Notice of Privacy Practices

Our Duty to Protect Your Health Information

Tampa Bay Dermatologic Surgery, LLC, doing business as Tampa Mohs Surgery ("we," "us," or "our"), is required by federal and state law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices regarding your health information, and to abide by the terms of the Notice currently in effect. We are required to notify you if a breach of your unsecured health information occurs.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your protected health information without your written authorization:

Uses and Disclosures Requiring Your Written Authorization

For uses and disclosures not described in this Notice, we will obtain your written authorization before using or disclosing your health information. This includes, but is not limited to, most uses of psychotherapy notes (if applicable), marketing purposes, and the sale of your health information. You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health information:

• Right to access: You have the right to inspect and obtain a copy of your health information maintained by our practice, with limited exceptions. We may charge a reasonable fee for copies. You may request your records in an electronic format if we maintain them electronically.
• Right to request amendments: You have the right to request that we amend your health information if you believe it is incorrect or incomplete. We may deny your request under certain circumstances, and we will provide a written explanation if we do.
• Right to an accounting of disclosures: You have the right to request a list of certain disclosures we have made of your health information, excluding disclosures for treatment, payment, healthcare operations, and certain other purposes.
• Right to request restrictions: You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to all restrictions, but we must comply with any agreed-upon restriction. We must also comply with a request to restrict disclosure to a health plan if the disclosure is for payment or healthcare operations and the health information relates to a service you paid for in full out of pocket.
• Right to request confidential communications: You have the right to request that we communicate with you in a specific way or at a specific location. For example, you may request that we contact you only at a certain phone number or address.
• Right to a copy of this Notice: You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
• Right to be notified of a breach: You have the right to be notified if a breach of your unsecured protected health information occurs.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as any health information we receive in the future. We will post the current Notice on our website. You may request a paper copy of the current Notice at any time by contacting our office.

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

To file a complaint with the Office for Civil Rights, visit hhs.gov/hipaa/filing-a-complaint or call 1-800-368-1019 (TDD: 1-800-537-7697).

Privacy Officer Contact Information

To exercise any of the rights described in this Notice, obtain a copy of this Notice, or file a complaint with our practice, please contact: