AMERICAN DERMATOLOGY ASSOCIATES, LLC
NOTICE OF PRIVACY PRACTICES
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
This office is permitted by federal privacy laws to make uses and disclosures of your Protected Health Information for purposes of treatment, payment and health care operations (TPO). Protected Health Information (PHI) is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination, and test results, diagnoses, treatment, and applying for future care of treatment. It also includes billing documents for those services. An example of how American Dermatology Assoc., LLC (ADA) may use your protected health Information for treatment is providing it to a specialist. We might have to send information regarding your medical care to your insurance company to receive payment. ADA obtains services and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.
Other Uses and Disclosures for which ADA is permitted or required to use or disclose confidential without your written authorization are listed below.
Public Health – As authorized by law, we may disclose your Protected Health Information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse & Neglect – We may disclose your Protected Health Information to public authorities as allowed by law to report abuse or neglect.
Health Oversight- Federal law allows us to release your Protected Health Information to appropriate health oversight agencies or for health oversight activities. This includes disclosure to the Food and Drug Administration relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements. We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected Health Information.
Judicial/Administrative Proceedings- We may disclose your Protected Health Information in the course of any judicial or administrative proceeding as allowed or required by law, with your authorization, or as directed by a proper court order.
Law Enforcement- We may disclose your Protected Health Information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecution, or to the extent an individual is in the custody of law enforcement. If you are an inmate of a correctional institution, we may disclose to the institution or its agents the Protected health Information necessary for your health and the health and safety of other individuals.
Decedents- We may release Protected Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release Protected Health Information about patients to funeral directors as necessary for them to carry out their duties.
Organ Procurement Organizations- Consistent with applicable law, we may disclose your Protected Health Information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of transplantation of organs for the purpose of tissue donation and transplant.
Serious Threat- To avert a serious threat to health or safety, we may disclose your Protected Health Information consistent with applicable law to prevent or lessen a serious, imminent threat to the health of safety of a person or the public. We may also use and disclose your Protected Health Information to assist in disaster relief efforts.
Specialized Government Functions- We may disclose your Protected Health Information for specialized government functions as authorized by law such as to armed Forces personnel, for national security purposes, or to public assistance program personnel.
Workers Compensation- If you are seeking compensation through Workers Compensation, we may disclose you Protected Health Information to the extent necessary to comply with laws relating to Workers Compensation.
Employers- Expect in cases involving workers’ compensation, disclosures to your employer will be made only if you execute a specific authorization for the release 0of that information to your employer.
Separate Uses
Notification- Unless you object, we may use or disclose your Protected Health Information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your =death. Our patient information sheet asks you to list those family members or friends that you are comfortable with us communication with regarding your health care. However, using our best judgment, we may disclose to family members, or close personal friends, Protected Health Information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency. An example of this would be allowing a family member to pick up medical information from our office to go to a specialist you need to see when we know that the family member is aware of your medical situation and assisting you to obtain health care. Please notify us immediately if there is someone that you absolutely do not want us to communicate with regarding your Protected Health Information.
Other Uses- Other uses and disclosures, besides those identified in this Notice, will be made only as otherwise by law or with your written authorization and you may revoke the authorization as provided in this Notice under “Individual Rights”.
Appointment Reminders- ADA 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. We will leave messages regarding these services on answering machines or sending them through the mail unless specifically asked not to in writing by you.
Individual Rights
The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have a right to:
*Request a restriction on certain uses and disclosures of your health information by delivering the request to our office. We are not required to grant the request, but we will comply with any request granted
*Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.
*Request that you be allowed to inspect and copy our health record and billing record – you may exercise this right by delivering the request to our office.
*Appeal a denial of access to your Protected Health Information, expect in certain circumstances.
*Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office. We may deny your request if you ask us to amend information that: a) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; b) is not part of the Protected Health Information kept by or for the office; c) if not part of the information that you will have an opportunity to submit a statement of disagreement to be maintained with your records.
*Receive confidential communications.
*Request that communication of your Protected Health Information be made by alternative means or at an alternative location by delivering the request in wring to our office.
*Obtain an accounting of disclosures of your Protected Health Information as required to be maintained by law by delivering a request to our office. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures to family member or friends relevant to that person’s involvement in your care or in payment of such care; or, uses or discloses to notify family or other responsible for your care of your location, condition, or your death
*Revoke authorizations that you make previously to use or disclose information by delivering a written revocation to our office, except to the extent information has been disclosed or action has already been taken.
If you want to exercise any of the above rights, please contact the Privacy Office, Administrator at (913) 631-6330 at 6333 Long Street Shawnee Mission KS 66216, in person or in writing, during regular, business hours. That person will inform you of the steps that need to be taken to exercise your rights.
American Dermatology Associates, LLC
The office is required to:
*Maintain the privacy of your Protected Health Information as required by law.
*Provided you with a notice as to our duties and privacy practices as to the information we collect and maintain about you.
*Abide by the terms of this Notice.
*Notify you if we cannot accommodate a requested restriction or request.
*Accommodate your reasonable request regarding methods to communicate Protected Health Information with you.
We reserve the right to amend, chance, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the Protected Health Information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy or our “Notice” or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have question, would like additional information, or want to report a problem regarding the handling of your information, you may contact our Administration at (913) 631-6330. Additionally, if you believe your privacy rights have been violated, you my file a written complaint at our office by delivering the written complaint to ADA Administrator, 6333 Long St., Shawnee Mission, KS 66216. You may also file a complaint by S.W., Washington, D. D. 20201 or www.hhs.gov.
*We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.
*We cannot and will not retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Effective Date- This Notice is first in effect on April 14, 2003