This notice describes how medical information about you may be used and disclosed by Garden State Dermatology, LLC and how you can get access to this information. Please review it carefully.
As required by HIPAA, this notice explains how we are required to maintain the privacy of your health information and how we may use and disclose your health information. We may use and disclose your medical records only for the following purposes: treatment, payment, and health care operations.
- Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would be contacting a previous health care professional to discuss your case.
- Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review.
- Health care operations include the business aspects of running our practice such as conducting quality assessment and improvement activities, auditing functions, cost‐ management analysis, and customer service.
We may also create and distribute “de‐identified” health information by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about treatment alternatives or other health‐related benefits and services that may be of interest to you. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our office:
- The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to your immediate family members, other relatives, close personal friends or other individuals you identify. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
- The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an accounting of disclosures of protected health information.
- The right to obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
Please note that there is no violation of privacy when you are called by name for your examination or if you should overhear part of a telephone conversation while checking out. These types of incidental disclosures are acknowledged by HIPAA as being an inevitable consequence of the practical limitations of space. The office makes every attempt to protect your personal health information as the act requires by being careful that it is not available to those who should not have access to it.
This notice is effective as of September 15, 2014, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. You may request a written copy of Notice of Privacy Practices from this office.
Please feel free to speak with a staff member if you have any questions about this notice.
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.