Privacy Practices

Notice of Privacy Practices for the offices of MEDICAL AND SURGICAL DERMATOLOGY, LLC, Columbus, NC, dba Westgate Dermatology, Spartanburg, SC

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review the policy in detail, acknowledge your receipt in your intake forms, and let us know if you would like a paper copy for your records.

This practice is required to:

  • Maintain the privacy of your health information;

  • Provide you with a notice of the legal duties and privacy practices regarding PHI collected and maintained about you;

  • Notify you if you are affected by a breach of unsecured PHI; and

  • Abide by the terms of this notice.

We reserve the right to change our privacy practices and update this Notice accordingly. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well as any PHI we receive in the future. This practice will not use or disclose your PHI without your authorization, except as described in this notice.

Uses and disclosures to carry out treatment, payment, and health care operations

Treatment - This practice may use or disclose your protected health information (PHI) in consultation between health care providers relating to your treatment or for your referral to another health care provider for treatment.

Payment - This practice may use or disclose your protected health information (PHI) for billing, claims management, collection activities, or obtaining payment.

Health Care Operations - This practice may use or disclose your protected health information (PHI) for reviewing the competence or qualifications of health care professionals, or for conducting training programs in which students, trainees, or practitioners participate. This practice may use or disclose your PHI for accreditation, certification, licensing or credentialing activities. This practice may use or disclose your PHI to our business associates who participate in our healthcare operations. These disclosures will only be made after we have a compliant Business Associates Agreement from the business associate. The business associates will comply with the HIPAA rules and assure the compliance of any subcontractor with which they do business.

This practice may use or disclose your protected health information (PHI) to remind you of your appointment, to give you information about your treatment and alternatives, or to discuss other health related services. If you do not wish to receive appointment reminders or health care treatment information, please notify us on the Phone and Email Communications form.

Authorized Uses or Disclosures

A valid authorization requires completion of the HIPAA Privacy Authorization Form in our office. This form is to be completed annually and is available in our office. For any other use or disclosure, you can give us a written, valid authorization. Your authorization must have specific instructions for the use and disclosure you want us to make. You have the right to revoke the authorization in writing at anytime before the information is used or disclosed. We will use and disclose your protected health information when required by federal, state, or local law.

Patient Rights under HIPAA

The following information describes some of your rights under the HIPAA Standards. You should be aware that there may be some situations when there could be limitations placed on your rights. See https://www.hhs.gov/hipaa for more information. There are also uses and disclosures for which an authorization or opportunity to agree or object is not required. See https://www.hhs.gov/hipaa for more information.

Right of an individual to request a restriction of uses and disclosures -This practice will permit and individual to request that we restrict the uses or disclosures of PHI about the individual to carry out treatment, payment or health care operations or to others involved in your care or in your payment. You may restrict certain disclosures of PHI to a health plan for payment or healthcare operation where payment in full is made out of pocket for a healthcare item or service. We will agree to this restriction as long as payment is honored.

Confidential communication requirements -This practice will permit an individual’s reasonable request to receive communications of PHI from our practice by an alternative means or at an alternative location.

Access to PHI -An individual has a right of access to inspect and obtain a copy of PHI about the individual in a designated record set. As permitted by state and federal law, we may charge you a reasonable cost-based fee for a copy of your record. Questions about the fee can be directed to the Practice Administrator.

Amendment of PHI -An individual has the right to have this practice amend PHI in a designated record set for as long as the PHI is maintained in the designated record set.

Accounting of disclosures of PHI -An individual has a right to receive an accounting of disclosures of PHI made by this practice in the past six years. Upon request, an individual may request an accounting annually at no charge.

Right of Breach Notification -An individual has the right to and will receive a notification of any breach of their unsecured PHI as defined by the Breach Notification Rule. This practice will provide notice in accordance to HIPAA standards.

Copy of this Notice -You have a right to a copy of this notice.

Complaints -If at anytime you feel that your rights under HIPAA have been violated, please contact the Privacy Officer/Practice Administrator or the US Department of Health and Human Services.

Privacy Officer/Practice Administrator
Medical and Surgical Dermatology, LLC
52 Hospital Dr., Ste. 3a, Columbus, NC 28722