Provider Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION THAT WE CREATE AND OBTAIN ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION: PLEASE REVIEW IT CAREFULLY.

This office uses health information about you for treatment, to obtain payment for treatment, and to evaluate the quality of care that you receive. Continuity of care is part of treatment, and your records may be shared with other providers to whom you are referred. Information may be shared by face to face communication, telephone, paper mail, fax, or other methods.

We may use or disclose identifiable health information about you without your authorization for the reasons listed: to provide you with medical treatment or services,to notify a family member or another person responsible for your care,for such medical treatment or services,for obtaining payment and reimbursement for services,for confirming coverage,for billing or collection activities,for utilization reviews, to maintain our health care operations, for funeral director, coroner, or medical procedures, for public health purposes, for research studies, and for emergencies. In any other situation, we will ask for your written authorization before disclosing any identifiable information about you. Any specific written authorization you provide may be revoked, at any time, by writing to us.

NOTE: We may change our policies at any time, but before we make a significant change in our policies we will change our notice and post the new notice in our waiting room.

YOUR INDIVIDUAL RIGHTS: You have the right to look at or obtain a copy of your health information that we use to make decisions about you. If copies are requested, we will need your request in writing. You also have the right to amend only the protected health information that we created if you believe your record is incorrect or if important information is missing. You also have the right to obtain a list of instances where we or our business associates shared your medical information for purposes other than listed above.

COMPLAINTS: If you have a concern about your privacy rights, or disagree with a decision we made about access to your records, you may contact our office LAREDO DERMATOLOGY ASSOCIATES @956-726-1646 or send a written complaint to the U.S. Department of Health and Human Services.

OUR LEGAL DUTY: We are required, by law, to protect the privacy of your information, provide this notice about our information practices, follow the information practices described in this notice, and obtain your acknowledgment of receipt of this notice.

Please sign and date the aknowledgement on this page verifying that you have read this notification and keep this page for your records.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.