Information about hipaa amendment of health information dermatology practices





 

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Skin & Laser Surgery Specialists - Manhattan, New York, Hackensack, New Jersey & Boca Raton, Florida
David J. Goldberg, M.D.
Privacy Statement

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 (AS A PATIENT
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your
Individually Identifiable Health Information (IIHI). 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 IIHI. 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 IIHI
Your privacy rights in your IIHI

Our obligations concerning the use and disclosure of your
IIHI
The terms of this notice apply to all records containing your IIHI
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. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Practice Administrator at 20 Prospect Avenue, Suite 702,
Hackensack, NJ 07601 (201) 441-9890; or at 33 E. 70th St, NY, NY
(212) 628-8980

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
  INFORMATION (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we
may use and disclose your IIHI.

1. Treatment. Our practice may use your IIHI to treat you. For
  example, we may ask you to have laboratory tests (such as blood
  or urine tests), and we may use the results to help us reach a
  diagnosis. We might use your IIHI in order to write a
  prescription for you, or we might disclose your IIHI to a
  pharmacy when we order a prescription for you. Many of the
  people who work for our practice — including, but not limited
  to, our doctors and nurses — may use or disclose your IIHI in
  order to treat you or to assist others in your treatment.
  Additionally, we may disclose your IIHI to others who may assist
  in your care, such as your spouse, children or parents.
Finally, we may also disclose your IIHI to other health care
providers for purposes related to your treatment.

2. Payment. Our practice may use and disclose your IIHI in order
  to bill and collect payment for the services and items you may
  receive from us. For example, we may contact your health insurer
  to certify that you are eligible for benefits (and for what
  range of benefits), and we may provide your insurer with details
  regarding your treatment to determine if your insurer will
  cover, or pay for, your treatment. We also may use and disclose
  your IIHI to obtain payment from third parties that may be
  responsible for such costs, such as family members. Also, we may
  use your IIHI to bill you directly for services and items. We
  may disclose your IIHI to other health care providers and
  entities to assist in their billing and collection efforts.
3. Health Care Operations. Our practice may use and disclose your
  IIHI 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 IIHI 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 IIHI
  to other health care providers and entities to assist in their
  health care operations.

4. Treatment Options. Our practice may use and disclose your IIHI
  to inform you of potential treatment options or alternatives.
5. Disclosures Required By Law. Our practice will use and disclose
  your IIHI when we are required to do so by federal, state or
  local law.

D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may
use or disclose your identifiable health information:

1. Public Health Risks. Our practice may disclose your IIHI to
  public health authorities that are authorized by law to
  collect information for the purpose of:
Maintaining vital records, such as births and deaths

Reporting child abuse or neglect
Preventing or controlling disease, injury or disability

Notifying a person regarding potential exposure to a
communicable disease
Notifying a person regarding a potential risk for
spreading or contracting a disease or condition

Reporting reactions to drugs or problems with products or
devices
Notifying individuals if a product or device they may be
using has been recalled

Notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or neglect of
an adult patient (including domestic violence); however,
we will only disclose this information if the patient
agrees or we are required or authorized by law to disclose
this information
Notifying your employer under limited circumstances
related primarily to workplace injury or illness or
medical surveillance.

2. Health Oversight Activities. Our practice may disclose your
  IIHI to a health oversight agency for activities authorized by
  law. Oversight activities can include, for example,
  investigations, inspections, audits, surveys, licensure and
  disciplinary actions; civil, administrative, and criminal
  procedures or actions; or other activities necessary for the
  government to monitor government programs, compliance with
  civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our practice may use and
  disclose your IIHI in response to a court or administrative
  order, if you are involved in a lawsuit or similar proceeding.
  We also may disclose your IIHI in response to a discovery
  request, subpoena, or other lawful process by another party
  involved in the dispute, but only if we have made an effort to
  inform you of the request or to obtain an order protecting the
  information the party has requested.

4. Law Enforcement. We may release IIHI if asked to do so by a
  law enforcement official:
Regarding a crime victim in certain situations, if we are
unable to obtain the person’s agreement

Concerning a death we believe has resulted from criminal
 conduct
Regarding criminal conduct at our offices

In response to a warrant, summons, court order, subpoena
or similar legal process
To identify/locate a suspect, material witness, fugitive
or missing person

In an emergency, to report a crime (including the
location or victim(s) of the crime, or the description,
identity or location of the perpetrator)
5. Serious Threats to Health or Safety. Our practice may use and
  disclose your IIHI when necessary to reduce or prevent a
  serious threat to your health and safety or the health and
  safety of another individual or the public. Under these
  circumstances, we will only make disclosures to a person or
  organization able to help prevent the threat.

6. Military. Our practice may disclose your IIHI if you are a
  member of U.S. or foreign military forces (including veterans)
  and if required by the appropriate authorities.
7. National Security. Our practice may disclose your IIHI to
  federal officials for intelligence and national security
  activities authorized by law. We also may disclose your IIHI
  to federal officials in order to protect the President, other
  officials or foreign heads of state, or to conduct
  investigations.

8. Inmates. Our practice may disclose your IIHI to correctional
  institutions or law enforcement officials if you are an inmate
  or under the custody of a law enforcement official. Disclosure
  for these purposes would be necessary: (a) for the institution
  to provide health care services to you, (b) for the safety and
  security of the institution, and/or (c) to protect your health
  and safety or the health and safety of other individuals.
9. Workers’ Compensation. Our practice may release your IIHI for
  workers’ compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain
about you:

1. Confidential Communications. You have the right to request
  that our practice communicate with you about your health and
  related issues in a particular manner or at a certain
  location. For instance, you may ask that we contact you at
  home, rather than work. In order to request a type of
  confidential communication, you must make a written request to
  the HIPAA Compliance Officer specifying the requested method
  of contact, or the location where you wish to be contacted.
  Our practice will accommodate reasonable requests. You do not
  need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a
  restriction in our use or disclosure of your IIHI for
  treatment, payment or health care operations. Additionally,
  you have the right to request that we restrict our disclosure
  of your IIHI to only certain individuals involved in your care
  or the payment for your care, such as family members and
  friends. We are not required to agree to your request;
  however, if we do agree, we are bound by our agreement except
  when otherwise required by law, in emergencies, or when the
  information is necessary to treat you. In order to request a
  restriction in our use or disclosure of your IIHI, you must
  make your request in writing to the HIPAA Compliance Officer.
  Your request must describe in a clear and concise fashion:

The information you wish restricted;
Whether you are requesting to limit our practice’s use,
disclosure or both;

to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and
  obtain a copy of the IIHI 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 to the HIPAA Compliance Officer
  in order to inspect and/or obtain a copy of your IIHI. Our
  practice may charge a fee for the costs of copying, mailing,
  labor and supplies associated with your request. Our practice
  may deny your request to inspect and/or copy in certain
  limited circumstances; however, you may request a review of
  our denial. Another licensed health care professional chosen
  by us will conduct reviews.

4. Amendment. You may ask us to amend your health information if
  you believe it is incorrect or incomplete, and you may request
  an amendment for as long as the information is kept by or for
  our practice. To request an amendment, your request must be
  made in writing and submitted to the HIPAA Compliance Officer.
  You must provide us with a reason that supports your request
  for amendment. Our practice will deny your request if you fail
  to submit your request (and the reason supporting your
  request) in writing. Also, we may deny your request if you ask
  us to amend information that is in our opinion: (a) accurate
  and complete; (b) not part of the IIHI kept by or for the
  practice; (c) not part of the IIHI which you would be
  permitted to inspect and copy; or (d) not created by our
  practice, unless the individual or entity that created the
  information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right
  to request an "accounting of disclosures." An "accounting of
  disclosures" is a list of certain non-routine disclosures our
  practice has made of your IIHI for non-treatment, non-payment
  or non-operations purposes. Use of your IIHI as part of the
  routine patient care in our practice is not required to be
  documented. For example, the doctor sharing information with
  the nurse; or the billing department using your information to
  file your insurance claim. In order to obtain an accounting of
  disclosures, you must submit your request in writing to the
  HIPAA Compliance Officer. All requests for an "accounting of
  disclosures" must state a time period, which may not be longer
  than six (6) years from the date of disclosure and may not
  include dates before April 14, 2003. The first list you
  request within a 12-month period is free of charge, but our
  practice may charge you for additional lists within the same
  12-month period. Our practice will notify you of the costs
  involved with additional requests, and you may withdraw your
  request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to
  receive a paper copy of our notice of privacy practices. You
  may ask us to give you a copy of this notice at any time. To
  obtain a paper copy of this notice, contact the HIPAA
  Compliance Officer.
7. Right to File a Complaint. If you believe your privacy rights
  have been violated, you may file a complaint with our practice
  or with the Secretary of the Department of Health and Human
  Services. To file a complaint with our practice, contact the
  HIPAA Compliance Officer. All complaints must be submitted in
  writing. You will not be penalized for filing a complaint.

8. 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 IIHI may be revoked at any time in writing.
  After you revoke your authorization, we will no longer use or
  disclose your IIHI for the reasons described in the
  authorization. Please note, we are required to retain records
  of your care.
Again, if you have any questions regarding this notice or our
health information privacy policies, please contact the HIPAA
Compliance Officer.

Telephone - New York, NY: 212-750-8900 - Hackensack, NJ: 201-441-9890 - Hillsborough, NJ: 908-359-8980 - Boca Raton, FL: 800-718-5504
 

 
 

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