology Consultants, P.S.C. to use or disclose your health information for the following purposes:
1. Treatment. We will use and disclose your protected health information to provide treatment to you and to coordinate your health care. This includes coordination of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we will use and disclose your protected health information to a pharmacy when we have ordered a prescription for you. We will also disclose your protected health information to a physician we have referred you to or to a physician that referred you to our practice to ensure that the physician has the appropriate information to diagnose and to treat you.
2. Payment. We will use and disclose your protected health information to bill and to collect payment for your health care services. This may include contacting your health care plan to verify your eligibility or coverage for your insurance benefits, reviewing services provided to you for medical necessity, and utilization review procedures. We may also use and disclose your protected health information to obtain payment from third parties that may be responsible for these costs, including family members. We may also use your protected health information to bill you directly for services and items.
3. Health Care Operations. We may use or disclose your protected health information in order to perform the business activities of this practice. This includes, but is not limited to, evaluating the quality of care you received from us, training medical, nursing, and medical assistant students, conducting business planning activities. For example, we may use or disclose your protected health information to contact you to remind you of your appointment or to notify you of laboratory results. We may use or disclose your protected health information to another entity in order for them to conduct specific health care operations, including reviewing the competence of health care professionals and quality assessment. We may call you by name when our staff is ready to see you when you are in the reception room. We may use or disclose your protected health information to inform you of health-related benefits or services that may be of interest to you. We will share your protected health information with third parties “business associates” that perform services for us (e.g., transcription, billing). When an arrangement is made with a business associate, we will have a written contract that protects the privacy of your protected health information.
4. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
5. Required by law. As required by law, we may use and disclose your health information.
6. Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
7. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
8. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.
9. Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
10. Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors.
11. Organ donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
12. Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or Dermatology Consultants’ privacy board.
13. Public safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
14. Worker’s compensation. We may disclose your health information as necessary to comply with worker’s compensation laws.
II. When Dermatology Consultants, P.S.C. May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Dermatology Consultants, P.S.C. will not use or disclose your health information without your written authorization. If you do authorize Dermatology Consultants, P.S.C. to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information. You may ask us not to use or disclose any part of you protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must specifically state the restriction requested and to whom it applies. Dermatology Consultants, P.S.C. is not required to agree to the restriction that you requested. If Dermatology Consultants does agree to the requested restriction, we may not use or disclose your protected health information except when otherwise required by law, or when it is needed to provide emergency treatment. Requests for restrictions must be in writing to the Privacy Officer.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. We will accommodate your reasonable requests. We may require you to provide us with specific information as to how payment will be handled or for an alternative address or other method of contact. You do not need to give us a reason for your request. Your request should be in writing to the Privacy Officer.
3. You have the right to inspect and obtain a copy of your health information. Your health information consists of your medical records and billing records and any other records that your physician and the practice use for making decisions about you. Under federal law, however, this does not include any psychotherapy notes. All requests must be submitted in writing to the Privacy Officer.
4. You have a right to request that Dermatology Consultants, P.S.C. amend your health information that is incorrect or incomplete. Dermatology Consultants, P.S.C. is not required to change your health information and will provide you with information about Dermatology Consultants’ denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by Dermatology Consultants, except that Dermatology Consultants, does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), and 4 (information provided to you), of section I of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices. To receive a paper copy of this Notice of Privacy Practices contact:
Privacy Officer
1401 Harrodsburg Road, C-415
Lexington, KY 40504
859-278-9492
IV. Changes to this Notice of Privacy Practices
Dermatology Consultants, P.S.C. reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Dermatology Consultants, P.S.C. is required by law to comply with this Notice.
If Dermatology Consultants does amend this Notice of Privacy Practices, this revised noticed will be posted in our office. You have the right to request a copy of this revised notice on or after the date it becomes effective.
V. Complaints
Complaints about this Notice of Privacy Practices or how Dermatology Consultants, P.S.C. handles your health information should be directed to:
Privacy Officer
1401 Harrodsburg Road, C-415
Lexington, KY 40504
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at www.hhs.gov/ocr/regmail.html.
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