Notice of Privacy Practices

This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully. Dr. Dorene Dermatology (the Practice) is committed to protecting the privacy of medical information we create or obtain about you. This Notice tells you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information. We are required by law to: (i) make sure your medical information is protected; (ii) give you this Notice describing our legal duties and privacy practices with respect to your medical information; and (iii) follow the terms of the Notice that is currently in effect. The privacy practices described in this Notice will be followed by all health care professionals, employees, medical staff, trainees, students and volunteers of the Practice.

How We May Use and Disclose Health Information

We will use and disclose your protected health information (PHI) about you for treatment, health care operations, and where otherwise required by law. The following paragraphs describe different ways we may use and disclose your medical information, including examples, although they are not exhaustive. We abide by all applicable laws related to the protection of this information.

Treatment: We may use or disclose medical information about you to provide you with medical treatment or services. For example, your medical history as provided by you may be relevant to your doctor's treatment plan and a nurse, technician, or other member of your care team may obtain treatment information about you and document that information in your medical record, access to which is available to your doctor. In addition, your medical information may be provided to a physician to whom you have been referred or are otherwise seeing to ensure that the physician has the necessary information to diagnose or treat you.

For our health care operations: Your PHI may be used and disclosed by us to support the business activities of Dr. Dorene Dermatology, also called health care operations. For example, the Practice may use a sign-in sheet at the registration desk, and we may also call you by name in the waiting room when your doctor is ready to see you. These health care operation activities also include, but are not limited to, training of new employees or medical staff, quality assessment activities, employee review activities, and conducting or arranging for other business activities. We may also use the medical information we have to determine where we can make improvements in the services and care we offer.

To provide you with treatment alternatives: We may use or disclose your PHI to provide you with information about treatment alternatives or other health-related benefits and services that may improve your overall health or otherwise be of interest to you.

For appointment reminders: We may use or disclose your PHI to contact you to remind you of your appointment, by mail or by telephone. Our message will include the name of our practice or the name of our physician as well as the date and time for your appointment or a reminder that an appointment needs to be scheduled.

To others involved in your health care: With your permission, we may disclose to a member of your family, a relative, a close friend or any other person you identify, any medical information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. For example, we may discuss post procedure instructions with the person who drove you to the facility unless you tell us specifically not to share the information.

We may use or disclose your medical information to notify a family member or any other person that is responsible for your care of your location and general health condition. Finally, we may use or disclose your medical information to an authorized public or private entity to assist in (1) disaster relief efforts and (2) to coordinate uses and disclosures to family or other individuals involved in your health care.

As required by law: The use or disclosure of your PHI will be made in compliance with the law and will be limited to the relevant requirements of the law.

For public health activities: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your medical information, if directed by the public health authority, to any other government agency that is collaborating with the public health authority.

As required by the Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.

For communicable disease exposure: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

For health oversight: We may disclose your PHI to a health oversight agency for activities authorized by law. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs (such as Medicare or Medicaid), other government regulatory programs and civil rights laws.

For legal proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena or other lawful request.

For law enforcement: We may disclose your PHI, so long as all legal requirements are met, for law enforcement purposes. Examples of these law enforcement purposes include (1) information requests for identification and location purposes, (2) information pertaining to victims of a crime, (3) suspicion that death has occurred as a result of criminal conduct, (4) if a crime occurs on the premises of Dr. Dorene Dermatology, and (5) in a medical emergency where it is likely that a crime has occurred.

Due to criminal activity: Consistent with applicable federal and state laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

For correctional institutions: We may use or disclose your medical information if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.

For military activity and national security: When the appropriate conditions apply, we may use or disclose medical information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits; or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

For workers’ compensation: Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

For required uses and disclosures: Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act and its regulations.

All other uses and disclosures of PHI not recorded in this Notice will require a written authorization from you or your personal representative. You may revoke such authorization at any time, in writing, but it will not apply to any actions we have already taken.

Your Rights

You have certain rights related to your protected health information (PHI). The following paragraphs state your rights and provide a brief description of how you may exercise these rights.

You can request how we can communicate with you. Reasonable requests will be accommodated, but we may condition this accommodation on the provision of additional information such as an alternative address or other methods of contact. Please make this request in writing.

You have the right to request a restriction of your protected health information. You may ask the practice not to use or disclose any part of your PHI for the purposes of treatment, payment, or health care operations. You may also request that any part of your medical information not be disclosed to specific individuals. Your request must state the specific restriction requested and to whom you want the restriction to apply. If we agree to the requested restriction, we will honor the restriction request unless the information is needed to provide emergency treatment or unless we notify you that we are no longer able to honor your request. We are obligated to comply with your request to restrict disclosure of information to a health plan if you pay out of pocket in full for a service or product, unless a law prohibits this. With this in mind, please discuss any restriction you wish to request with your physician. All restriction requests must be submitted in writing and approved in advance.

You have the right to inspect and obtain a copy of your protected health information. You may see and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the information. This may include your medical and billing records and any other records that we use for making decisions about you. Upon request, we will provide you a copy of records that were created and stored electronically in an electronic format. Under federal law, there are some exceptions to records which may be copied and the request may be denied. We may charge you a reasonable cost-based fee for a copy of your records. Please contact us if you have questions about access to your medical records.

You may have the right to ask us to amend your medical information. You may request an amendment of your medical information if you feel that the information is not correct for as long as we maintain the information. Please contact our Practice in writing with an explanation of the reason for the request. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a disagreement with us, and we will respond to you in writing.

You have the right to obtain a paper copy of this notice from us. You have the right to obtain a paper copy of this notice from us, upon request. We will provide you a copy of this Notice the first day we treat you at our practice. In an emergency situation we will give you this Notice as soon as possible. If you would like a paper copy of this Notice or subsequent revisions, please request one in writing or when you are in our office.

If you believe your privacy rights have been violated, you may file a complaint. You may complain to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated. Complaints must be submitted in writing. You will not be penalized for filing a complaint, and we will not retaliate against you for filing a complaint.

You may authorize for other uses and disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.