This
notice describes how personal and medical information
about you may be used and disclosed, and how
you can get access to this information.
You
have a right to ask for a copy at any time.
Please review it carefully.
Understanding
the type of information we collect
We
collect information about you when you visit
the SKIN. PLLC for services. It may include
your date of birth, address, identification
numbers (like social security numbers), and
other personal information. It also may include
medical, health, and billing information.
Our
Privacy Commitment to you
We
at SKIN, PLL C take confidentiality and privacy
of your health information very seriously. Only
people who have both the need and the legal
right may see your information. Unless you give
us permission in writing, we will only disclose
your information for the purposes of treatment,
payment, healthcare operations, or when we are
required by law to do so.
-
Treatment
We
may use and disclose your health information
to provide, coordinate, or manage your health
care and related services. For example, a nurse
may obtain medical information from you to determine
the proper care and services to provide.
-
Payment
We
may use and disclose information so that the
care you receive can be properly billed and
paid for. For example, if you have Medicaid,
we will need to disclose your health information
to the Medicaid Program in order to be reimbursed
for our services.
-
Healthcare Operations
We
may need to use and disclose information for
our healthcare operations. For example, we may
use information to review the quality of care
you receive.
-
Exceptions
Certain
kinds of sensitive records will require your
written permission to be released even for treatment,
payment, and healthcare operations.
-
As Required By Law
We
will release information when we are required
by law to do so. Examples of such releases would
be for law enforcement or national security
purposes, subpoenas or other court orders, communicable
disease reporting, disaster relief, review of
our activities by government agencies, to avert
a serious threat to health or safety, or in
other kinds of emergencies.
-
With Your Permission
If
you give us permission in writing, we may use
and disclose your personal information. You
have the right to change your mind and revoke
this permission at any time, in writing. We
cannot take back any uses or disclosures that
have already been made with your previous permission.
Your
Privacy Rights
You
have the following rights regarding the health
information that we collect about you. Your
requests must be made in writing to the Health
Department Privacy Contact listed at the end
of this document.
Your
Right to Receive a Written Copy of the Notice
of Privacy Practices
You may ask for a paper copy of the notice at
any time.
Your
Right to Inspect and Copy
In most cases, you have the right to look at
or get copies of your records. You may be charged
a fee for the cost of copying your records.
Your
Right to Amend
You may ask us to change your records if you
feel that there is a mistake. We can deny your
request for certain reasons, but we must give
you a written reason for our denial.
Your
Right to a List of Disclosures
You have the right to ask for a list of disclosures
of your health information made after April
14, 2003. This list will not include the times
that information was disclosed for treatment,
payment, or health care operations. The list
will not include information provided directly
to you, or information that was sent with your
written permission.
Your
Right to Request Restrictions on our Use or
Disclosure of Information
You have the right to ask for limits on how
your information is used or disclosed. We are
not required to agree to such requests.
Your
Right to Request Confidential Communications
You have the right to ask that we share information
with you in a certain way or in a certain place.
For example, you may ask us to send information
to your work address instead of your home address.
You do not have to explain the reason for your
request.
Changes
to this Notice
We
reserve the right to revise this notice. A revised
notice will be effective for health information
we already have about you as well as any information
we may receive in the future. We are required
by law to comply with whatever notice is currently
in effect. Any changes to our notice will be
posted in our main clinic areas and published
on our web site, www.grandtraverse.org. We will
provide you with a revised copy upon your request.
For
More Information
If
you would like more information about any part
of this Notice of Privacy Practices, there is
a longer more detailed version available. You
may ask for a copy of this at any time.
If
you want to exercise your rights under this
notice, or file a complaint, you may call or
write to the Privacy Contact at the number or
address below. If your request to us must be
in writing, we will help you prepare your written
request, if you wish.
Privacy
Contact
SKIN, PLLC
2233 Wisconsin Ave., NW
Suite
230
Washington, DC 20007
Phone: 202.298.7546
Complaints
to the Federal Government
If
you believe that your privacy rights have been
violated, you have the right to file a complaint
with the federal government at the address below.
We will not retaliate against you for filing
a complaint with the Health Department or the
federal government.
This notice was published and becomes effective
on April 2, 2007
