Privacy Notice

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.

A. Our Policy Regarding Your Health Information

We are committed to preserving the privacy and confidentiality of your health information. This Privacy Notice describes how Epoch Dermatology PLLC (the “Practice”) may use and disclose your protected health information according to applicable laws and regulations. It also describes your rights with respect to your protected health information. Your “protected health information” includes most information about your physical and mental health, such as symptoms, treatment, test results, and demographic data, which contains details that can be used to identify you. We are required by law to maintain the privacy of your “protected health information” and to provide you with this notice of our legal duties and privacy practices.

We reserve the right to change this notice and to make the revised notice effective for all protected health information that we maintain at that time and any information we may receive in the future. We will post a copy of the current notice in our facility and we will make any revised notice available at the facility for you to request a copy. We are required to abide by the terms of this notice while it remains in effect, including any future revisions that we may make to the notice as required or authorized by law.

B. Uses and Disclosures with and without Your Authorization

We must obtain your written permission or “authorization” to use or disclose your protected health information except in the limited situations listed below, which do not require your written authorization:

1. Treatment

We will use and disclose your protected health information to provide, coordinate and manage your health care and related services. We may disclose your protected health information to health care providers, including providers not affiliated with the Practice, so that they may provide you with treatment. For example, we may disclose your protected health information to a pharmacy to fill a prescription, to a laboratory to order a test, or to a specialist for a consultation.

2. Payment

We will use and disclose your protected health information, as needed, for the Practice to obtain payment for our health care services. For example, we may disclose protected health information to your health insurance company so we may obtain prior approval for a surgery, to determine whether you are eligible for benefits or to determine whether a particular service is covered under your plan. We may also disclose your protected health information to other health care providers, health plans, or health care clearinghouses for their payment activities.

3. Health Care Operations

We will use and disclose your protected health information for our health care operations. For example, we may use your protected health information to evaluate the performance of the Practice’s personnel and to perform licensing, training, and accreditation activities.

4. Law Enforcement Purposes

We may disclose your protected health information to law enforcement officials under certain circumstances when we are required or permitted by law to disclose such information.

5. Public Health Activities

The Practice may disclose your protected health information to certain public health authorities and others according to specific rules that apply to public health activities.

6. Health Oversight Activities

The Practice may disclose your protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations, proceedings and actions; inspections; licensure or disciplinary actions; and other activities necessary for appropriate oversight of the health care system and oversight of certain programs and entities as authorized by law.

7. Judicial and Administrative Proceedings

We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order.

8. Specialized Government Functions

In certain circumstances, Federal regulations authorize the Practice to use and/or disclose your protected health information for specialized government functions.

9. Suspected Abuse, Neglect or Domestic Violence

The Practice will disclose medical information that reveals that you may be a victim of abuse, neglect or domestic violence to a government authority if the Practice is required by law to make such disclosure.

10. To Avert a Serious Threat to Health or Safety

The Practice may, consistent with applicable law and standards of ethical conduct, use or disclose protected health information if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

11. Research

We may use and disclose your protected health information for research as long as such research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to preserve the privacy of your protected health information.

12. Medical Examiners, Funeral Directors, and Organ Donation

The Practice may disclose your protected health information to a medical examiner for identification purposes, to determine the cause of death or for other purposes authorized by law.

13. Workers’ Compensation

The facility may disclose your protected health information, as authorized by and in compliance with workers’ compensation laws.

14. Appointment Reminders

The Practice may, from time to time, use or disclose your protected health information to contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that we believe may be of interest to you.

15. De-identified Information

The Practice may de-identify your protected health information according to specific Federal rules so that the information does not identify you and cannot be used to identify you.

16. Business Associates

The Practice may disclose your protected health information to a business associate of the Practice if we obtain satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your protected health information.

17. Personal Representatives

The Practice may disclose your protected health information to or according to the direction of a person who, under applicable law, has the authority to represent you in making decisions related to your health.

18. Family and Friends

Under certain circumstances, the Practice may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your protected health information directly relevant to such person’s involvement with your care or the payment for your care.

19. Required by Law

In addition to those uses and disclosures listed above, we may use and disclose your protected health information if and to the extent we are required by law.

C. Your Rights

You have the following rights regarding your protected health information:

1. Right to Revoke an Authorization

You may revoke an Authorization in writing, at any time.

2. Right to Request Restrictions on Uses and/or Disclosures

You may request restrictions on the use and/or disclosure of your protected health information, or of certain parts of your protected health information, for treatment, payment or health care operations.

3. Right to Request Confidential Communications

You may request to receive confidential communications of protected health information by alternative means or at alternative locations.

4. Right to Inspect and Copy Information

According to Federal regulations, you may generally inspect and obtain a copy of your protected health information that we maintain in a designated record set.

5. Right to Amend your Information

You may request that we amend your protected health information that we maintain in a designated record set.

6. Right to Receive an Accounting

You may request an accounting of certain disclosures of your protected health information made by the Practice after April 14, 2003.

7. Right to Receive a Copy of Notice

Upon your request, we will provide you with a paper copy of this Privacy Notice.

8. Right to Complain

You have the right to complain to the Practice or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated.

D. Privacy Contact

The Practice’s contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Contact. You may contact the Privacy Contact at:

Epoch Dermatology PLLC
520 Franklin Avenue, Suite 211
Garden City, NY 11530
(516) 506-0800