We are pleased to announce that we are the first location in Michigan to offer the Sensus Healthcare SRT-100TM system! Learn More

HIPPA PRIVACY POLICY

INTRODUCTION

At Holland Dermatology, we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. This Notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Each time you visit Holland Dermatology a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

  • Basis for planning your care and treatment,
  • Means of communication among the health professionals who contribute to your care,
  • Legal document describing the care you received.
  • Means by which you or a third-party payer can verify that services billed were actually provided,
  • A tool in educating health professionals,
  • A source of data for medical research,
  • A source of information for public health officials charged with improving the health of this state and the nation,
  • A source of data for our planning and marketing,
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of Holland Dermatology, the information belongs to you. You have the right to:

  • Inspect and copy your protected health information. This would include your medical and billing records and any other records that your physician and the practice uses for making decisions about you.
  • Amend your protected health information. You have the right to request an amendment to your records when you disagree with the content. But at the same time, the doctor has the right to deny those requests.
  • Obtain an accounting of disclosures of your health information. You have the right to know everyone to whom the office discloses record information for purposes other than treatment, payment, and health care operations.
  • Request communications of your health information by alternative means or at alternative locations. You have the right to specify the manner in which you receive communication about your records or upcoming appointments.
  • Request a restriction on certain uses and disclosures of your information. You have the right to restrict who sees your medical records such as, family members or employees of this establishment.
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

OUR RESPONSIBILITIES

Holland Dermatology is required to:

  • Maintain the privacy of your health information,
  • Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
  • Abide by the terms of this notice.
  • Notify you if we are unable to agree to a requested restriction,
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied us or give you a revised notice during one of your visits with us.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions and would like additional information, you may contact th practice at 616-738-3997.

If you believe your privacy rights have been violated, you can file a complaint with the practice's Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services 200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

WE WILL USE YOUR HEALTH INFORMATION FOR TREATMENT.

For example: Information obtained by a nurse, physician, or other member of our establishment will be recorded in your record and used to determine the course of treatment that should work best for you. We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you.

WE WILL USE YOUR HEALTH INFORMATION FOR PAYMENT.

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

WE WILL USE YOUR HEALTH INFORMATION FOR REGULAR HEALTH CARE OPERATIONS.

For example: Members of the medical staff may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

ROUTINE USE AND DISCLOSURES FOR HEALTHCARE OPERATIONS.

  • We may contact you by phone to provide appointment reminders.
  • We may also call you by name in the waiting room when your physician is ready to see you.
  • We may contact you by phone or mail to provide you with test results and to provide information that describes or recommends treatment alternatives regarding your care.

BUSINESS ASSOCIATES

There are some services provided in our organization through contacts with business associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've 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.

WORKERS COMPENSATION

We may disclose health information to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

PUBLIC HEALTH

As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patient, workers, or the public.

HOLLAND  |  ZEELAND  |  GRAND HAVEN  |  SAUGATUCK

OFFICE HOURS

  • Mon8:00am-4:00pm
  • Wed8:00am-4:00pm
  • Fri8:00am-4:00pm

PHONES OPEN

  • Mon - Thu8:00am-4:30pm
  • Fri8:00am-4:00pm

Phones are closed during the lunch hour from 12pm-1pm.

LOCATION

441 120th Ave.

Holland, Michigan 49424

Located between James St. and Lakewood Blvd.

Phone: (616) 738-3997

Fax: (616) 738-3996

Holland Dermatology