Patient Notice of Privacy Practices: Bay Dermatology

Bay Dermatology and Cosmetic Surgery, P.A.: Expert Care, Natural Results

Effective Date of this Notice: April 14, 2003

NOTICE OF PRIVACY PRACTICES

As required by the Privacy Regulations Created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our practice is dedicated to maintaining the privacy of your Protected Health Information (PHI). 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 are also 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 PHI. By federal and state law we must follow the terms of the notice that we have in effect at the time.

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. Any revision or amendment to this notice will be effective for all 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 of Privacy Practices in each our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI)
1. Uses and Disclosures for Treatment, Payment and Health Care Operations:
  
  Treatment. We may use or disclose your PHI to physicians, nurses and all other health care personnel who provide you with your health care services or are involved in your care. For example we may ask you to have a laboratory test (such as blood or urine tests), and we may use the results to help us reach a diagnosis and treat you accordingly.
  
  Payment. We may use and disclose your PHI to obtain payment for your health care services. For example, we may contact your health insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will cover your treatment.
  
  Health Care Operations. We may use and disclose your PHI to operate our practice. As an example of the way 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. We may disclose your PHI to other health care providers and entities to assist in their health care operations.
2. Others Involved In Your Healthcare:
  
  Unless you object, we may disclose your PHI to a family member, other relative, friend or any other person that you identify that directly relates to that person’s involvement in your health care. We may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
3. Emergencies:
  
  We may use or disclose your PHI in an emergency treatment situation.
4. Other Permitted and Required Uses and Disclosures that may be made without your authorization or opportunity to object:
  
  We may use or disclose your PHI in the following situations without your authorization, these situations include:
  1. Required by law, legal proceedings, or law enforcement. We make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with crime; or when ordered by a judicial or administrative proceeding.
  2. Public Health. We report information about births, deaths, and various diseases, to government officials in charge of collecting that information, and we provide coroners, medical examiners, organ procurement entities, and funeral directors, necessary information relating to an individual’s death.
  3. Health Oversight Activities. We may disclose your PHI to assist the government when it conducts an investigation or inspection of a health care provider or organization.
  4. Research. We may disclose your PHI to researchers conducting research that has been approved by an Institutional Review Board or Privacy Board.
  5. Public Safety. We may disclose your PHI to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
  6. Military. We may disclose your PHI for military and or national security purposes.
  7. Worker’s Compensation. We may disclose your PHI as necessary to comply with worker’s compensation laws.
  8. Appointment Reminders. We may disclose your PHI to contact you and remind you of an appointment.
YOUR HEALTH INFORMATION RIGHTS
1. You have the right to inspect and have the office copy PHI. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
2. You have the right to request restriction on certain uses and disclosures of your PHI. We will consider your request, but are not required to accept it. These requests must be in writing.
3. You have the right to obtain a paper copy of this notice. Ask the front desk for a copy of this notice.
4. You have the right to Amend. You may ask us to amend your PHI if you believe it is incorrect or incomplete. To request an amendment your request must be made in writing. You must provide us with a reason that supports your request. Our practice will deny your request if it is not submitted in writing or does not state the reason for the request. We may also deny your request if the information is accurate and complete in our opinion.
5. You have a right to receive a list of disclosures we have made. Such as disclosures required by law, disclosures to government officials, and disclosures for worker’s compensation. This request must be made in writing and must state the time period. The time period may not be longer than six years and may not be before April 14, 2003. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
QUESTIONS

If you have any questions about any part of this notice, or if you want more information about our privacy practices, please contact the Privacy Officer, Stacey Bowen, Tampa Office Manager at 813-264-5447 or in writing to Bay Dermatology & Cosmetic Surgery, P.A. 3657 Madaca Lane, Tampa, FL 33618
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES

We reserve the right to change this notice at any time in the future. We will post a current copy of this Notice of Privacy Practices in our waiting room as well as on our web site @ www.baydermatology.com

THIS NOTICE BECOMES EFFECTIVE APRIL 14, 2003

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