LIFETIME DERMATOLOGY – NOTICE OF PRIVACY PRACTICES
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.
Your medical information is personal. We are committed to protecting your medical information. We create a record of the care and services you receive at this office. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by this office whether made by your personal physician or one of the office’s employees.
This Notice will tell you about the ways in which we may use and disclose your medical information. This Notice will also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.
This office is required by law to:
(1) make sure that medical information that identifies you is kept private;
(2) give you this Notice of our legal duties and privacy practices with respect to medical information about you; and
(3) follow the terms of the Notice that is currently in effect.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
215 East Big Beaver
Troy, MI 48083
Effective date of this notice: June 10,2021
How this Office May Use and Disclose Your Medical Information
The following describes the different ways that your medical information may be used or disclosed by this office. For clarification we have included some examples. Not every possible use or disclosure is specifically mentioned. However, all of the ways we are permitted to use and disclose your medical information will fit within one of these general categories:
Treatment. We will use medical information about you to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians and other office personnel who are involved in providing you medical treatment. LifeTime Dermatology may have to coordinate medical information about you with other departments at various hospitals or laboratories, such as consulting doctors’ offices, pharmacies, pathologists, laboratories, etc. We may also find it necessary in order to provide optimum medical care to disclose medical information about you to individuals outside our organization, such as your family members, trusted friends, clergy, or others that we may be in contact with to assist us in providing services as a part of your care and treatment.
Payment. We may use and disclose medical information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received here so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
Health Care Operations. We may use and disclose health information pertaining to your care and treatment at our organization in order to implement our health care operations in the most productive manner. For example, we may determine that it is necessary to utilize medical information from your records to review our staff policies concerning treatment. We may also compile statistics from your records together with other patient’s files in order to determine if certain medical techniques are effective, and if we need to consider new treatments. We may compare medical information from your records with information from other hospitals or physician offices to determine how we may improve delivery of our medical services.
Appointment Reminders. We may use and disclose health information in order to contact you by telephone, mail or e-mail in order to remind you or confirm an appointment for treatment.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Public Safety. We may use and disclose health information about you when it is necessary to prevent a serious and imminent threat to your health and safety or the health and safety of the public or another individual. However, any disclosure we may feel necessary to implement would only be to an individual in a position to counter the threat.
Notification and Communication With Individuals Involved In Your Care. We may disclose to an individual involved in your care, such as a family member, friend, your personal representative or any other person involved in your care, health information relevant to that person’s involvement in your care. We may disclose your health information to notify or assist in notifying a family member, friend, your personal representative, or any other person who is responsible for your care. We may provide information to an individual who assists in paying for your care and treatment. We may also divulge information about your condition to your family or friends as well as advising that you have been admitted to a hospital, if relevant. [Also, we may disclose medical information which concerns you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location]. If you are available to either agree or object, we will give you the opportunity to object prior to making this notification. If you are not in a condition to make this determination, then our health care professionals will use their best judgment in notifying your family and other concerned individuals.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition.
Public Health Safety Issues. It is required by law that under the following circumstances, we may disclose your health information to public health authorities for reasons related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect, or domestic violence; reporting to the Food and Drug Administration regarding any problems with reactions to medications or products; notification regarding an individual who may have been exposed to a disease or who may be at risk for contracting or spreading a disease or condition.
Health Oversight Activities. We may disclose health information to health agencies for activities related to audits, investigations, inspections, and licensure proceedings. This is required in order for the government to monitor the health care system, government programs, and compliance with civil rights statutes.
Required by Law. We will disclose health information concerning your health information when we are required to do so by federal, state or local law.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may use your medical information to defend the office or to respond to a court order.
Law Enforcement. We may release medical information about you if required by law when asked to do so by a law enforcement official.
Coroners and Medical Examiners. We may release medical information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties.
National Security Issues. We may disclose health information about you to authorized federal officials for military, national security, intelligence, counterintelligence, and other national security issues required by law.
Workers Compensation. We may disclose health information about you in order to comply with workers compensation laws.
Organ Donation. We may disclose health information concerning you to health oversight agencies which are involved in procuring, banking or transplanting organs and tissues, in order to assist in donation and transplantation.
Military Service. We may disclose health information concerning you if you are a member of the armed forces as may be required by military command authorities.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official when necessary for your health or the health and safety of others.
Your Rights Regarding Your Medical Information:
You have the following rights regarding the medical information this office maintains about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care so long as this office maintains the medical information. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy your medical information, you must submit your request in writing to:
215 East Big Beaver
Troy, MI 48083
A “Request for Inspection of Protected Health Information” form is available from the receptionist.
If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. For information regarding such a review contact the Privacy Officer for LifeTime Dermatology.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by this office.
To request an amendment, your request must be made in writing and submitted to LifeTime Dermatology. In addition, you must provide a reason that supports your request. A “Request for Amendment of Protected Health Information” form is available from the receptionist.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us;
- Is not part of the medical information kept by this office;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures this office has made of your medical information.
To request this accounting of disclosures, you must submit your request in writing to:
215 East Big Beaver
Troy, MI 48083
A “Request for Accounting of Disclosures of Protected Health Information” form is available from the receptionist.
Your request must state a time period which may not be longer than six years and may not include dates before April 13, 2003. The first list which you request within a 12-month period will be sent to you at no cost. We may charge a reasonable, cost-based fee for each subsequent request within the 12-month period, provided that we inform you in advance of the fee and provide you with the opportunity to withdraw or modify the request for a subsequent accounting in order to avoid or reduce the fee.
Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure we make of your medical information.
LifeTime Dermatology is not required to agree to your request for a restriction. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment, is permitted to be disclosed without my permission by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Privacy Rules, or is required to be made to the Secretary of the Department of Health and Human Service to investigate or determine our compliance with the Privacy Rules.
To request restrictions, you must make your request in writing to:
215 East Big Beaver
Troy, MI 48083
A “Request for Restrictions on Use and Disclosure of Protected Health Information” form is available from the receptionist.
In your request, you must advise us of the following:
- What information you want to limit;
- Whether you want to limit use or disclosure, or both; and
- To whom you want the limits to apply (e.g. protecting confidentiality as to disclosures to your spouse).
Right to Request Confidential Communications. You have the right to request that we communicate with you about health information through reasonable alternative means or at a certain location. For example, you may request that we only contact you at work or by mail. In order to request this information, you must submit your request in writing to the following: LifeTime Dermatology
215 East Big Beaver
Troy, MI 48083
A “Request for Confidential Communications” form is available from the receptionist.
We will not inquire as to the reason for your request. We will attempt to make all reasonable accommodations.
Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this notice upon request, and at any time. You are entitled to this paper copy even if you have received a prior electronic transmittal of the notice.
You may obtain a copy of this Notice at our website: https://lifetimedermatology.com
To obtain a paper copy of this notice, you must submit your request in writing to the following:
230 West Maple Road
Troy, MI 48084
REVISIONS TO THIS NOTICE
We reserve the right to revise this Notice. Any revised Notice will be effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of any revised Notice in this office. Any revised Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you visit the office we will offer you a copy of the current Notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health and Human Services. To file a complaint with this office, contact us at 248-362-3500. All complaints must be submitted in writing.
THIS OFFICE WILL NOT PENALIZE YOU IN ANY WAY FOR FILING A COMPLAINT.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of health information not covered by this notice or other applicable laws will be made only with your written permission through a written authorization. If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons contained in your written authorization. You understand that we are unable to revoke any disclosures which we may have already made with your permission. Further, you understand that we are required to retain our records of the care and treatment which we provide to you.