I. Reasons the Company Collects, Uses and Discloses Personal Health Information
Individually identifiable information about your past, present or future health or condition, the provision of health care to you, or payment for such health care is considered “Protected Health Information” (“PHI”). We use and disclose PHI about you for treatment, payment, and health care operations.
For example, we may use your PHI in order to diagnose your present condition or we may provide information regarding your medical condition to another medical doctor or dentist to whom we refer you for additional care. We may disclose your PHI to nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
We may use and disclose your PHI so that we may be paid for the medical treatments we provide you. For example, we or others may bill and receive payment from you, and insurance company or other third party for treatment and services provided to you. We may submit PHI about you to your insurance company in order to receive payment for services we have provided to you.
We may use and disclose your PHI to evaluate and improve our medical care (such as quality improvement) and to operate and manage our office. For example, we may use and disclose PHI to a peer review organization or a health plan that is evaluating our care. When appropriate, we may share your health information with a person involved in, or paying for, your care (such as a family member or significant other). We may notify your family about your location or condition or disclose such information to an entity assisting in disaster relief. We may be asked by the sponsor of your health plan to provide your PHI to the sponsor. If we are asked to do so, we intend to honor such requests unless we are prohibited by law from doing so.
If you are a member of the Armed Forces, we may release your PHI as required by military command authorities. If you are a member of a foreign military we may release your PHI to the foreign military command authority.
We may share information with others that have a relationship with you for their health care operation activities such as appointment reminders, treatment alternatives, and health-related benefits and services. Subject to certain requirements, we may give out PHI without your authorization for public health purposes, auditing purposes, research studies, and emergencies. We provide PHI when otherwise required by law, such as for law enforcement in specific circumstances, or for judicial or administrative proceedings. If you are involved in a lawsuit or dispute, we may disclose your PHI a response to a court or administrative order. We may disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. We may release your health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness. In any other situation, we will ask for your written authorization before using or disclosing your PHI. If you choose to sign an authorization to allow disclosure of your PHI, you can later revoke that authorization to stop any future uses and disclosures (other than for treatment, payment and health care operations).
We may disclose your PHI to our business associates that perform functions on our behalf or provide us with services if necessary. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose the information for any other purpose than appears in their contract with us.
We may disclose your PHI to authorized federal officials for intelligence and other national security activities authorized by law.
II. Your Rights Regarding Protected Health Information About You
You have the right to inspect and copy your medical and billing records by written request to the Company at the address below. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.
You have the right to request that the Company amend your PHI if such PHI is incorrect
You have the right to request that we restrict or limit our use of your PHI used for treatment, payment or health care operations. You may request us to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request to the Company. We are not required to agree with your request, but we try to accommodate your request. You must make this request in writing to Company and you must list what PHI you would like to restrict or limit and in to whom you would like such restrictions or limitations to apply.
You have the right to request an accounting of certain PHI disclosures made by the Company. You must make this request in writing to Company.
You have the right to request that we communicate with you by alternative means or at alternative locations. You must make this request in writing to Company.
III. Contact Information
Simply Dermatology PLLC
900 Walt Whitman Road, Suite 101, Melville, NY 11747
Email Address: email@example.com
Telephone: (631) 377-7222