Notice of Privacy Practices

Your Rights

You have the right to get a copy of your paper or electronic medical record. You may ask to see or receive a paper or electronic copy of your medical record and other health information we maintain about you. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

You have the right to ask us to correct your medical record. You may ask us to correct health information that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will provide a written explanation within 60 days.

You have the right to request confidential communications. You may ask us to contact you in a particular way, such as at a specific telephone number, email address, or mailing address. We will accommodate reasonable requests.

You have the right to ask us to limit what we use or share. You may ask us not to use or disclose certain health information for treatment, payment, or health-care operations. We are not required to agree to every request. If you pay in full out of pocket for a health-care item or service, you may ask us not to disclose that information to your health insurer for payment or health-care operations, and we will honor that request unless disclosure is required by law.

You have the right to get a list of certain disclosures. You may ask for an accounting of certain disclosures of your health information made during the six years before your request. The accounting does not include disclosures for treatment, payment, health-care operations, or certain other disclosures permitted by law. We will provide one accounting per year at no charge; we may charge a reasonable, cost-based fee for additional requests within 12 months.

You have the right to get a copy of this notice. You may ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.

You have the right to choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your rights and make choices regarding your health information. We will verify that the person has authority before acting on a request.

You have the right to file a complaint. You may complain if you believe your privacy rights have been violated. You may contact our Privacy Contact using the information below. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your choices about what we share. If you have a clear preference, tell us and we will follow your instructions when applicable.

You may tell us whether to share information with family members, close friends, or others involved in your care or payment for your care. You may also tell us whether to share information in a disaster-relief situation. If you are unable to communicate your preferences, such as during an emergency, we may share information when we reasonably believe it is in your best interest or when necessary to lessen a serious and imminent threat to health or safety.

We will not use or share your health information for marketing purposes, sell your health information, or share most psychotherapy notes unless you provide written authorization, except as permitted or required by law. You may revoke an authorization in writing at any time, subject to actions we have already taken in reliance on it.

Our Uses and Disclosures

We may use or disclose your health information for treatment, payment, and health-care operations.

Treatment. We may use or disclose your health information to provide, coordinate, or manage your dermatologic care. For example, we may share information with another physician, a laboratory, pathology provider, pharmacy, hospital, or another health-care professional involved in your treatment.

Payment. We may use or disclose your health information to bill for and receive payment for services. For example, we may share information with your health insurer, Medicare, another payer, or a billing service to determine coverage, obtain authorization, submit a claim, or collect payment.

Health-care operations. We may use or disclose your health information to operate and improve our practice, evaluate the quality of care, conduct training, manage our business, perform audits, address legal matters, and contact you when necessary.

We may also use or disclose your health information as permitted or required by law, including for public-health activities; reporting adverse reactions to medications or product problems; preventing or reducing a serious threat to health or safety; reporting suspected abuse, neglect, or domestic violence when permitted or required by law; health-oversight activities; workers’ compensation claims; law-enforcement requests; judicial or administrative proceedings; research when permitted by law; organ and tissue donation; and disclosures to coroners, medical examiners, or funeral directors.

We will disclose health information when required by federal or California law, including to the U.S. Department of Health and Human Services when it is investigating or determining our compliance with federal privacy law.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will notify you promptly if a breach occurs that may have compromised the privacy or security of your health information.

We must follow the duties and privacy practices described in this Notice and provide you with a copy of it.

We will not use or disclose your health information other than as described in this Notice unless you give us written authorization. If you provide authorization, you may revoke it in writing at any time. Revocation will not affect any action already taken based on your authorization.

We may change the terms of this Notice. Any changes will apply to all health information we maintain about you. The current Notice will be available upon request in our office and on our website at www.beverlyhillsdermatology.com.

Privacy Contact and Complaints

If you have questions about this Notice, want to exercise any of your privacy rights, or wish to file a complaint with our practice, please contact:

Privacy Contact: Boris Zaks, M.D. Boris Zaks, M.D., Inc. 435 N. Roxbury Drive, Suite 408 Beverly Hills, California 90210 Telephone: (310) 552-3376

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by submitting a complaint through its website at www.hhs.gov/hipaa/filing-a-complaint, by calling 1-877-696-6775, or by writing to:

U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201

We will not retaliate against you for filing a complaint.