Notice of Privacy Practices

As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

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.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually identifiable health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your protected health information (PHI) and to notify affected individuals following a breach of unsecured PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your PHI
• Your privacy rights regarding your PHI
• Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. WE MAY USE AND DISCLOSE YOUR PHI IN THE FOLLOWING WAYS:

1. Treatment. Our practice may use your PHI to treat you (e.g., a doctor treating you for a condition asks another doctor about your overall health condition).
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us (e.g., giving information about you to your health insurance plan so it will pay for your services).
3. Health Care Operations. Our practice, and its affiliated entities and management company, may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment. We will notify you about your appointment utilizing an automated phone system, a personal call, text or by mail. This notification may involve leaving a message on an answering machine or other automated or electronic equipment for such purposes, which could (potentially) be received or intercepted by others.
5. Sign In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
6. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
7. Health-Related Benefits and Services. Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
8. Release of Information to Family/Friends. Our practice will routinely disclose to your responsible party(ies) the PHI directly relevant to his/her involvement with your health care, PHI related to payment of your health care, and PHI used for notification purposes. Our practice may release your PHI to another responsible party(ies) you identify, that is involved in your care.
9. We will not use or disclose your medical information for marketing purposes without your prior written authorization.
10. Sale of PHI. We will not sell your PHI without your prior written authorization.

Please note that our practice does not provide mental health services and therefore does not maintain psychotherapy notes.

C. USE AND DISCLOSURE OF PHI IN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or

disclose your PHI:

1. Public Health Risk Reporting. Our practice may disclose your PHI to public health authorities that are authorized by law. For example, we are required to report certain communicable diseases to the state’s public health department.
2. Law Enforcement. Your PHI may be disclosed to law enforcement agencies, military, and national security without your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.
3. Workers’ Compensation. Our practice may release your PHI for workers’ compensation and similar programs that provide benefits for work-related injuries or illnesses.
4. Disclosures Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
5. Responding to Lawsuits. We can share PHI about you in response to a court or administrative order, or in response to a subpoena.

 D. YOUR RIGHTS REGARDING YOUR PHI

You have the certain rights regarding the PHI that we maintain about you, and you may ask us how to exercise any such rights. These rights include:

• The right to choose someone to act for you (i.e., if you have given someone medical power of attorney or if someone is your legal guardian) with respect to the exercising of your rights.
• The right to request restrictions on the use and disclosure of your PHI, including to request that a health plan not be informed of treatment for which you paid entirely out of pocket, which we will say “yes” to unless a law requires us to share that information. For other requested restrictions, note that we are not required to agree to your request, and we may say no if it could affect your care.
• The right to prohibit the sale of your PHI, its use for marketing purposes, or participation in research.
• The right to request to receive confidential communications concerning your medical condition and treatment in a specific manner.
• The right to inspect and obtain copies of your medical record and other health information we have about you.
• The right to request an amendment or corrections to your medical record. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• The right to receive an accounting of how and to whom your PHI has been disclosed outside of our practice if not for treatment, payment, health care operations, or certain other disclosures (such as any you asked us to make).
• The right to file a complaint if you believe your privacy rights have been violated. You may do so by contacting the Privacy Officer at [email protected]. You may also file a complaint to the secretary of the U.S. Department of Health and Human Services by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling 1-877-696-6775. There will not be retaliation against you for filing a complaint.
• The right to receive a printed copy of this notice.

All requests must be in writing and directed to U.S. Dermatology Partners, ATTN: Privacy Officer, 5310 Harvest Hill Rd, Ste. 290, Dallas, TX 75230. Our practice may charge a fee for the costs associated with any request.

E. RIGHT TO PROVIDE AN AUTHORIZATION 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. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

If you have any questions regarding this notice or our privacy policies, please contact our Privacy Officer at:

U.S. Dermatology Partners

5310 Harvest Hill Rd, Suite 290

Dallas, TX 75230

[email protected]

Effective Date of Notice: October 10, 2024