HIPAA Notice Of Privacy Practices

We are required by law to:

• Maintain the privacy of protected health information
• Give you this notice of our legal duties and privacy practices regarding health
  information about you
• Follow the terms of our notice that is currently in effect

We may use and disclose your medical records for each of the following purposes:

• Treatment means providing, coordinating, or managing health care and related services by
  one or more health care providers. This includes downloading an electronic record of your
  current and past prescription medications. An example of this would include a physical
  examination.
• Payment means such activities as obtaining reimbursement for services, confirming
  coverage, billing or collection activities, and utilization review. An example of this would be
  sending a bill for your visit to your insurance company for payment.
• Health Care Operations include the business aspects of running our practice, such as
  conducting quality assessment and improvement activities, auditing functions, costmanagement
  analysis, and customer service. An example would be an internal quality
  assessment review.

We may also use and disclose your medical records for:

• Public health purposes;
• To protect victims of abuse, neglect, or domestic violence;
• Health oversight activities such as investigations, audits, and inspections;
• Law enforcement purposes;
• Lawsuits and similar proceedings;
• When otherwise required by law;
• When requested by law enforcement as required by law or court order;
• To coroners, medical examiners, and funeral directors;
• Organ and tissue donation;
• Research under strict federal guidelines;
• Reduce or prevent a serious threat to public health and safety;
• Workers’ compensation or other similar programs if you are injured at work;
• Accreditation purposes; and
• Specialized government functions such as intelligence and national security

We may also create and distribute de-identified health information by removing all references to
individually identifiable information.

We may contact you to provide appointment reminders, information about treatment alternatives, or
other health-related benefits and services that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke
such authorization in writing and we are required to honor and abide by that written request, except
to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you
can exercise by presenting a written request to the Privacy Officer:

• The right to request restrictions on certain uses and disclosures of protected health
  information, including those related to disclosures to family members, other relatives,
  close personal friends, or any other person identified by you. We are, however, not
  required to agree to a requested restriction. If we do agree to a restriction, we must
  abide by it unless you agree in writing to remove it.
• The right to request that we restrict the disclosure of certain health information to a
  health plan if the disclosure is for payment or health care operations and pertains to
  a health care item or service for which you have paid out of pocket in full
• The right to reasonable requests to receive confidential communications of protected
  health information from us by alternative means or at alternative locations.
• The right to inspect and copy your protected health information.
• The right to amend your protected health information.
• The right to receive an accounting of disclosures of protected health information.
• The right to obtain and we have the obligation to provide to you a paper copy of this
  notice from us at your first service delivery date.
• The right to provide and we are obligated to receive a written acknowledgement that
  you have received a copy of our Notice of Privacy Practices.
• The right to receive a privacy breach notice through written notification if the practice
  discovers a breach of your unsecured PHI, and determines through a risk
  assessment that notification is required.
• The right to request an electronic copy of your protected health information.

We are required by law to maintain the privacy of your protected health information and to provide
you with notice of our legal duties and privacy practices with respect to protected health information.

We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post revisions in our
premises.

Please contact us for more information:

Ken Seymore
Privacy Officer
DERMATOLOGY ASSOCIATES
1707 Riggins Road
Tallahassee, FL 32308
(850) 877-4134

For more information about HIPAA or to file a complaint:
The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1- 877-696-6775