Notice of Privacy Practices
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.
This notice applies to health information maintained by SB Dermatology, PLLC d/b/a Elite Dermatology Collective ("Elite").
Your rights
Access and copies. You may inspect or request an electronic or paper copy of your medical record and other health information we maintain about you. We generally respond within 30 days, subject to permitted extensions, and may charge a reasonable, cost-based fee allowed by law.
Correction. You may ask us to amend information you believe is inaccurate or incomplete. We may deny certain requests and will explain a denial in writing.
Confidential contact. You may request that we contact you by an alternative method or at another location. We will accommodate reasonable requests.
Restrictions. You may ask us to limit certain uses or disclosures for treatment, payment, or health care operations. We generally need not agree. If you pay in full out of pocket for a service or item and ask us not to disclose information about it to your health plan for payment or health care operations, we must agree unless disclosure is required by law.
Accounting. You may request an accounting of certain disclosures made in the previous six years. Some disclosures, including many for treatment, payment, or operations, are excluded. One accounting in a 12-month period is free; an additional accounting may carry a reasonable, cost-based fee.
Copy of notice. You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically.
Representative. A person with legal authority to act for you may exercise your privacy rights; we may verify that authority. Special rules may apply to minors and to information protected by other laws.
Complaints. You may complain to our Privacy Officer or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you.
Your choices
You may tell us your preferences for sharing relevant information with family, friends, or caregivers involved in your care or payment, and for disaster-relief communications. If you cannot express a preference, we may share information when permitted by law and in your best interest. You may ask us to limit communications to particular contacts or methods.
We will obtain written authorization where required, including for most uses of psychotherapy notes, sales of protected health information, and certain marketing uses. We will obtain appropriate written authorization before using identifiable patient photographs, videos, or testimonials for public advertising or social media. You may revoke an authorization in writing, except to the extent we have already relied on it.
How we use and disclose health information
Treatment. We may use and share information to provide or coordinate your care. For example, we may send a biopsy specimen and clinical history to a dermatopathology laboratory or discuss treatment with your referring clinician.
Payment. We may use information to collect payment and administer accounts. Elite is a direct-pay practice and generally does not submit insurance claims for its professional services. At your request, we may provide an itemized receipt or superbill. Outside laboratories, pharmacies, and other providers may bill separately.
Health care operations. We may use and disclose information for quality improvement, staff training, administrative work, compliance, and practice management. For example, we may review charts to improve follow-up procedures.
Business Associate Providing Only Administrative Services: We may share PHI with a Business Associate Entity that provides only Administrative Services to Elite Dermatology Collective. A Business Associate Agreement will be in place for any such entity.
Other legally permitted or required uses. These may include public health and safety reporting, suspected abuse or neglect reporting, health oversight, lawful judicial or administrative proceedings, certain law enforcement requests, workers’ compensation, organ donation, coroners and funeral directors, research when legally permitted, and averting serious threats to health or safety. We may disclose information when otherwise required by law. Additional legal conditions and safeguards apply to these disclosures.
Communications. We may contact you regarding appointments, test results, prescriptions, care coordination, billing, and other care-related matters using phone, voicemail, secure messaging, portal, text, or email as permitted by law and your communication preferences.
Additional Protections for Certain Health Information. Certain health information may be subject to additional confidentiality protections under federal or Arkansas law, including substance use disorder treatment records protected by 42 CFR Part 2.
To the extent Elite Dermatology Collective receives or maintains records protected by 42 CFR Part 2, we will comply with applicable restrictions on their use and disclosure.
These records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against a patient without the patient’s specific written consent or an appropriate court order accompanied by a subpoena or other legal mandate, as required by law.
When Part 2 records are lawfully disclosed for treatment, payment, or healthcare operations pursuant to the required consent, certain subsequent disclosures may be permitted under HIPAA. Other applicable federal and Arkansas confidentiality protections will continue to be observed.
Arkansas SHARE. Elite does not currently participate in the Arkansas State Health Alliance for Records Exchange (SHARE).
Our legal responsibilities
We must maintain the privacy and security of protected health information, provide this notice, follow the notice currently in effect, and notify affected individuals following a reportable breach of unsecured health information. We will not use or disclose information other than as described here unless authorized in writing or otherwise permitted or required by law.
We reserve the right to change this notice and apply the revised terms to all information we maintain, including information collected before the change. The current notice will be available upon request, at our office, and on our website.
Contact and complaints
Emily Staggs, DCNP | HIPAA Privacy Officer
Elite Dermatology Collective
324 N College Avenue, Room 201, Fayetteville, AR 72701
Mailing: PO Box 8431, Fayetteville, AR 72703
Phone: 479-287-9978 | Email: info@elitedermcollective.com
Website: www.elitedermcollective.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/hipaa/filing-a-complaint/ or 1-877-696-6775. We will not retaliate.