Notice of Privacy Practices

This Notice Describes How Medical Information About You May Be Used and Disclosed 

and How You May Receive Access to This Information.

Please Review It Carefully

 

The HIPAA Privacy Law requires us to provide this Notice to you regarding our privacy practices, our legal duties to protect your private information and your rights concerning health information about you. We are required to follow the privacy practices described in this Notice whenever we use or disclose your protected health information (PHI). Other companies or persons that perform services on our behalf, called Business Associates, must also protect the privacy of your information. Business Associates are not allowed to release your information to anyone else unless specifically permitted by law. There may be other state and federal laws, which provide additional protections related to communicable disease, mental health, substance or alcohol abuse, or other health conditions. 

 

This Notice explains how that information, called “Protected Health Information” may be used and disclosed to others. The terms of this Notice apply to health information produced or obtained by Sanova Dermatology. 

 

Our Commitment to You

Sanova Dermatology is committed to maintaining the privacy of your health information. This practice strives to maintain the highest degree of integrity in its interactions with patients and the delivery of quality healthcare. The practice, its employees, and business associates will at all times strive to maintain compliance with all laws, regulations, and requirements affecting the practice of medicine and the handling of patient information. The protection of the privacy of the individual’s and the security of an individual’s electronic protected health information (“ePHI) is a critical concern to this practice, and to the trust our patients offer in out treatment of their medical issues. 

Uses and Disclosures

Your protected health information may be used and disclosed by Sanova Dermatology’s physicians, staff, and others involved in your care for purposes of treatment, payment and health care operations. The following are common types of uses and disclosures your physician’s office is authorized to make. While not a complete list of allowable disclosures, these examples will provide you with an understanding of acceptable disclosures made by this practice.

  • Treatment: Our practice will use and may share health information about you to provide, coordinate, or manage your health care and treatments.  For example, a nurse or medical assistant will obtain treatment information about you and record it in a medical record. Alternatively, one of our physicians may use information about you for a consultation with, or a referral to, another physician to diagnose your illness and determine which treatment option, such as surgery or medication, will best address your health needs. Except in emergency circumstances, we will make a “good faith effort” to get your permission prior to making disclosures outside Sanova Dermatology for treatment purposes. 
  • Payment: We may use and disclose health information about you to obtain payment for the care and services that we have provided to you.  For example, we may need to provide your health plan provider with information about you, your diagnosis, and the treatment provided to you at Sanova Dermatology so that your health insurer will pay us, or reimburse you, for the treatment. We may also contact your health insurance to obtain prior approval about a potential treatment.  
  • Health Care Operations: We may use and share health information about you for Sanova Dermatology’s health care operations. These business activities include, but are not limited to, planning, management, quality assessment, and improvement activities for the treatments that we deliver.  For example, we may use your health information to evaluate the skills of our physicians, nurses, and other health care providers in caring for you. We also may use your information to review quality and health outcomes. We will obtain your written permission before making disclosures to others outside Sanova Dermatology for health care operations purposes.
  • Business Associates: We will share your protected health information with third party “business associates” that perform various activities on our behalf. Examples of a Business Associate include, billing services, transcription services, and legal services. Prior to disclosing any PHI with a business associate, we will establish a written contract that contains terms that will protect the privacy of your information. Business associates and their subcontractors must also comply with HIPAA Privacy and Security Regulations. We verify their understanding and responsibility.
  • Appointment Reminders: We may use and disclose PHI to contact you for appointment reminders and to communicate necessary information about your appointment.
  • Health-Related Benefits, Services and Treatment Alternatives: We may also contact you about new or alternative treatments or other health care services that may be of interest to you.  For example, we may offer to mail newsletters, coupons, or announcements to you. If you prefer not to have these materials sent to you, you may “Opt-Out” of this at any time by contacting our office.
  • Fundraising Communications: We may contact you as part of a fundraising effort.  For example, we may use or disclose your information in order to contact you for fundraising activities supported by Sanova Dermatology and its operations. We would only release your name, address and phone number, and the dates you received treatment. If you do not want us to contact you for fundraising efforts, you may “Opt-Out” of this at any time by contacting our office.

 

Additional Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object. These situations include:

  • As Required by Law: We must disclose health information about you if federal, state, or local law requires us. We will maintain compliance with the law and will limit the disclosure to the minimum necessary. If required, you will be notified of any disclosure. 
    • Legal Proceedings: If you are involved in a lawsuit, dispute, or other judicial or administrative proceeding, we may disclose health information about you in response to a court order, subpoena, other lawful process.
  • Required by HIPAA Law: The Secretary of the Department of Health and Human Services (HHS) may investigate privacy violations. If your health information is requested as part of an investigation, we must share your information with HHS.   
  • Law Enforcement:  We may disclose your health information to a law enforcement official if required or allowed by law. These reasons include:
  • Legal processes and otherwise required by law
  • To identify or locate a suspect, fugitive, material witness, victim of a crime, or missing person
  • Suspicion that death has occurred as a result of criminal conduct
  • About criminal conduct at our location 
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • Workers Compensation: If you are seeking compensation due to a work-related injury, we may release health information about you to the extent necessary to comply with laws relating to Workers Compensation claims.
  • Public Health Risks: We may disclose health information about you for public health purposes or to public health or legal authorities who are permitted by law to collect or receive the information. Examples include disclosure to prevent or controlling disease, or injury. We are permitted by law to notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition. We may also disclose your PHI, if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We also may disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
  • Abuse or Neglect: We believe abuse or neglect to be a serious issue. We may disclose your PHI to a public health authority authorized to receive reports of child abuse or neglect. We may also disclose your information if, in our best judgement, we believe you have been a victim of abuse, neglect, or domestic violence. When disclosing PHI in cases of abuse or neglect, we will follow applicable state and federal laws.
  • Organ and Tissue Donation: Consistent with applicable law, we may release your health information to organ procurement organizations or others engaged in the transplantation of organs to enable a possible transplant.
  • Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release your PHI to a funeral director, as necessary, to carry out his/her duties.
  • Research: Federal law permits Sanova Dermatology to use or disclose health information about you for research purposes, if the research is reviewed and approved by an Institutional Review Board to protect the privacy of your health information before the study begins. We may disclose your information if we have your written authorization to do so. In some instances, researchers may be allowed to use information about you in a restricted way to determine whether the potential study participants are appropriate. We will make a “good faith effort” to acquire your permission or rejection to participate in any research study prior to releasing any protected information about you.
  • Health Oversight Activities: We must disclose health information to a health oversight agency for activities that are required by federal, state or local law. Oversight activities include investigations, inspections, industry licensures, and government audits. These activities are necessary to enable government agencies to monitor various health care systems, government programs, and industry compliance with civil rights laws. Most states require that identifying information about you, such as your social security number, be removed from information releases for health oversight purposes, unless you have provided written permission for the disclosure.
  • Military Activity and National Security: If you are a member of the military or a veteran, we will disclose health information about you as required by command authorities, for the purpose of determination by the Department of Veterans Affairs of your eligibility of benefits, or to foreign military authority if you are a member of that foreign military service; or if you give us your written permission. We are also permitted to disclose your health information to authorized federal officials for other specialized government functions such as national security or intelligence activities.

 

Additional Uses and Disclosures That May Be Made with Your Written Authorization.

For any purpose other than the ones described above, we may only use or share your health information when you give us your written authorization to do so. For example, you will need to sign an authorization form before we can send your health information to your life insurance company. You may revoke an authorization at any time. If you revoke your authorization, we will no longer disclose your PHI for the reasons covered by your written authorization. 

Note: We are unable to undo any disclosures previously made with your authorization.

 

Additional Uses and Disclosures That May Be Made with the Opportunity to Agree or Object. 

Sanova Dermatology may share your PHI; however, you have the opportunity to agree or object to the use or disclosure of all or part of the disclosure. If you are not present or able to agree or object to the use or disclosure, then we may, using professional judgement, determine whether the disclosure is in your best interest. These situations include:

  • People Assisting in Your Care: In certain limited situations, Sanova Dermatology may disclose essential health information to people such as family members, relatives, or close friends who are helping care for you or helping you pay your health care bills. We will disclose information to them only if these people need to know the information to help you.  For example, we may provide limited information to a family member so that they may pick up a prescription for you. Generally, we will ask you prior to making disclosures if you agree to such disclosures. If you are unable to make health-related decisions or it is an emergency, Sanova Dermatology will determine if it would be in your best interest to disclose pertinent health information about you to the people assisting in your care.
  • Marketing: We must also obtain your written authorization before using your health information to send you any marketing materials. The only exceptions to this requirement are that:
    • We can provide you with marketing materials in a face-to-face encounter or a promotional gift of very small value, if we so choose
    • We may communicate with you about products or services relating to your treatment, to coordinate or manage your care, or provide you with information about different treatments, providers or care settings. 
  • Highly Confidential Information: Federal and state law requires special privacy protections for certain “Highly Confidential Information” about you, including any part of your health information that is about: Child abuse and neglect, Domestic abuse of an adult with a disability, Mental illness or developmental disability treatment or services, Alcohol or drug dependency diagnosis, treatment, or referral, HIV/AIDS testing, diagnosis, or treatment, Sexually transmitted disease, Sexual assault, Genetic testing, In Vitro Fertilization (IVF), Information maintained in psychotherapy notes. Before we share your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written permission.

 

Your Rights Regarding Health Information We Maintain About You

  • You have the right to inspect and receive a copy of your PHI

As long as we maintain your Protected Health information, you may request to inspect and receive a copy of your records. You may obtain your medical record that contains medical and billing records and any other records your physician uses for health care decisions. For PHI in a designated record set that is maintained in an electronic format, you can request an electronic copy of such information. There may be a charge for copies of your PHI.

To make such a request, complete a “Request for Inspecting and Copying PHI” Form. 

However, federal law prohibits you from inspecting or copying: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action proceeding; and laboratory results that are subject to law that prohibits access. You will receive a letter if you are denied access. You have the right to appeal the denial. Please contact our Privacy Officer if you have any questions.

  • You have the Right to Request Amendment 

If you believe that any of the health information we have about you is incorrect or incomplete, you have the right to ask us to change the information, for as long as Sanova Dermatology maintains the information. To request an amendment to your health information, your request must be in writing, signed, and submitted to the Privacy Officer. You may also submit a Request for Amendment of Protected Health Information form. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be maintained with your records. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. 

 

  • You have the Right to Request Restrictions on Use and Disclosure: You have the right to request a restriction or limitation on certain uses and disclosures of your health information.

To request restrictions, you must make your request in writing. Complete a Request for Restrictions on Use and Disclosure of PHI form. If you wish to submit your request in another manner, your written request must include:

  • What information you wish to limit 
  • Whether you wish to limit our use, disclosure, or both
  • To whom you want the limits to apply – for example, if you want to prohibit disclosures for insurance payment, health care operations, for disaster relief purposes, to persons involved in your care, or to your spouse. 
  • You or your personal representative must sign it. 

We are not required to agree to your request, but we will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction. 

  • You have the Right to an Accounting of Disclosures: With some exceptions, you have the right to receive an accounting of certain disclosures of your PHI. Complete the Request for Accounting of Non-Authorized Use or Disclosure form. If you wish to submit a request in another manner, your accounting request must be in writing and signed by you or your personal representative, and submitted to our Privacy Officer. Your request must specify the time in which the disclosures were made. These disclosures may not go back further than six years from the date of the request. You may receive one free accounting in any 12-month period. There will be a charge for more than one request in a 12-month period.
  • You have the Right to Request Alternate Communications: You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box. Complete the Request for Alternative means of Communication of PHI form. If you wish to submit a request in another manner, You must submit your request in writing to the practice manager. Your request must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests. 
  • You have the Right to Receive a Copy of this Notice: You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time. 
  • Right to Cancel Authorization to Use or Disclose: Other uses and disclosures of your health information not covered by this Notice or the laws that govern us will be made only with your written authorization. You have the right to revoke your authorization in writing at any time, and we will discontinue future uses and disclosures of your health information for the reasons covered by your authorization. We are unable to take back any disclosures that were already made with your authorization, and we are required to retain the records of the care that we provided to you. 

 

For Further Information

If you have questions, or would like additional information, you may contact the Privacy Officer at danielk@sanovaderm.com or at the address listed below.

 

To File a Complaint

You may submit any complaints with respect to violations of your privacy rights to Sanova Dermatology Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services if you feel that your rights have been violated. There will be no retaliation from Sanova Dermatology for making a complaint.

 

Changes to this Notice

If we make a material change to this Notice, we will post the revised copy in our office, and provide a revised Notice available at our reception desk or on our website. 

 

Contact Information

Unless otherwise specified, to exercise any of the rights described in this Notice, for more information, or to file a complaint, please contact the Privacy Officer. 

 

Privacy Officer

Daniel Kopfensteiner

1601 E. Pflugerville Parkway. Suite 1202

Pflugerville, TX. 78660

T: 512-492-8740

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