ASSOCIATES IN DERMATOLOGY AND CUTANEOUS SURGERY
NOTICE OF PRIVACY PRACTICES

Effective 4/14/03
If you have any questions about this Notice, please contact the Privacy Officer for the Group, Mina Meyer, at (314) 576-1411.
WHO WILL FOLLOW THIS NOTICE
This Notice describes the Group's practices and that of:

  • all employees
  • staff
  • other of the Group's personnel

OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Group's office. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the Group.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:

  • Make sure that medical information 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 this Notice currently in effect

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians or other Group personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside of the Group who may be involved in your medical care after you leave the office, such as family members, referring physicians, home health care nurses, clergy or others we use to provide services that are part of your care. For Payment: We may use and disclose medical information about you so that the treatment and services you receive at the Group's office may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received at the office so your health plan will pay us or reimburse you for the 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. This may include, without limitation, history and physical, treatment summary or any other reports.
For Heath Care Operations: We may use and disclose medical information about you for the Group's health care operations. These uses and disclosures are necessary to run the Group's practice and ensures that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many Group patients to decide what additional services the Group should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians and other Group personnel for review and learning purposes. We may also combine the medical information we have with medical information from other providers, including physicians and hospitals, to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
Business Associates: There may be some services provided within the Group through contracts with Business Associates. Examples include our lawyers, accountants, billing companies, management companies, equipment vendors, and consultants. When these services are contracted, we may disclose some or all of your health information to our Business Associates so that they can perform the job we've asked them to do. To protect your health information, however, we require the Business Associates to appropriately safeguard your information in compliance with the HIPAA privacy laws.

Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health Related Benefits and Services: We may use and disclose medical information to tell you about health related benefits or services that may be of interest to you.

Individuals Involved In Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends that your are in the hospital and your condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your location, status and condition.

We will not provide this information or even acknowledge your presence in the Hospital at your request. Contact the Privacy Officer at (314) 576-1411 if you do not want this information provided.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.

Food and Drug Administration: As required by law, we may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

As Required by Law: We will disclose medical information about you when required to do so by federal, state or local law.

To Avert A Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosure would only be to someone able to help prevent the threat.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU -
SPECIAL SITUATIONS

Military: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers Compensation: We may release medical information about you for workers' compensation or similar programs to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law. These programs provide benefits for work-related injuries or illness.
Public Health Risks: As required by law, we may disclose medical information about you for public health activities. These activities generally include the following: ¨ to prevent or control disease, injury or disability; ¨ to report births and deaths; ¨ to report child abuse or neglect; ¨ to report reactions to medications or problems with products; ¨ to notify people of recalls of products they may be using; ¨ to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and ¨ to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities and Registries: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure surveys. These activities are necessary for the government to monitor health care systems, government programs, and compliance with civil rights laws. We may disclose medical information to certain registries in accordance with applicable law. Such registries are intended to improve patient outcomes.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official: ¨ in response to a court order, subpoena, warrant, summons or similar process; ¨ to identify or locate a suspect, fugitive, material witness, or missing person; ¨ about the victim of a crime, or, if under certain limited circumstances, we are unable to obtain the person's agreement; ¨ about a death we believe may be the result of criminal conduct; ¨ about suspected criminal conduct at The Group; 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 may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of The Group to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities: We may release medical information about you to authorized federal officials so they may conduct lawful intelligence and counter-intelligence and other national security activities.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:

Right To Inspect and Copy: You have the right to inspect and have copied medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and have copied medical information that may be used to make decisions about you, you must submit your request in writing to our Privacy Officer. Call Mina Meyer at (314) 576-1411 for more information about written requests. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Group will 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 Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Group.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer at 222 S. Woods Mill Road, Ste. 710N, Chesterfield, MO 63017. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not 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 us, unless the person or entity that created the information is no longer available to make the amendment;
  • is not part of the medical information kept by or for the Group
  • 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 an 'accounting of disclosures'. This is a list of the disclosures we made of medical information about you. To request this list or 'accounting of disclosures', you must submit your request in writing to the Privacy Officer at 222 S. Woods Mill Road, Ste. 710N, Chesterfield, MO 63017. Your request must state a time period that may not be longer than six years and may not include dates before 4/14/03. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period is free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right To Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or in the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the Privacy Officer at 222 S. Woods Mill Road, Ste. 710N, Chesterfield, MO 63017. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example disclosures to your spouse. We will provide you with written notice if we do not agree to your request. 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 certain locations. For example, you can ask that we only contact you at work or by mail.

To request confidential communications in a certain way or at a certain location, you must make your request in writing to the Privacy Officer at 222 S. Woods Mill Road, Ste. 710N, Chesterfield, MO 63017. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right To A Paper Copy of This Notice: 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. To obtain a paper copy of this Notice, please call the Privacy Officer at (314) 576-1411.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the Group's office. The Notice will contain on the first page, in the top right hand corner, the effective date. In addition, each time you register at the Group's offices for treatment or health care services, we will offer you a copy of the current Notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Group or with the Secretary of the Department of Health and Human Services. To file a complaint with the Group, contact the Privacy Officer at (314) 576-1411. All complaints must be submitted in writing.
You will not be penalized for filing a complaint
OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this Notice or other laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made in reliance upon your current authorization, and that we are required to retain our records of the care that we provided to you.

 

Questions or Comments?
We encourage you to contact us whenever you have an interest about our services.

Call (314) 576-1411

222 S. Woodsmill Rd., Suite 710N
Chesterfield, MO 63017