Cosmetic and Procedural Dermatology Center, LLC
215 Morris Avenue, Spring Lake, NJ 07762
Phone: (732) 449-3005
 
 

Cosmetic and Procedural Dermatology Center, LLC

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 CAREFULLY.

During your treatment at Cosmetic & Procedural Dermatology, LLC., doctors, nurses, and other caregivers may gather information about your medical history and your current health.  This notice explains how that information may be used and shared with others.  It also explains your privacy rights regarding this kind of information.  The terms of this notice apply to health information created or received by Cosmetic & Procedural Dermatology.  We are required by law to make sure that your protected health information (PHI) that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; follow the terms of the notice that is currently in effect; and notify you in the event there is a breach of any unsecured protected health information.

YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED FOR THE FOLLOWING PURPOSES

Treatment: We may use your information to provide, coordinate, and manage your care and treatment.  For example, our physician may share your information with another physician for a consultation or referral.

Payment: We may use and disclosed PHI about you so that the treatment and services you receive may be billed to, and paid by your insurance company, or another third party.  For example, we may need to give your health plan information about treatment you received at Cosmetic & Procedural Dermatology so your health plan will pay us or reimburse you for 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.  We may disclose information about you for purposes of an independent review of a denial of a claim based on lack of medical necessity.

Health Care Operations: We may use and disclose PHI for Cosmetic & Procedural’s health operations.  Health care operations are the uses and disclosures of information that are necessary to run Cosmetic & Procedural Dermatology and make sure that all if our patients receive quality care.  For example we may use PHI to review our treatment and services, and to evaluate the performance of our staff and physicians in caring for you.

Appointment Reminders and Other Health Information: We may use PHI to send you reminders about future appointments.  We may also send you refill reminders or other communications about your current medication.  We may contact you with information about new or alternative treatments or other health care services or for purposes of care coordination.  We are not required to obtain your written authorization for face to face communication.

To People Assisting in Your Care: Cosmetic & Procedural Dermatology will only disclose PHI to those taking care of you, paying bills, or close family members and friends if these people need to know this information to help you and then only to the extent permitted by law.  We may, for example, provide limited PHI to allow a family member to pick up a prescription for you.  If you are able to make your own health care decisions, this practice will ask your permission before using your PHI for these purposes.  If you are unable to make health care decisions, we will disclose relevant medical information to the family member or person responsible for making decisions if we feel it is in your best interest to do so, including in an emergency situation.

Research: Federal law permits Cosmetic & Procedural Dermatology to use and disclose PHI for research purposes, either with your specific, written authorization or when the study has been reviewed for privacy protection by an institutional Review Board or Privacy Board before the research begins.  In some cases, researchers may be permitted to use the information in a limited way to determine whether the study or potential participants are appropriate.

As required by Law: We will disclose PHI when we are required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety: We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosures must be only to someone able to help prevent the threat. 

To Business Associates:  Some services are provided by or to Cosmetic & Procedural Dermatology through contracts with business associates.  Examples include Cosmetic & Procedural Dermatology’s attorneys, consultants, collection and billing agencies, and accreditation organizations.  We may disclose information about you to our business associate so that they can perform the job we have contracted with them to do.  To protect the information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and not to redisclose the PHI unless permitted by law.

YOUR MEDICAL INFORMATION MAY BE RELEASED IN THE FOLLOWING SPECIAL LIMITATIONS

Organ and Tissue Donation: We may release your PHI to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.  The information that they may disclose is limited to the information necessary to make transplant possible.

Military and Veterans:  If you are a member of the armed forces, we will release PHI as requested by military command authorities if we are required to do so by law, or when we have your written consent.  We may also release PHI about foreign military personnel to the appropriate foreign military authority as required by law or with written consent.

Workers’ Compensation: We may release PHI for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health: We may disclose PHI to public health authorities about you for public health activities.  These disclosures generally include the following:

Preventing or controlling disease, injury or disability;
Reporting births and deaths;
Reporting child abuse or neglect, or abuse of a vulnerable adult;
Reporting reactions to medications or problems with products;
Notifying people of recalls of products they may be using;
Notifying a per son who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or
Reporting to the FDA as permitted or required by law.

Health Oversight Activities: Cosmetic & Procedural Dermatology may disclose PHI to a health oversight agency for health oversight activities that are authorized by law. These oversight activities include, for example, government audits, investigations, inspections, and licensure activities.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes: We may disclose PHI in response to a valid court order or administrative order.  We also may disclose PHI in response to certain types of subpoenas, discovery requests or other lawful process.  We may disclose information in the context of civil litigation where you have put your condition at issue in the litigation.

Law Enforcement: We may release PHI if asked to do so by a law enforcement official in response to a valid court order, grand jury subpoena, or warrant, or with your written consent.  In addition, we are required to report certain type of wounds, such as gunshot wounds and some burns.  In most cases, reports will include only the fact of injury, and any additional disclosures would require your consent or a court order.

We may also release to law enforcement that is not a part of the health record such as (non-medical information) for the following reasons:
To identify or locate a suspect, fugitive, material witness, or missing person:
If you are the victim of a crime and, if, under certain limited circumstances, we are unable to obtain your agreement;
About a death we believe may be the result of criminal conduct
About criminal conduct at our facility; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors: We will release PHI to a coroner or medical examiner in the case of certain types of death, and we must disclose health records upon the request of the coroner or medical examiner.  This may be necessary, for example to identify you or determine the cause of death.  We may also release the fact of death and certain demographic information about you to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities: We will release PHI to authorized federal officials for intelligence. Counter-intelligence, and other national security activities only as required by law or with your written consent.

Protective Services for the President and Others: We will disclose PHI to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations only as required by law or with your written consent.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release medical information about you to the correctional institution or law enforcement official only as permitted by law.

YOU HAVE THE FOLLOWING RIGHTS REGARDING PROTECTED HEALTH INFORMATION

Right to Inspect and Copy:  You have the right to inspect and receive a copy of your PHI that is used to make decisions about your care.  Usually, this includes medical and billing records maintained by Cosmetic & Procedural Dermatology.  If you wish to inspect and copy medial information, you must submit your request in writing to J. Barton Sterling M.D.  If you request a copy of the information, we may charge a reasonable fee for the costs of the copying, mailing, or other supplies associated with your request to the extent permitted by state and federal law.  If we maintain your health information electronically as part of a designated record set, you have the right to receive a copy of your health information in the electronic format upon your request.  You may also direct us to transmit your health information (whether hard copy or electronic form) directly to an entity or person clearly and specifically designated by you in writing.

We may deny your request to inspect or copy your information in certain very limited circumstances.  For example, we may deny access if your physician believes it will be harmful to your health or could cause a threat to others.  In these cases, we may supply the information to a third party who may release the information to you.  If you are denied access to medical information, you may review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

Right to Request Amendment:  If you believe that medical information we have about you is incorrect or incomplete, you have the right to ask us to change the information.  You have the right to request an amendment for as long as the information is kept by or for Cosmetic & Procedural Dermatology. To request a change to your information, your request must be made in writing and submitted to J. Barton Sterling M.D.  In addition, you must provide a reason that supports your request.  Cosmetic & Procedural Dermatology may deny your request for an amendment if it is not in writing or does to 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 Cosmetic & Procedural Dermatology, unless the person or entity that created the information no longer is available to make the amendment;
Is not part of the medical information kept by or for Cosmetic & Procedural Dermatology.
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 and “accounting of disclosures.”  This is a list of the disclosures we made of PHI.   This list will not include disclosures for treatment, payment, and health care operations; disclosures that you have authorized or that have been made to you; disclosures for facility directories; disclosures for national security or intelligence purposes; disclosures to correctional institutions or law enforcement with custody of you; disclosures that took place more than six years before the date of request; and certain other disclosures.  To request this list you must submit your request in writing to J. Barton Sterling M.D.  Your request must state the time period for which you would like the accounting.  The accounting period must not go back further than six years from the date of your request.
                           
Right to Request Restriction: You have the right to request a restriction or limitation of PHI we use or disclose about you.  If you pay out of pocket in full for and item or service, then you may request that we do not disclose information pertaining solely to such item or service to your health plan for purposes of payment or health care operations.  We are required to agree with such a request, unless you request a restriction on the information we disclose to a health maintenance organization and the law prohibits us from accepting payment from you above the cost sharing amount for the item or service that is subject of the requested restriction.  However, we are not required to agree to any other request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or you request that we remove the restriction.  To request restrictions, you must do so in writing to J. Barton Sterling M.D.  In your request, you must tell us

(1)  What information you want to limit (2) whether you want to limit our use, disclose, or both; and (3) to whom you want the limits to apply, for example, if you want to prohibit disclosures to your spouse.

Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or only by mail.  To request confidential communication, you must make your request in writing to J. Barton Sterling M.D.  We will accommodate all reasonable requests.  Your request must specify how, when, and where you wish to be contacted.

Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this notice at any time.

CHANGES TO THIS NOTICE
The effective date of this notice is January 1, 2016.  We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you, as well as any information we receive in the future.  If the terms of this notice are changed, Cosmetic & Procedural Dermatology will provide you with a revised notice upon request, and we will post the revised notice in designated locations at 215 Morris Avenue Spring Lake, N.J. 07762.

Complaints or Questions: If believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  To file a complaint with Cosmetic & Procedural Dermatology, or to ask a question about this notice, contact Mary Ann Yarnell / Compliance Office at 732-449-3005.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Other Uses and Disclosures of Protected Health Information:  We are required to obtain written authorization from you for most uses and disclosures of PHI for marketing purposes and disclosures that constitute a sale of PHI.  Except as described in this notice, we will not use or disclose your PHI without specific written authorization from you.  If you provide us with this written authorization to use or disclose PHI, you may revoke that authorization in writing at any time.  If you revoke your authorization, we will no longer use or disclose PHI for the reasons covered by your written authorization, except to the extent we have already relied on your authorization.  We are unable to take back disclosures we have already made with your permission, and we are required to retain our records of the care we provided to you.

Revised January 1, 2016
 

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