Our dermatology practice, Sheard
& Drugge, PC, has the responsibility to treat all patient
information with the utmost discretion and confidentiality,
and to prohibit improper release in accordance with the confidentiality
requirements of state and federal laws and regulations.
Protected health information includes information related to
claims, medical records and other personally identifiable records.
Disclosure of your protected health information within our dermatology
practice is on a need-to-know basis. All employees are required
to sign a confidentiality agreement as a condition of employment
whereby they agree not to request, use or disclose protected
health information of our dermatology practice patients unless
necessary to perform their job. Disclosure of your protected
health information to persons outside our dermatology practice
is done only pursuant to authorization from you or in conjunction
with appropriate nondisclosure agreements.
Under our dermatology practice's confidentiality
policy, you have the right:
- To inspect and copy records containing patient
identifiable health information.
- To approve the release of protected health
information about you beyond the uses authorized at the time
- To request our dermatology practice's written
procedures regarding your rights to confidentiality.
Providing Consent to Release Protected
The written authorization you provide at the time
of enrollment is valid for all dependents covered by your plan.
This authorization allows our dermatology practice to use protected
health information for the purposes listed below:
- Submitting Insurance Claims
- Quality Assurance Reviews
- Administering your Health Care
- Complying with government requirements, research,
You may authorize our dermatology practice to
release protected health information to a third party for all
other purposes by signing a written authorization which you
may revoke at any time. Examples of other purposes include:
release of information to your attorney or release of information
requested by a third party to process a workers' compensation
or automobile insurance claim.
If you lack the ability to consent to the release
of your protected health information, your legally appointed
representative may authorize release of the information and
may have access to the information.
Use of Information for Quality Assurance
and Outcomes Assessment Activities
Internal use and disclosure of protected health
information for quality assurance purposes is limited to those
with a need to know based on their job functions. Any disclosure
of protected health information to external peer review panels
or consultants is done so only after the external party signs
a confidentiality agreement.
Inspecting Your Health Information
If you wish to inspect or obtain copies of your
protected health information, please send your written request
to Sheard and Drugge, PC, 50 Glenbrook Road Suite 1C, Stamford,
CT 06902. We will arrange a convenient time for you to visit
our office for inspection. We will provide copies to you for
a nominal fee. If your request for inspection or copying of
your protected health information is denied, we will provide
you with the specific reasons and an opportunity to appeal our
decision. We are committed to protecting the confidentiality
of your health information.