Notice of Privacy Practices

Our Duty to Protect Your Health Information

Tampa Bay Dermatology, a division of Premier Dermatology, LLC, is required by federal and state law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We are required to notify you if a breach of your unsecured PHI occurs.

How We May Use and Disclose Your Health Information

We may use and disclose your PHI for the following purposes without your written authorization:

Treatment

We may use your health information to provide, coordinate, or manage your dermatological care and related services. For example, we may share information with other healthcare providers involved in your treatment, such as your primary care physician, a laboratory performing tests on your behalf, or a specialist to whom we refer you.

Payment

We may use and disclose your health information to bill and collect payment for the services we provide. For example, we may share information with your health insurance company, Medicare, or Medicaid to obtain payment or verify coverage. This may include providing information about a treatment or procedure to your insurance company for prior authorization or to determine whether your plan will cover the treatment.

Healthcare Operations

We may use and disclose your health information for our healthcare operations, which include quality assessment, employee review, training programs, accreditation, certification, licensing, auditing, compliance programs, and business planning activities.

Other Permitted Uses and Disclosures

We may also use or disclose your health information without your authorization for the following purposes:

• As required by law — including reporting certain diseases, injuries, or conditions to public health authorities
• Public health activities — such as reporting adverse reactions to medications or products
• Health oversight activities — audits, investigations, inspections, and licensing actions by health oversight agencies
• Judicial and administrative proceedings — in response to a court order or subpoena
• Law enforcement purposes — as required by law or in response to a lawful request
• To avert a serious threat — to health or safety of a person or the public
• Workers' compensation — as authorized by workers' compensation laws
• Organ and tissue donation — to organizations involved in organ procurement
• Military and veterans — as required by military command authorities
• Coroners, medical examiners, and funeral directors — as necessary for their duties
• Inmates and law enforcement custody — if you are an inmate of a correctional institution or under custody of a law enforcement official

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes other than those described above, including:

• Most uses and disclosures of psychotherapy notes (if applicable)
• Uses and disclosures of PHI for marketing purposes
• Disclosures that constitute a sale of PHI

You may revoke a written authorization at any time by submitting a written request to our office. Revocation will not affect any disclosures we have already made in reliance on your prior authorization.

Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

• Right to Access: You have the right to inspect and obtain a copy of your health information maintained by our office. Requests must be submitted in writing. We may charge a reasonable fee for copying costs.
• Right to Request Amendments: You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Requests must be submitted in writing with a reason for the amendment. We may deny your request under certain circumstances and will provide a written explanation.
• Right to an Accounting of Disclosures: You have the right to request a list of disclosures we have made of your health information for purposes other than treatment, payment, healthcare operations, and certain other activities. The first request within a 12-month period will be provided free of charge.
• Right to Request Restrictions: You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except if you pay for a service in full out of pocket and request that we not disclose the information to your health plan.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information in a particular way or at a particular location. For example, you may ask that we contact you only at your work phone number or by email.
• Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may obtain a copy by contacting our office.
• Right to Be Notified of a Breach: You have the right to be notified in the event that we discover a breach of your unsecured health information.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with the Department of Health and Human Services, visit:

www.hhs.gov/hipaa/filing-a-complaint

Changes to This Notice

We reserve the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. The current notice will be posted on our website and available at our office.

Contact Information

For questions about this Notice or to exercise any of your rights, please contact: