PRIVACY NOTICE
THIS NOTICE DESCRIBES HOW
YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
About the Notice
This notice tells you
about your privacy rights, Dermatology Clinic's duty to protect health
information that identifies you, and how the Dermatology Clinic may use or
disclose health information that identifies you without your written permission.
This notice does not apply to health information that does not identify you or
anyone else.
In this Privacy Notice,
"medical information" means the same as "health information."
Health information includes any information that relates to:
1) your past, present, or future physical or mental health or condition;
2) providing health care to you; or
3) the past, present, or future payment for your health care.
Your Privacy Rights
The law gives you the
right to:
- Look at or get a copy
of the health information that the Dermatology Clinic has about you, in most
situations. The Dermatology Clinic may require that your request for
information be in writing;
- Ask The Dermatology
Clinic to correct certain information, including certain health information,
about you if you believe the information is wrong or incomplete. You must
submit your request in writing to the Dermatology Clinic office or program
that has the information. If the Dermatology Clinic denies your request to
change the information, you can have your written disagreement placed in your
record;
- Ask for a list of the
times the Dermatology Clinic has disclosed health information about you for
reasons other than treatment, payment, health care operations, and certain
other reasons as provided by law, except when you have authorized or asked
that the Dermatology Clinic disclose the information. You must put this
request in writing and must include the name(s) of the Dermatology Clinic
program, office, or facility from which a list of disclosures is requested;
- Ask The Dermatology
Clinic to limit the use or disclosure of health information about you more
than the law requires. However, the law does not require The Dermatology
Clinic to agree to limit uses and disclosures;
- Tell the Dermatology
Clinic where and how to send you messages that include health information
about you, if you think sending the information to your usual address could
put you in danger. You must put this request in writing, and you must be
specific about where and how to contact you;
- Ask for and get a paper
copy of this notice from Dermatology Clinic; and
- Withdraw permission you
have given the Dermatology Clinic to use or disclose health information that
identifies you, unless Dermatology Clinic has already taken action based on
your permission. You must withdraw your permission in writing.
You may exercise any of
the rights described above by contacting the Dermatology Clinic office or
program that has health information about you, or by contacting the Dermatology
Clinic Privacy Officer as described at the end of this notice.
Dermatology Clinic's Duty
to Protect Health Information that Identifies You
- The Dermatology Clinic
is required by law to protect the privacy of your health information. This
means that the Dermatology Clinic will not use or disclose your health
information without your authorization except in the ways we tell you in this
notice. The Dermatology Clinic will safeguard your health information and keep
it private.
- The Dermatology Clinic
will ask you for your written authorization to use or disclose your health
information in ways other than those stated in this notice. If you give such
an authorization, you may revoke it at any time, but the Dermatology Clinic
will not be liable for uses or disclosures made before you revoked your
authorization.
- If you receive direct
health care or dental care services from the Dermatology Clinic, the
Dermatology Clinic is required to provide you with this notice of its legal
duties and privacy practices, and to ask you to sign a form saying that you
have received this notice. Otherwise, the Dermatology Clinic is required to
provide you with this notice upon your request. If the Dermatology Clinic
changes the contents of this notice, it will make the new notice available at
its facilities and on its website, www.thedermatologyclinic.com, within 30
days of the effective date of the changed notice. The new notice will apply to
all health information maintained by the Dermatology Clinic, no matter when
the Dermatology Clinic got or created the information.
- The Dermatology Clinic
employees must protect the privacy of your health information as part of their
jobs with the Dermatology Clinic. The Dermatology Clinic does not give
employees access to your health information unless they need it as part of
their jobs. The Dermatology Clinic will punish employees who do not protect
the privacy of your health information.
How the Dermatology Clinic
Uses and Discloses Health Information that Identifies You
1. Treatment
The Dermatology Clinic may
use or disclose your health information to provide, coordinate, or manage health
care or related services. This includes providing care to you, consulting with
another health care provider about you, and referring you to another health care
provider. For example, the Dermatology Clinic can use or disclose your health
information to refer you to a community program for services. The Dermatology
Clinic may also contact you to remind you of an appointment or to tell you about
treatment alternatives, additional benefits, or other health-related information
that may be of interest to you.
2. Payment
The Dermatology Clinic may
use or disclose health information about you to pay or collect payment for your
health care. For example, the Dermatology Clinic can use or disclose your health
information to bill your insurance company for health care provided to you.
3. Health care
operations
The Dermatology Clinic may
use or disclose health information about you for health care operations. Health
care operations include:
- Conducting quality
assessment and improvement activities;
- Reviewing the
competence, qualifications, and performance of health care professionals or
health plans;
- Training health-care
professionals and others;
- Conducting
accreditation, certification, licensing, or credentialing activities;
- Carrying out activities
related to the creation, renewal, or replacement of a contract for health
insurance or health benefits;
- Providing medical
review, legal services, or auditing functions; and
- Engaging in business
management or the general administrative activities of Dermatology Clinic.
For example, the
Dermatology Clinic may use or disclose your health information to make sure
providers bill only for care you receive.
4. Family member,
other relative, or close personal friend
The Dermatology Clinic may
disclose health information about you to a family member, other relative or
close personal friend when:
- The health information
is related to that person's involvement with your care or payment for your
care; and
- You have had an
opportunity to stop or limit the disclosure before it happens.
5. Government
programs providing public benefits
The Dermatology Clinic may
disclose health information about you as needed for the administration of a
government benefit program, such as Medicaid.
6. Health oversight
activities
The Dermatology Clinic may
sometimes use or disclose health information about you for health oversight
activities. Health oversight activities include:
- Audits or inspections;
- Investigations of
possible fraud;
- Investigations of
whether someone licensed by the Dermatology Clinic is providing good care; and
- Other activities
necessary for oversight of the health care system, government benefit
programs, or to enforce civil rights laws.
7. Public health
The Dermatology Clinic may
disclose health information about you to:
- A public health
authority for purposes of preventing or controlling disease, injury, or
disability, or to report vital statistics;
- An official of a
foreign government agency who is acting with the public health authority;
- A government agency
allowed to receive reports of child abuse or neglect;
- The Food and Drug
Administration (FDA) to report problems with FDA-regulated medications,
products, or activities;
- A person who may have
been exposed to a communicable disease or who is at risk of contracting or
spreading a disease or condition; or
- A person or agency
investigating work-related illness or injury or conducting workplace medical
surveillance.
8. Victims of abuse,
neglect, or domestic violence
If the Dermatology Clinic
believes you are the victim of abuse, neglect, or domestic violence, the
Dermatology Clinic may sometimes disclose health information about you to a
government agency that receives reports of abuse, neglect, or domestic violence
if:
- A law requires the
disclosure;
- You agree to the
disclosure;
- A law allows the
disclosure and the disclosure is needed to prevent serious harm to you or
someone else; or
- A law allows the
disclosure, you are unable to agree or disagree, the information is needed for
immediate action, and the information will not be used against you.
If the Dermatology Clinic
makes a report under this section, the Dermatology Clinic will tell you or your
representative about the report unless it believes that telling you would place
you at risk of harm.
9. Serious threat to
health or safety
The Dermatology Clinic may
use or disclose health information about you if it believes the use or
disclosure is needed:
- To prevent or lessen a
serious and immediate threat to the health and safety of a person or the
public;
- For law enforcement
authorities to identify or catch an individual who has admitted participating
in a violent crime that resulted in serious physical harm to the victim,
unless the information was learned while initiating or in the course of
counseling or therapy; or
- For law enforcement
authorities to catch an individual who has escaped from lawful custody.
10. For other law
enforcement purposes
TheDermatology Clinic may
disclose health information about you to a law enforcement official for the
following law enforcement purposes:
- To comply with a grand
jury subpoena, summons, investigation, or similar lawful process;
- To identify and locate
a suspect, fugitive, witness, or missing person;
- In response to a
request for information about an actual or suspected crime victim;
- To alert a law
enforcement official of a death that the Dermatology Clinic suspects is the
result of criminal conduct;
- To report evidence of a
crime on the Dermatology Clinic's property;
- To provide information
learned while providing emergency treatment to an individual regarding
criminal activity; or
- As necessary for a
correctional institution or other entity having lawful custody of an
individual to provide health care to the individual or for the health and
safety of other inmates or its employees.
11. For judicial or
administrative proceedings
The Dermatology Clinic may
disclose health information about you in response to an order or subpoena issued
by a regular or administrative court.
12. As required by law
The Dermatology Clinic may
use or disclose health information about you when a law requires the use or
disclosure.
13. Contractors
The Dermatology Clinic may
disclose health information about you to a Dermatology Clinic contractor if the
contractor:
- Needs the information
to perform services for the Dermatology Clinic; and
- Agrees to protect the
privacy of the information.
14. Secretary of
Health and Human Services
The Dermatology Clinic
must disclose health information about you to the Secretary of Health and Human
Services when the Secretary wants it to enforce privacy protections.
15. Purposes
relating to death
The Dermatology Clinic may
disclose health information about you to:
- Coroners or medical
examiners for the purpose of identifying a deceased person or determining the
cause of death;
- Funeral directors for
the purpose of preparing a deceased person for burial or cremation; or
- Organ procurement
organizations for the purpose of organ, eye, or tissue donation.
16. Research
The Dermatology Clinic may
use or disclose health information about you for research if a research board
approves the use. The board will ensure that your privacy is protected when your
health information is used in research. Your health information may also be
used:
- To allow a researcher
to prepare for research, as long as the researcher agrees to keep the
information confidential; or
- After you die, for
research that involves information about people who have died.
17. Other uses and
disclosures
The Dermatology Clinic may
use or disclose health information about you:
- To create health
information that does not identify any specific individual;
- To the U.S. or a
foreign military for military purposes, if you are or have been a member of
the group asking for the information;
- For purposes of lawful
national security activities;
- To federal officials to
protect the President and others;
- For security clearances
and medical suitability determinations required by the U.S. government;
- To a prison or jail, if
you are an inmate of that prison or jail, or to law enforcement personnel if
you are in custody;
- To comply with workers'
compensation laws or similar laws; and
- To tell or help in
telling a family member or another person involved in your care about your
location, general condition, or death.
Complaint Process
If you believe that the
Dermatology Clinic has violated your privacy rights, you have the right to file
a complaint with the:
- The Dermatology Clinic
Privacy Officer by mail at 5247 DiDesse Street, Baton Rouge, LA 70808; or by
telephone at 1-225-769-7546;
- U.S. Secretary of
Health and Human Services at 200 Independence Ave. S.W., Washington, D.C.
20201, or by telephone at (800) 368-1019;
There will be no
retaliation for filing a complaint.
For further information,
contact the Dermatology Clinic office or program from which you received
services. You may also contact the Dermatology Clinic Privacy Officer by mail at
5247 DiDesse Street, Baton Rouge, LA 70808; or by telephone at 1-225-769-7546.
Effective Date: April 14,
2003
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