Effective Date: June 26, 2026
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 us using the phone number or contact form provided at the end of this notice.
Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, plan for future care or treatment, and billing related information. This notice applies to all of the records of your care generated by your healthcare provider.
Our Responsibilities
SINY Dermatology is required by law to maintain the privacy of your health information and to provide you with a description of our legal duties and privacy practices regarding your health information. The current notice will be available from any receptionist in our waiting area. This notice will also serve to advise you as to your rights with regard to your medical information.
How We May Use and Disclose Medical Information About
You
- For Treatment: We may use medical information about you to provide, coordinate, and manage your treatment of services. We may disclose medical information about you to other doctors, nurses, technicians (e.g. clinical laboratories or imaging companies), medical students, or other personnel who are involved with your care. We may communicate your information either orally or in writing by mail or facsimile. We may also provide subsequent copies of various reports that should assist in treating you.
- For Payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company, or a third party payer. For example, we may need to give your insurance company information before it approves or pays for the health care services we recommend for you.
- For Health Care Operations: We may use or disclose, as needed, your health information in order to support our business activities. These activities may include, but are not limited to quality assessment activities, employee review activities, licensing, legal advice, accounting support, information systems support, and conductive or arranging for other business activities. In addition, we may also call you by name in the waiting room when your care provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment by telephone or reminder card.
- Business Associates: These are services provided in our organization through contracts with business associates. Examples include billing collections, document destruction, software support and quality assurance. If these services are contracted, we may disclose your health information to our business associates so that they can perform the job that we have asked them to do and bill you or your third party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information through a written contract.
Other Permitted and Required Uses and Disclosures that May Be Made with Your Consent, Authorization, or Opportunity to Object
We also may use and disclose your health information as set forth below. You have the opportunity to agree or object to the use or disclosure of all or part of your health information in these instances. If you are not present or able to agree or object to the use or disclosure of the health information (such as in an emergency situation), then your clinician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the information that is relevant to your health care will be disclosed.
- Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may release medical information about you to a friend or family member who is involved in your medical care who helps to pay for your care. 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 condition, status, and location.
- Future Communications: We may communicate to you via newsletters, mailings, or other means regarding treatment options, information on health-related benefits or services; to remind you that you have an appointment for medical care; or other community based initiatives or activities in which or facility is participating. If you are not interested in receiving, these materials, please contact us.
Other Permitted and Required Uses and Disclosures that May Be Made without Your Consent, Authorization, or Opportunity to Object
We may use or disclose your eHealth information in the following situations without your authorization or without providing you with an opportunity to object. These situations include:
- As Required by Law: We may disclose health information to the following types of entities, including but not limited to:
- Food and Drug Administration
- Public Health or Legal Authorities charged with preventing or controlling disease, injury, or disability
- Correctional Institutions
- Workers Compensation Agents
- Organ and Tissue Donation Organizations
- Military Command Authorities
- Health Oversight Agencies
- Funeral Directors, Coroners, and Medical Directors
- National Security and Intelligence Agencies
- Protective Services for the President and Others
- Authority that receives reports on abuse and neglect
Law Enforcement/Legal Proceedings: Many states have requirements for reporting which may include population based activities relating to improving health or reducing health care costs, cancer registries, birth defect registries, and others.
Your Health Information Rights
Although your health record is the physical property of the practice that compiled it, you have the right to:
- Breach Notification: You have the right to be notified promptly following a breach of your unsecured protected health information.
- Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. We ask that you submit your request in writing. Usually, this includes medical and billing records. 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. The person conducting the review will not be the person who denied your response. Requests for access to and copies of your medical information must be submitted to SINY Dermatology in writing. The practice charges a $5.00 copying fee for copies of the medical record.
- Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing. You have the right to request an amendment for as long we keep the information. We may deny your request for amendment
and if this occurs, you will be notified of the reason for denial.
- An Accounting of Disclosures: You may have the right to request an accounting of our disclosures of medical information about you except for certain circumstances, including disclosures for treatment, payment, health care operations, or where you specifically authorized a disclosure. SINY Dermatology will provide the first accounting to you in any 12-month period without charge, upon your written request. The cost for subsequent requests for an accounting within the 12-month period will be $5.00
- 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 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 procedure that you had. We ask that you submit these requests in writing. We are generally not required to agree to your restriction request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. If you pay for a service or health care item entirely out-of-pocket, you have the right to request that we do not disclose that information to your health insurance plan for purposes of payment or health care operations, and we are legally required to honor that request unless a law requires us to share that information.
- Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will agree to the request to the extent that is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes. We ask that you submit these requests in writing.
- 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 exercise any of your rights, please obtain the required forms from the practice and submit your request in writing to the practice as indicated below.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us by calling (800) 778-3090 or by contacting the Secretary of the Federal Department of Health and Human Services by calling 1-800-368-1019, or by contacting the Office of Civil Rights regional office. All complaints must also be submitted in writing within 180 days of when you knew that the act or omission complained of occurred. 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 the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we are unable to take back any disclosures we have already made with your permission and we are required to retain our records of the care that we provided to you.
Telephone Number: (800) 778-3090
Use our contact form to submit a request in writing
