PATIENT PRIVACY NOTICE

THE FOLLOWING NOTICE DESCRIBES Fort Worth Dermatology Associates, PA HIPAA PRIVACY PRACTICES, HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.

• Your confidential healthcare information may be released to other healthcare professionals within the organization for the purpose of providing you with quality healthcare.
• Your confidential healthcare information may be released to your insurance provider for the purpose of the organization receiving payment for providing you with needed healthcare services.
• Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
• Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
• Your confidential healthcare information may be released to a pubic health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.
• Disclosure of the following PHI requires your written authorization: use of psychotherapy notes, disclosure of PHI for marketing, and disclosures that constitute a sale of PHI. You may revoke your permission to release confidential healthcare information at any time.
• You may be contacted by the organization to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
• You have the right to restrict the use of your confidential healthcare information. However, the organization may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.
• You have the right to receive confidential communication about your health status.
• You have the right to review and photocopy any/all portions of your healthcare information.
• You have the right to make changes to your healthcare information.
• You have the right to know who has accessed your confidential healthcare information and for what purpose.
• You have the right to restrict disclosure to your health plan of any PH| created from a service that you have paid for out of pocket.
• You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
• The organization is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.
• The organization will notify patients) when a reportable breach is discovered. Notification will be discovered. Notification will include a brief description of the how breach occurred, a description of the PHI involved, and steps patients) should take to protect themselves from harm. The notification will also include contact information for the individual to ask questions.
• Fort Worth Dermatology Associates, PA shall abide by the terms of this notice. The organization reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Patients will receive a mailed copy of any changes to this notice within 60 days of making the changes.
• Health plans are prohibited from using or disclosing genetic information of an individual for underwriting purposes.
• You have the right to complain to the organization if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the organization:
  ATTN: Stephen D Maberry, MD
  Fort Worth Dermatology Associates, PA
  1200 West Rosedale Street
  Fort Worth, TX 76104
  • All complaints will be investigated. No personal issue will be raised for filing a complaint with the organization.
• For further information about this Privacy Notice, please contact:
  • Stephen D Maberry, MD
  • HIPAA Privacy/Security Officer
  • 817-336-8131
• This notice is effective as of 09-23-2013. This date must not be earlier than the date on which the notice is printed or published.