Notice of Privacy Practices

Spring Dermatology

Please correct the errors described below.

Effective Date: This Notice is effective on or after June 7, 2008

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

Uses and Disclosures

Treatment

Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory test and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment

Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treatment.

Health care operations

Your health information may be used as necessary to support the day to day activities and management of Spring Dermatology For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law enforcement

Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Public health reporting

Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Other uses and disclosures require your authorization

Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

Additional Uses of Information

Appointment Reminders

Your health information will be used by our staff to send you appointment reminders.

Information about treatment.

Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you information describing other health-related goods and service that we believe may interest you.

Individual Rights

You have certain rights under the federal privacy standards. These include:

  • The right to request restrictions on the use and disclosure of your protected health information
  • The right to receive confidential communications concerning your medical condition and treatment.
  • The right to inspect and request a copy of your protected health information.

As permitted by federal regulation, we require that requests to inspect or request a copy of protected health information is submitted in writing. You may obtain a form to request access to your records by contacting the Receptionist or Medical Records. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

  • The right to amend or submit corrections to your protected health information.
  • The right to receive an accounting of how and to whom your protected health information has been disclosed.
  • The right to receive a printed copy of this notice.

HIPAA permits us to charge a reasonable cost based fee. The Texas State Board of Medical Examiners (TSBME) has set limits on fees for copies of medical records that under some circumstances may be lower than the charges permitted by HIPAA. In any event, the lower of the fee permitted by HIPAA or the fee permitted by TSBME will be charged.

Spring Dermatology Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.

Complaints/ Contact Person

If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Spring Dermatology 20311 Kuykendahl Road Spring, Texas 77379

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concerns to the same address.

You will not be penalized or otherwise retaliated against for filing a complaint. To file complaints involving covered entities located in Texas send to the address below:

U. S. Department of Health & Human Services HIPAA Complaint 7500 Security Blvd., C5-24-04 Baltimore, MD 21244

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