Fill out the form below if you are an existing patient here at Knoxville Institute of Dermatology and need to have your information updated.
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This Act gives you, the patient, the right to understand and control how your personal health information (“PHI” is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we prepared this explanation of how we are to maintain this privacy of your health information and how we may disclose your personal information.
We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operation.
We may also create and distribute de-identified health information by removing all reference to individually identifiable information.
We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services.
The following use and disclosures of PHI will only be made pursuant to us receiving a written authorization from you:
You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken across relying on your authorization. You may have the following rights with respect to your PHI.
If you have paid for services “out of pocket”, in full, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
This notice is effective as of September 24, 2014 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPPA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practice from our office.
You have recourse if you feel that your protections have been violated by our office. You have the right to file a formal, written complaint with the office and with the Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.
Feel free to contact the Practice Compliance Officer, in person or in writing, for more information at 6516 Kingston Pike, Knoxville, TN 37919.