HIPAA Statement

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY

This notice is effective as of April 14, 2003

USES AND DISCLOSURE OF HEALTH INFORMATION

TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

Pinehurst Dermatology, PA uses and discloses your protected health information of treatment, payment and health care operations.   Some examples of when our office may use or disclose your health care information for these purposes include

• Sharing tests results with other health care providers for confirmation of a diagnosis;
• Providing your diagnosis or other information about your health to your insurance provider or our billing service to obtain payment for the health care services we provide;
• Reviewing information as part of our quality improvement program.

OTHER USES AND DISCLOSURES

Pinehurst Dermatology, PA may also use and disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:

• Providing you with information related to your health;
• Contacting you regarding appointments, information and treatment alternatives, or other health related services;
• Incidental uses or disclosures (e.g., listing your name on a sign in sheet, etc.);
• Compliance with all laws (including reports or suspected abuse, neglect or violence);
• Providing certain specified information to law enforcement or correctional institutions;
• Providing information to a coroner, medical examiner, funeral director, or organ procurement organization;
• Public health activities when requested by a public health authority of the FDA;
• Responding to health oversight agencies;
• Responding to court or administrative tribunal orders, subpoenas, discovery requests or other lawful process;
• Research activities;
• When necessary to avert a serious threat to health or safety;
• Military affairs, veterans affairs, national security, intelligence, Department of  State or presidential protective service activities;
• Providing information regarding your location, general condition or death to public or private disaster relief agencies; or
• Informing family member, other relative, or close personal friend when information is relevant to the individual’s involvement with your care;
• Notification of your location, general condition or death;
• To assist in your health care (e.g. pick-up prescriptions or other documents);

Authorization for other uses

Pinehurst Dermatology, PA will make other uses and disclosures of your protected health information only after obtaining your written authorization.  If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us in writing that you wish to revoke your authorization. 

YOUR RIGHTS REGARDING THE PRIVACY

OF YOUR HEALTH INFORMATION

Subject to limitations, outlined by law, you have certain rights related in use and disclosure of your protected health information, including the right to:

·     Request restrictions on certain uses and disclosures.  However, Pinehurst Dermatology PA, is not obligated to agree to requested restrictions.

·     Receiver confidential communications of protected health information.

·     Inspect and copy your protected health information with some limited exception;

·     Amend your health information;

·     Receive an accounting of disclosures of your health information;

·     Obtain a copy of this notice.

PINEHURST DERMATOLOGY, P.A. DUTIES REGARDING THE PRIVACY OF

YOUR HEALTH INFORMATION

Subject to limitations, outlined by law, you have certain rights related in use and disclosure of your protected health information, including the right to:

·     Pinehurst Dermatology, PA is required by law to maintain the privacy of protected health information and to provide individuals with a notice of our legal duties and privacy practices with respect to protected health information.

·     Pinehurst Dermatology, PA is required to abide by the terms of privacy notice that is currently in effect.

·     Pinehurst Dermatology, PA , reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information.  Revised notice will be posted in our office and available upon request. 

CONCERNS

If you believe your privacy rights have been violated, you may make a complaint by contacting Pinehurst Dermatology PA, Privacy Officer, 185 Page Road, Suite A, Pinehurst, NC, 28374, Telephone; (910) 295-5567 or the Secretary for the Department of Health and Human Services.  No individual will be retaliated against for filing a complaint.

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