In accordance with 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 protected health information. Please review this Notice carefully.
A. Our commitment to your privacy.
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 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 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 you PHI
- Your privacy rights in your PHI
- Our obligation concerning the use and disclosure of your PHI
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 of Privacy Practices. Any revisions 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 email us or call 731-422-7999.
C. We may use and disclose your protected health information (PHI) in the following ways:
The following categories describe the different ways in which we may use and disclose your PHI.
1. Treatment. Our practice may use your PHI 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 PHI in order to write a prescription for you, or we might disclose your PHI 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 PHI in order to treat you or assist others in your treatments. Additionally, we may disclose your PHI to others who may assist you in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you 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 PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI 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 PHI 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 PHI to evaluate the quality of care you receive 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.
4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you. However, if we wish to provide your PHI to third parties for their marketing activities, we will ask for your authorization in writing before doing so.
7. Release of Information to Family/Friends. Our practice may use and disclose your PHI to friends or family members or others that are involved in your care, who accompany you, or who assist in taking care of you or assist in paying for your care, when you are incapacitated, or in an emergency, or when you agree or you fail to object when you have the opportunity to do so. If you are unavailable or unable to object, we will use our best judgment.
8. Disclosure Required by Law. Our practice may use and disclose your PHI when we are required to do so by federal, state, or local law.
9. Telephone Communication. We will leave information on your answering machine, such as appointment reminders.
D. Use and disclosure of your PHI in certain special circumstances.
The following categories describe unique scenarios in which we may use or disclose your protected health information:
1. Public Health Risks. Our practice may use and disclose your PHI 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 a 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 or its designee or agent relating primarily to workplace injury or illness or medical surveillance.
- Other circumstances involving public health when required or permitted by law.
2. Health Oversight Activities. Our practice may use and disclose your PHI 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 laws and the health care system in general.
3. Judicial and Administrative Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI 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 or your attorney of the request or to obtain an order protecting the information the party has been requested.
4. Law Enforcement. We may release PHI if asked to do so by law enforcement officials:
- 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 of victim(s) of the crime, or the description, identity or location of the perpetrator).
5. Deceased Patients. Our practice may use and disclose your PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may use and disclose your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an IRB or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to the individual's privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.
8. Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious and imminent 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.
9. Military. Our practice may use and disclose your PHI if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
10. National Security. Our practice may use and disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
11. Inmates. Our practice may use and disclose your PHI 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.
12. Worker's Compensation. Our practice may release your PHI for worker's compensation and similar programs.
13. Business Associates. Some of our services are provided by outside vendors. For example, we may use an outside copy service to make copies of patient medical records for us. To protect your PHI, we require these vendors to agree in writing to keep your PHI safe using the same standards that we are required to observe.
14. For Data Breach Notification Purposes. We may use your contact information to provide legally-required notices of unauthorized acquisition, access, or disclosure of your PHI.
E. Your rights regarding your PHI.
You have the following rights regarding the PHI 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: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Drive, Jackson, TN 38301, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will generally accommodate reasonable requests, but reserves the right to refuse a request. 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 PHI (but only PHI that we created) for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosures of your PHI 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, except for requests for a restriction on the disclosure of PHI to a health plan if: (i) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (ii) the PHI pertains solely to a health care item or service for which the individual, or person on behalf of the individual other than the health plan, has paid Dermatology Clinic of Jackson in full. 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 of disclosure of your PHI, you must make your request in writing to Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Drive, Jackson, TN 38301. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice's disclosure or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies. 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 to: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Dr., Jackson, TN 38301, in order to inspect and/or obtain a copy of your PHI. 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 a review.
4. Amendment. You may ask us to amend your health information (as to PHI that we created, but not medical records of other providers) 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: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Dr., Jackson, TN 38301. You must provide us with a reason that supports 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 opinion: (a) accurate and complete; (b) not part of the PHI kept by or for our practice; (c) not part of the PHI 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 (which does not include a failure or refusal to amend).
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 PHI for non-treatment or operations purposes. Use of your PHI 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: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Dr., Jackson, TN 38301. 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: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Dr., Jackson, TN 38301.
7. Rights 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: Privacy Officer, Dermatology Clinic of Jackson, 27 Medical Center Dr., Jackson, TN 38301. 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 in subparagraphs C(1) through C(9) or D(1) through D(14) above by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosures of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
9. Uses and Disclosures of Your Highly Confidential Information. Federal and state laws require specific privacy protections for certain highly confidential information about you ("Highly Confidential Information"). Highly Confidential Information includes information about your PHI that: (i) is maintained in psychotherapy notes; (ii) is about mental health and development disabilities services; (iii) is about alcohol and drug abuse prevention, treatment and referral; (iv) is about HIV/AIDS testing & diagnosis, or treatment; (v) is about communicable disease(s); or (vi) is about genetic testing. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your authorization.
10. Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in the waiting room of the practice and on our website at www.dermjax.com.
Again, if you have any questions regarding this Notice or our health information privacy policies, please email us or call 731.422.7999.