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ROSE DERMATOLOGY &
LASER, LLC |
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DIANE LORIA ROSE,
MD, FAAD |
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NOTICE OF PRIVACY
PRACTICES FOR PROTECTED HEALTH
INFORMATION |
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EFFECTIVE DATE
APRIL 14, 2003 |
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THIS
NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAYBE USED AND
DISCLOSED
AND HOW YOU MAY GET ACCESS TO THIS
INFORMATION. PLEASE READ THIS
CAREFULLY. |
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OUR RESPONSIBILITIES |
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We are required by law to maintain
the privacy of your health information
and provide a description of our
privacy practices. We will abide by
the terms of this notice and notify
you if we cannot agree to a requested
restriction. |
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HOW YOUR MEDICAL INFORMATION
WILL BE USED AND DISCLOSED |
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USE and RELEASE OF MEDICAL
INFORMATION |
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We will use your medical
information as part of rendering
patient care (clinical and billing)
for: |
- Payment, Treatment, Healthcare
Operations
- Business Associates
- Appointment Reminders
- Treatment Alternative Education
- Health-related Benefits of
Service
- As required by law to
State/Federal Agencies
- Family or friends involved in
your care
- Entities assisting in Disaster
Relief
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YOUR HEALTH INFORMATION RIGHTS |
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Although your health-record is the
physical property of the healthcare
provider, you have the RIGHT to: |
- Access Information
- Request Amendments
- An Accounting of Disclosures
- Request Privacy Restrictions
- Request Alternate Communication
- File Complaints
- Obtain a Detailed Paper Copy of
this Notice
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COMPLAINTS |
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If you believe your privacy rights
have been violated, you may file a
complaint with us by contacting the
Privacy Official or with the Secretary
of the Department of Health and Human
Services. All complaints must be
submitted in writing and you will not
be penalized for filing a complaint. |
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CHANGES IN THIS NQTICE |
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We reserve the right to change
this notice and the revised or changed
notice will be effective for all
information we already have about you,
as well as, any information we receive
in the future. |
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