Notice Of Privacy Practices

As Required by the Privacy Regulations Created as a  Result of the Health Insurance Portability and Accountability Act of  1996 (HIPAA)



Our office is dedicated to maintaining the privacy of your protected health information (PHI).   PHI is information about you, including demographic information, that  may identify you and that relates to your past, present or future  physical or mental health or condition and related health care services.   In conducting our business, we will create records regarding you and  the treatment and services we provide to you.  Our privacy policies and  procedures have long been in practice to maintain our patients’  confidentiality.  These policies and procedures have evolved as the  needs of technology and medical practices change.  These policies and  procedures as outlined in this Notice will continue to be monitored and  may change when appropriate.

The United States Congress has passed the Health  Insurance Portability and Accountability Act.  We are required by law to  provide you with this Notice of our legal duties and the privacy  practices that we maintain in our office concerning your PHI. We are  required by law to maintain the confidentiality of health information  that identifies you.  By law, we must follow the terms of the Notice  that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

  • How we may use and disclose your PHI
  • Your privacy rights in regard to your PHI
  • Our obligations concerning the use and disclosure of your PHI

We may change the  terms of our Notice, at any time.  The new Notice will be effective for  all PHI that we maintain at that time.   You may request a copy of our  most current Notice at any time.  We will post a copy of our current  Notice in our offices in a visible location at all times and on our  website at


Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha , 909 N 96th St, Suite 201, Omaha, NE 68114


The following are examples of the types of uses and  disclosures of your PHI that our office may make under this Notice.   These examples are not meant to be exhaustive, but to describe the types  of uses and disclosures that may be made by our office.

1.  Treatment. Our office will use and disclose your PHI to treat you.  For example,  we may ask you to have laboratory tests (such as blood or urine tests),  and we may use the results to help us reach a diagnosis.  We might use  your PHI in order to write a prescription for you, or we might disclose  your PHI to a pharmacy when we order a prescription for you.  Many of  the people who work for our office – including, but not limited to, our  doctors and nurses – may use or disclose your PHI in order to treat you  or to assist others such as hospitals, specialists, home health agencies  or your primary care physician in your treatment.  Additionally, we may  disclose your PHI to others who may assist in your care, such as your  spouse, children or parents.

a.  Appointment Reminders/Returning Your Phone Call/Treatment Options/Health Related Benefits. Our office will try to disclose only the minimum necessary PHI for our patients while completing these tasks.

b.  Release of Information to Family/Friends. Our office may release your PHI to your spouse, friends and/or family  members that are involved in your care unless you request in writing, as  described below, that such disclosures not be made.

2.  Payment. Your PHI will be used, as needed, to obtain payment for your health  care services.  This may include certain activities that your health  insurance plan may undertake before it approves or pays for the health  care services we recommend for you such as:  making a determination of  eligibility or coverage for insurance benefits, reviewing services  provided to you for medical necessity, and undertaking utilization  review activities.  For example, obtaining approval for a hospital stay  may require that your relevant PHI be disclosed to your health plan to  obtain approval for the hospital admission.  We also may use and  disclose your PHI to obtain payment from third parties that may be  responsible for such costs, such as family members.  Also, we may use  your PHI to bill you directly for services and items.

3.  Health Care Operations. Our office may use and disclose your PHI to operate our business.  As  examples of the ways in which we may use and disclose your information  for our operations, our office may use your PHI to evaluate the quality  of care you received from us, or to conduct cost-management and business  planning activities for our office.

a.  Disclosures Required By Law. Our office will use and disclose your PHI when we are required to do so by federal, state or local law.

b.  Mailings. Our office may use your name and address for mailings regarding  services offered by our office.  If you do not want to receive these  materials, please contact our Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha, 909 N 96th St, Suite 201, Omaha, NE 68114 and request that these mailings not be sent to you.

c.  Business Associates. We will share your PHI with third party “business associates” that  perform various activities (e.g., billing, transcription services) for  the office.  Whenever an arrangement between our office and a business  association involves the use or disclosure of your PHI, we will have a  written contract that contains terms that will protect the privacy of  your PHI.


The following categories describe unique scenarios in  which we may use or disclose your identifiable health information  without your consent, authorization or opportunity to object:

1.  Public Health Risks/Serious Threats to Health or Safety. Our office may disclose your PHI to public health authorities that are  authorized by law to collect such information.   We may use and  disclose your PHI when necessary to reduce or prevent a serious threat  to your health and safety or the health and safety of another individual  or the public.  Under these circumstances, we will only make  disclosures to a person or organization able to help prevent the threat.   Examples:  Centers for Disease Control, Food and Drug Administration,  Social Service Organizations.

2.  Health Oversight Activities. Our office may disclose your PHI to health oversight agencies for  quality accreditation or other activities authorized by law.  Examples:  Tumor Registries, licensure, investigations, inspections, audits,  surveys, or disciplinary actions (such as civil, administrative, and  criminal procedures or actions), or other activities necessary for the  government to monitor government programs, compliance with civil rights  laws and the health care system in general.

3.  Legal Proceedings. Our office may disclose your PHI in the course of any judicial or  administrative proceeding, in response to an order of a court or  administrative tribunal (to the extent such disclosure is expressly  authorized), in certain conditions in response to a subpoena, discovery  request or other lawful process.

4.  Law Enforcement. Our office may also disclose your PHI, so long as applicable legal  requirements are met, for law enforcement purposes.  These law  enforcement purposes include, but are not limited to, (1) legal  processes and other proceedings required by law, (2) limited information  requests for identification and location purposes, (3) requests  pertaining to victims of a crime, (4) suspicion that death has occurred  as a result of criminal conduct, (5) in the event that a crime occurs on  our premises, and (6) medical emergency (not on our premises) and it is  likely that a crime has occurred.

5.  Abuse or Neglect. Our office may disclose your PHI to a public health authority that is  authorized by law to receive reports of child abuse or neglect.  In  addition, we may disclose your PHI if we believe that you have been a  victim of abuse, neglect or domestic violence to the governmental entity  or agency authorized to receive such information.  In this case, the  disclosure will be made consistent with the requirements of applicable  federal and state laws.

6.  Deceased Patients. Our office may release PHI to a medical examiner or coroner to  identify a deceased individual or to identify the cause of death.  We  may also disclose PHI to a funeral director, as authorized by law, in  order to permit the funeral director to carry out his/her duties.

7.  Research. Our office may use and disclose your PHI for research purposes in  certain limited circumstances.  We will obtain your written  authorization to use your PHI for research purposes except when: (a) our  use or disclosure was approved by an Institutional Review Board or a  Privacy Board; (b) we obtain the oral or written agreement of a  researcher that (i) the information being sought is necessary for the  research study; (ii) the use or disclosure of your PHI is being used  only for the research and (iii) the researcher will not remove any of  your PHI from our office; or (c) the PHI sought by the researcher only  relates to decedents and the researcher agrees either orally or in  writing that the use or disclosure is necessary for the research and, if  we request it, to provide us with proof of death prior to access to the  PHI of the decedents.

8.   Military. Our office may disclose your PHI if you are a member of U.S. or  foreign military forces (including veterans) and if required by the  appropriate authorities.

9.  National Security. Our office may disclose your PHI to federal officials for intelligence  and national security activities authorized by law.  We also may  disclose your PHI to federal officials in order to protect the  President, other officials or foreign heads of state, or to conduct  investigations.

10.  Inmates. Our office may disclose your PHI to correctional institutions or law  enforcement officials if you are an inmate or under the custody of a law  enforcement official.  Disclosure for these purposes would be  necessary: (a) for the institution to provide health care services to  you, (b) for the safety and security of the institution, and/or (c) to  protect your health and safety or the health and safety of other  individuals.

11.  Workers’ Compensation. Our office may release your PHI for workers’ compensation and similar programs.


You have the following rights regarding the PHI that we maintain about you:

1.  Confidential Communications. You have the right to request that our office communicate with you  about your health and related issues in a particular manner or at a  certain location.  For instance, you may ask that we contact you at  home, rather than work.  In order to request a type of confidential  communication, you must make a written request to Privacy Officer, (402)330-4555, Dermatology Specialist of Omaha, 909 N 96th St, Suite 201, Omaha, NE 68114 specifying the requested method of contact, or the location where you  wish to be contacted.  Our office will accommodate reasonable requests,  however our office is not required to agree to every or any restriction  that you may request.  You do not need to give a reason for your  request.

2.  Requesting Restrictions. You have the right to request a restriction in our use and/or  disclosure of your PHI for treatment, payment and/or health care  operations.  Additionally, you have the right to request that we  restrict our disclosure of your PHI to only certain individuals involved  in your care or the payment for your care, such as family members and  friends.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when  otherwise required by law, in emergencies, or when the information is  necessary to treat you.  In order to request such a restriction in our  use or disclosure of your PHI, you must make your request in writing to Privacy Officer, (402)330-4555,  Dermatology Specialists of Omaha, 909 N 96th St, Suite 201, Omaha, NE  68114 .  Your request must describe in a clear and concise fashion: (a)  the information you wish restricted; (b)  whether you are requesting to  limit our office’s use, disclosure or both; and (c)  to whom you want  the limits to apply.

3.  Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be  used to make decisions about you, including patient medical records and  billing records, but not including psychotherapy notes.  You must submit  your request in writing to Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha, 909 N 96th St, Suite 201, Omaha, NE 68114 in order to inspect and/or obtain a copy of your PHI.  Our office may  charge a fee for the costs of copying, mailing, labor and supplies  associated with your request.  Our office may deny your request to  inspect and/or copy in certain limited circumstances; however, you may  request a review of our denial.

4.  Amendment. You may ask us to amend your health information if you believe it is  incorrect or incomplete, and you may request an amendment for as long as  the information is kept by or for our office.  To request an amendment,  your request must be made in writing and submitted to Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha, 909 N 96th St, Suite 201, Omaha, NE 68114 .   You must provide us with a reason that supports your request for  amendment.   Our office will deny your request if you fail to submit  your request (and the reason supporting your request) in writing.  Also,  we may deny your request if you ask us to amend information that is in  our opinion: (a) accurate and complete; (b) not part of the PHI kept by  or for our office; (c) not part of the PHI which you would be permitted  to inspect and copy; or (d) not created by our office, unless the  individual or entity that created the information is not available to  amend the information.

5.  Accounting of Disclosures. All of our patients have the right to request an “accounting of  disclosures.”  An “accounting of disclosures” is a list of certain  non-routine disclosures our office has made of your PHI for  non-treatment or operations purposes.  Use of your PHI as part of the  routine patient care in our office is not required to be documented.   Examples: the doctor sharing information with the nurse; or the billing  department using your information to file your insurance claim.  In  order to obtain an accounting of disclosures, you must submit your  request in writing to Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha , 909 N 96th St, Suite 201, Omaha, NE 68114 All requests for an “accounting of disclosures” must state a time  period, which may not be longer than six (6) years from the date of  disclosure and may not include dates before April 14, 2003.  The first  list you request within a 12-month period is free of charge, but our  office may charge you for additional lists within the same 12-month  period.  Our office will notify you of the costs involved with  additional requests, and you may withdraw your request before you incur  any costs.

6.  Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our Notice.  You may ask us  to give you a copy of this Notice at any time.  To obtain a paper copy  of this Notice, contact Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha , 909 N 96th St, Suite 201, Omaha, NE 68114.

7.  Right to File a Complaint. If you believe your privacy rights have been violated, you may file a  complaint with our office or with the Secretary of the Department of  Health and Human Services.  To file a complaint with our office, contact  Privacy Officer, (402)330-4555, Dermatology Specialists of Omaha , 909 N 96th St, Suite 201, Omaha, NE 68114. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8.  Right to Provide an Authorization for Other Uses and Disclosures. Our office will obtain your written authorization for uses and  disclosures that are not identified by this Notice or permitted by  applicable law.  In addition, an authorization may be requested for uses  and disclosures that are identified in this Notice.  Any authorization  you provide to us regarding the use and disclosure of your PHI may be  revoked at any time in writing. After you revoke your authorization, we  will no longer use or disclose your PHI for the reasons described in the  authorization.  Please note, we are required to retain records of your  care.

Again, if you have any questions regarding this Notice or our health information privacy policies, please contact Privacy Officer, (402)330-4555, Dermatology Dermatology Specialists of Omaha , 909 N 96th St, Suite 201, Omaha, NE 68114.