Notice of Privacy Practices (*Revised 09/2024)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE READ IT CAREFULLY
Under the Health Insurance Portability & Accountability Act of 1996 (HIPAA) and its implementing regulations, your medical records and other individually identifiable health information, whether in electronic, paper, or oral form, are protected. This law gives you, the patient, the right to understand and control how your protected health information (PHI) is used. We are required by HIPAA to maintain the privacy of your PHI and to explain how we may use or disclose it.
How We May Use or Disclose Your Health Information
We may use or disclose your medical records for the following purposes:
- Treatment: To provide, coordinate, or manage your healthcare and related services with other healthcare providers (including consultations and referrals).
- Payment: To obtain reimbursement for services, confirm coverage, conduct billing and collection activities, and perform utilization review.
- Health Care Operations: For business activities, such as quality assessment, auditing, cost management, and customer service.
We may also disclose your PHI for the following purposes:
- Public Health and Safety: To assist with public health activities such as disease prevention, reporting adverse reactions, or addressing potential health or safety risks.
- Legal Requirements: To comply with a court order, subpoena, or other lawful requests.
Other Uses of Your PHI
We may contact you by phone or in writing to provide appointment reminders or information about treatment alternatives or health-related benefits and services that may interest you. If you prefer, you can choose to opt out of receiving these communications.
Certain uses and disclosures of your PHI will only be made with your written authorization, including:
- Use of psychotherapy notes
- Use of your PHI for marketing purposes
- Disclosures that constitute a sale of PHI
- Other uses and disclosures not described in this notice
You may revoke any authorization in writing, and we will honor your request, except where we have already relied on your prior authorization.
Your Rights Regarding Your Health Information
You have the following rights with respect to your PHI:
- Right to Request Restrictions: You can ask us to limit the use or disclosure of your PHI. We are not required to agree to all requests, but if we do, we will abide by the agreement.
- Right to Confidential Communications: You can request that we communicate with you in a specific way or at a specific location.
- Right to Inspect and Copy Your PHI: You may review and obtain copies of your medical records.
- Right to Amend Your PHI: You may request an amendment if you believe your information is incorrect or incomplete.
- Right to an Accounting of Disclosures: You can request a list of disclosures we have made of your PHI, except for those related to treatment, payment, or healthcare operations.
- Right to a Paper Copy of This Notice: You may request a paper copy of this notice at any time.
- Right to Notification of Breach: You will be notified if there is a breach of your unsecured PHI.
If you have paid for services "out of pocket", in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
Changes to This Notice
We reserve the right to change the terms of this notice and make the revised notice effective for all PHI we maintain. The current notice will be posted in our office and available upon request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Contact Information
If you have any questions about this notice or need more information, please contact:
Dipa Patel, M.D., Compliance Officer
Phone: (616) 248-8864
Dermatology at MidTowne, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.