Policies

Houston, Texas

DermSurgery Laser Center

NOTICE OF PRIVACY PRACTICES

EFFECTIVE DATE OF NOTICE: April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice, please contact our Administrator at (713) 791-9966.

OUR COMMITMENT TO YOUR PRIVACY

The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 contains provisions that give you greater access to your health information - your medical record, your billing and insurance records, and any other information our practice might collect from you to provide healthcare services to you or to receive payment for the healthcare services rendered. In essence, HIPAA provides you with greater control over how your health information is used and disclosed.

HIPAA also outlines the responsibilities that healthcare providers and insurance plans have to keep your health information confidential. For example, HIPAA requires we provide you with this Notice and that we follow its terms and the commitments we make in it.

DermSurgery Associates, PA is dedicated to maintaining the privacy of your health information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. These records are our property. However, as required by law, we will:

• Maintain the confidentiality of your health information.
• Provide you with this Notice of our legal duties and privacy practices concerning your health information.
• Follow the terms of our Notice of Privacy Practices in effect at the time.

In addition, unless it is specifically provided for by state or federal law, we may not use or disclose your health information without your written authorization. You may revoke your authorization at any time.