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NOTICE OF PRIVACY PRACTICES

Island Park Dermatology, LLC

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION (PHI)

Island Park Dermatology collects, receives, or shares information about your past, present or future health condition to provide health care to you, to receive payment for this health care, or to operate the dermatology clinic.

OUR PLEDGE REGARDING YOUR HEALTH INFORMATION

Island Park Dermatology is committed to protecting the privacy of health information we create and obtain about you. This Notice tells you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information. We are required by law to: (i) make sure your health information is protected; (ii) give you this Notice describing our legal duties and privacy practices with respect to your health information; and (iii) follow the terms of the Notice that is currently in effect.

HOW WE MAY USE AND RELEASE YOUR PROTECTED HEALTH INFORMATION

A. The following uses do NOT require your authorization, except where required by SC law:

  1. For treatment. Your PHI may be discussed by caregivers to determine your plan of care.
  2. To obtain payment. We may use and disclose PHI to obtain payment for our services from you, an insurance company or a third party.
  3. For health care operations. We may use and disclose PHI for clinic operations.
  4. Business Associates. Your medical information could be disclosed to people or companies outside Island Park Dermatology who provide services.
  5. We report to public health authorities, as required by law, information regarding births, deaths, various diseases, reactions to medications and medical products.
  6. Victims of abuse, neglect, domestic violence. Your PHI may be released, as required by law, to the South Carolina Department of Social Services when cases of abuse are suspected.
  7. Health oversight activities. We will release information for federal or state audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions.
  8. Judicial and administrative proceedings. Your PHI may be released in response to a subpoena or court order.
  9. Law enforcement or national security purposes. Your PHI may be released as part of an investigation by law enforcement or for continuum of care when in the custody of law enforcement.
  10. Military and Veterans. If you are a member of the U.S. or foreign armed forces, we may release your medical information as required by military command authorities.
  11. Uses and disclosures about patients who have died. We may provide medical information to coroners, medical examiners and funeral directors so they may carry out their duties.
  12. For purposes of organ donation. As required by law, we will notify organ procurement organizations to assist them in organ, eye or tissue donation and transplants.
  13. Research. We may use and disclosure your medical information for research purposes. Most research projects are subject to Institutional Review Board (IRB) approval. The law allows some research to be done using your medical information without requiring your written approval.
  14. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may release limited information to law enforcement personnel or persons able to prevent or lessen such harm.
  15. For workers compensation purposes. We may release your PHI to comply with workers compensation laws.
  16. Marketing. We may send you information on the latest treatment, support groups, reunions, and other resources affecting your health.
  17. Fundraising activities. We may use your PHI to communicate with you to raise funds to support health care services and educational programs we provide to the community. You have the right to opt out of receiving fundraising communications with each solicitation.
  18. Appointment reminders and health-related benefits and services. We may contact you with a reminder that you have an appointment.
  19. Disaster Relief Efforts. We may disclose your medical information to an entity assisting in disaster relief efforts so that your family can be notified about your condition. Note: incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights. Incidental uses or disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.

B. You may object to the following uses of PHI:

  1. Information shared with family, friends or others. Unless you tell us not to, we may release PHI to a family member, or person involved with your care or the payment for your care.
  2. Health plan. You have the right to request that we not disclose certain PHI to your health plan for health services or items when you pay for those services or items in full.

C. Your prior written authorization is required (to release your PHI) in the following situations: You may revoke your authorization by submitting a written notice. If we have a written authorization to release your PHI, it may occur before we receive your revocation.

  1. Any uses or disclosures beyond treatment, payment or healthcare operations and not specified in parts A & B above.
  2. Mental Health Records unless permitted under an exception in section A.
  3. Substance Use Disorder Treatment records unless permitted under an exception in section A.

WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

Although your health record is the physical property of Island Park Dermatology, the information belongs to you, and you have the following rights with respect to your PHI:

A. The Right to Request Limits on How We Use and Release Your PHI.

You have the right to ask that we limit how we use and release your PHI. We will consider your request, but we are not always legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations.

Your request must be in writing and state (1) the information you want to limit; (2) whether you want to limit our use, disclosure or both; (3) to whom you want the limits to apply, for example, disclosures to your spouse; and (4) an expiration date.

B. The Right to Choose How We Communicate PHI with You.

You have the right to request that we communicate with you about PHI and/or appointment reminders in a certain way or at a certain location (for example, sending information to your work address rather than your home address). You must make your request in writing and specify how and where you wish to be contacted. We will accommodate reasonable requests.

C. The Right to See and Get Copies of Your PHI.

You have the right to inspect and/or receive a copy (an electronic or paper copy) of your medical and billing records or any other of our records used to make decisions about your care. You must submit your request in writing.

D. The Right to a List of Instances of to Whom We Have Disclosed Your PHI.

This list may not include uses such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory as described above in this Notice of Privacy Practices. This list also may not include uses for which a signed authorization has been received or disclosures made more than six years prior to the date of your request.

E. The Right to Amend Your PHI.

If you believe there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we amend the existing information or add the missing information.

You must provide the request and your reason for the request in writing. We may deny your request in writing if the PHI is correct or if it originated in another facility’s record.

F. The Right to Receive a Paper or Electronic Copy of This Notice. You may ask us to give you a copy of this Notice at any time.

G. The Right to Revoke an Authorization.

If you choose to sign an authorization to release your PHI, you can later revoke that authorization in writing. This revocation will stop any future release of your health information except as allowed or required by law.

H. The Right to be Notified of a Breach.

If there is a breach of your unsecured PHI, we will notify you of the breach in writing.

HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think your privacy rights may have been violated, or you disagree with a decision we made about access to your PHI, you may file a complaint. Please be assured that you will not be penalized and there will be no retaliation for voicing a concern or filing a complaint. We are committed to the delivery of quality health care in a confidential and private environment.

PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you have any questions about this Notice or any complaints about our privacy practices please call the Privacy Officer at (843) 990-4511, or contact in writing: HIPAA Privacy Officer, 109 River Landing Drive, Suite 400, Daniel Island, SC 29492.

CHANGES TO THIS NOTICE We reserve the right to change the terms of this Notice at any time. The changes will apply to all existing PHI we have about you.

EFFECTIVE DATE OF THIS NOTICE This Notice went into effect on April 2, 2023 and was last revised on April 2, 2023.