Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW CAREFULLY.
SKN Dermatology is required by law to provide you with this notice that explains our privacy practices with regard to your medical information and how we may use and disclose your protected health information for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information and we describe them in this notice.
SKN Dermatology is strongly committed to maintaining the privacy of your protected health information and is required to abide by the privacy policies and practices outlined in this notice.
Ways in which we may use and disclose your Protected Health Information (PHI): The following paragraphs describe different ways that we use and disclose your protected health information as provided by the law. We have provided an example for each category, but the examples are not meant to be exhaustive. We assure you that all the ways we are permitted to use and disclose your health information fall within one of the categories.
Treatment: Your health information may be used by staff members or disclosed to other healthcare professionals to evaluate your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
Payments: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you have used to pay for services. For example, your health plan may request and receive information on dates of services, the services provided, and the medical condition being treated.
Health Care Operations: Your health information may be used to support the day-to-day activities and management of SKN Dermatology/Samantha Ghiselli MD, PLLC. For example, information on the services you receive may be used to support budgeting and financial reporting, and activities to evaluate and promote the quality of services.
Law Enforcement: Your health information may be disclosed to law enforcement agencies without your permission to support government audits and inspections to facilitate law enforcement investigations and to comply with government mandates and reporting.
Public Health Reporting: Your health information may be disclosed to the public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your authorization. If you change your mind after authorizing the disclosure of your information, you may submit a written revocation to the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.
Additional uses of information include:
Appointment Reminder: Your health information will be used by our staff to contact you regarding appointment reminders.
Information about treatments: Your information may be used to send you information on the treatment and management of your medical condition that you may find of interest. We may also send you information describing our health-related goods and services that we believe may be of interest to you.
Others Involved in Your Care: When necessary, we will use and disclose your protected health information to a family member, relative, close friend or any other person you identify who is involved in your medical care or payment of care.
Research: We may use and disclose your protected health information to researchers, provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
As Required by Law: We will use and disclose your protected health information as reuired by federal, state or local law authorities. You may request an accounting of such disclosures at any time (refer to An Accounting of Disclosures paragraph on the next page for details).
To Avert a Serious Threat to Public Health or Safety: We will use and disclose your protected health information to a public health authority that is permitted to collect or receive the information for the purpose of controlling disease, injury or disability. If directed by that health authority, we will also disclose your health information to a foreign government agency that is collaborating with the public health authority.
Worker’s Compensation: We will use and disclose your protected health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness in accordance with state law.
Military: Our practice may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
National Security: Our practice may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials in order to protect the President and other officials or foreign heads of state, or to conduct investigations.
Inmates: We will use and disclose your protected health information to a correctional institution or law enforcement official if you are an inmate of that correctional institution or under the custody of the law enforcement official. This information would be necessary for the institution to provide you with health care; protect the health and safety of others; or for the safety and security of the correctional institution.
Your Health Information Rights:
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
A paper copy of this notice. You have the right to receive a paper copy of this notice upon request. You may obtain a copy by asking our receptionist at your next visit or by calling and asking us to mail you a copy.
Inspect and copy. You have the right to inspect and copy the protected health information that we maintain about you in our designated record set for as long as we maintain that information. This designated record set includes your medical and billing records, as well as any other records we use for making medical decisions about you. Any psychotherapy notes that may have been included in records we received about you are not available for your inspection or copying by law. We may charge you a fee for the costs of copying, mailing or other supplies used in fulfilling your request as permitted by state law. If you wish to inspect or copy your medical information, you must submit your request in writing, bearing your signature, and send it to ATTN: Privacy Officer, Skn Dermatology, 501 S Cherry St, Suite 310, Glendale, CO 80246. You may mail in your request, or bring it to our office. We will have 30 days to respond to your request. If any or all of the information is stored off-site, we are allowed up to 60 days to provide the requested information but must inform you of this delay.
Request restrictions. You have the right to request a restriction or limitation of how we use or disclose your medical information for treatment, payment or healthcare operations. For example, you could request that we not disclose information about a prior treatment to a family member or friend who may be involved in your care or payment for that care. Your request must be made in writing to our Privacy Officer. We are not required to agree to your request if we feel it is in your best interest to disclose that information. However, if we do agree, we will comply with your request unless that information is needed for emergency treatment.
An accounting of disclosures. You have the right to request a list of the disclosures of your health information we have made outside of our practice that were not for treatment, payment or healthcare operations. Your request must be made in writing and must state the time period for the requested information. You may not request information for any dates prior to September 15, 2009 (the compliance date for federal regulation), nor for a period of time greater than six years (our legal obligation to retain information). Your first request for a list of disclosures will be free. If you request an additional list within 12 months of the first request, we may charge you a fee for the costs of providing the subsequent list as permitted by state law. We will notify you of such costs and afford you the opportunity to withdraw your request before any costs are incurred.
Request confidential communications. You have the right to request how we communicate with you to preserve your privacy. For example, you may request that we call you only at your work number, or by mail at a special address or postal box. Your request must be made in writing and must specify how or where we are to contact you. We will accommodate all reasonable requests.
File a complaint. If you believe we have violated your medical information privacy rights, you have the right to file a complaint with our practice or directly to the Secretary of Health and Human Services to file a complaint with our practice. You must make it in writing within 180 days of the suspected violation. Provide as much detail as you can about the suspected violation and send it to ATTN: Privacy Officer, Skn Dermatology, 501 S Cherry St, Suite 310, Glendale, CO 80246. You should know that there will be no retaliation for your filing a complaint.
Uses or Disclosures not covered:
Uses or disclosures of your protected health information not covered by this notice or the laws that apply to us may only be made with your written authorization. For example, if you request that we transfer your medical records to another provider, we will ask you to sign an authorization for us to do so. You may revoke your authorization in writing at any time and we will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization before the revocation are not affected by the revocation.
For more information: If you have questions or would like additional information, please contact SKN Dermatology at 303-962-3376.
Effective: 8.1.2024