This notice describes how medical information about you may be used and how you can obtain access to this information. Please review carefully.
Each time you visit a healthcare provider, a record of your visit is documented. We understand that information about you and your health care is very personal. Therefore, we strive to protect your privacy. We will only use and disclose your personal health information as allowed by law. We train our staff to be sensitive about privacy and respect the confidentiality of your personal health information. We are required by law to maintain this privacy and to provide you with notice of our legal duties and privacy practices. We will not use or share your information other than as described below unless you provide your consent to do so in writing. If at anytime you change your mind about this consent, simply notify us in writing of the change. We will comply with Florida Law, and will obtain your written consent for certain disclosures if required under state law.
Novem Dermatology, PA uses and discloses health information about you, in order to:
- provide treatment
- we are permitted to use and disclose your medical information to those involved in your treatment (for example: your primary care physician or a specialist).
- bill for your services
- We can use and share your health information, including your contact information, to contact, bill and get payment from you, your guarantor, health plan(s), and any other entities or individuals responsible for payment, and for other payment purposes, including accounting, debt-collection and related financial communication.
- complete administrative operations
- we are permitted to use or disclose your medical information for the purposes of health care operations, which are activities that support this practice and ensure that quality care is delivered.
There are some situations when Novem Dermatology does not need your written authorization before using your health information or sharing it with others as briefly explained below. For more information visit: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
- Law: if required by state or federal law to comply
- Medical Examiner, Coroner, funeral director, Organ Donation: to assist if an individual dies
- Public health and safety: preventing/reporting disease, participating in product recalls, reporting adverse medication reactions, reporting suspected abuse, neglect, or domestic violence, and preventing/reducing a serious threat to anyone’s health or safety.
- Research: as permitted by applicable laws and rules, once there are established protocols by an institutional review board to ensure your privacy. This information will be de-identified.
- Worker’s compensation/Employer: if employer requested your treatment or workers compensation claim made.
- Law enforcement: for law enforcement purposes or with law enforcement official (including for purposes of identifying or located suspects, fugitives, witnesses, or victims of crimes), or certain information relating to inmates, with health oversight agencies for activities authorized by law.
- Military: if you are a member of the military for activities set out by certain military command authorities as required by armed forces services. We may also release your information, if necessary, for national security, intelligence, or protective services activities.
- Business Associates: we may contract with certain outside persons or organizations to perform certain services (ex: billing company) on our behalf. At times it may be necessary for us to provide your protected health information. In such cases, we require these business associates, and any of their subcontractors, to appropriately safeguard the privacy of your information.
- Lawsuits and legal actions: if court or administrative order, or in response to a subpoena or discovery request.
- Appointment reminders, treatment alternative, and other services: We may contact you by telephone, mail, or both to provide appointment reminders, information about treatment alternatives, follow-up after an appointment, or notify you of other health-related benefits and services that may be of interest to you
- Test Results and Other Protected Health Information: In order to communicate with you regarding your health care, we may leave messages on your answering machine or with family or friends who may answer your phone with test results and other health information.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. You have the right to access and obtain paper and/or electronic copies of your personal health information. Requests must be made in writing and signed by you, or your personal representative. We will provide the copy within thirty (30) days of your request. We may charge a reasonable, cost-based fee for a copy of your records in accordance with a schedule of fees under federal and state law. You may also access your medical records using the patient portal. You have a right to request that your health information be amended or corrected. You must submit your request in writing and a reason supporting your requested amendment. We are not obligated to make all requested amendments but will give each request careful consideration. Please note that if we do grant your request, we may not delete information already in the medical record.
You have the right to request how we contact you by alternative means or locations (for example, which phone number, email, mailing address etc.). Please submit confidential communication requests in writing. You have the right to request a restriction on certain disclosures of your information to your health plan, only when you or someone on your behalf, other than your health plan, pays for the items or services in full. If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your insurer. These requests must be made in writing. You have the right to request a list of those with whom we have shared your information, except for disclosures made for the purposes of treatment, payment, and health care operations. Requests must be made in writing, signed by you or your legal representative. The list will only include disclosures made in the six years prior to the date on which the accounting is requested. The first accounting (within a 12 month period) is free; for additional requests within that period, you will be charged a reasonable, cost-based fee. You may choose someone to act on your behalf (i.e. legal guardian, medical power of attorney). A copy of this document must be provided to the privacy officer.
For certain health information, you have the right to request restrictions about what we share and how it is used for treatment, payment, or operations. We do not have to agree to your restriction request, unless otherwise described in this notice, but will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. To request a restriction, submit the following in writing: (a) the information to be restricted, (b) what kind of restriction you are requesting (i.e. on the use of information, disclosure of information or both), and (c) to whom the limits apply. Please send the request to the address and person listed below. You have both the right and choice to tell us to share information or limit disclosure with your family, close friends, or others involved in your care and share information in a disaster relief situation.
Unless you give us written permission, except as otherwise provided in this notice or applicable law, we will not sell your information or use or share your information for marketing purposes. We will not use or disclose your health information without written authorization from you or your legal representative for: psychotherapy notes, HIV+/AIDS status, drug/alcohol abuse records, marketing purposes, disclosures that constitute the sale of your PHI, or other uses and disclosure not described in this notice. We are required to notify you in writing of any breach of your unsecured personal health information without unreasonable delay (no later than 60 days after we discover the breach). You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice at your written request.
If you feel your rights have been violated, you may file a complaint with the Novem Dermatology Privacy Officer as per below or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Neither Novem Dermatology nor any of its personnel shall retaliate against you for filing such a complaint. The Secretary of the Department of Health and Human Services can be contacted at:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W. Washington, DC 20201 1-877-696-6775 www.hhs.gov/ocr/privacy/hipaa/complaints/
If you would like to request a copy of this notice, or have questions, please contact our privacy officer as described below.
For more information: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html
Attn: Privacy Officer
17653 N Dale Mabry Hwy
Lutz, FL 33548
Novem Dermatology reserves the right to change, modify or otherwise revise this Notice at any time. In addition, Novem Dermatology reserves the right to make the revised or changed Notice effective for the health information we already have in our possession regarding you as well as any information we receive in the future. We will post a copy of the current Notice in the Novem Dermatology office.
The Acknowledgement of Receipt of this document is signed during the initial consents and questionnaires. This Consent will be placed in your medical chart and will become part of the permanent medical record documentation.
Effective date of this Notice is June 6, 2021.
This Notice of Privacy Practices applies to the following organization:
Novem Dermatology, PA
17653 N Dale Mabry Hwy
Lutz, FL 33548