San Diego Family Dermatology (SDFD) is required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information. This information consists of all records related to your health, including demographic information, either created by San Diego Family Dermatology or received by San Diego Family Dermatology from other healthcare providers. An extended version of our policies is available to you in the purple binders in the waiting room.
Uses and disclosures of your protected health information not requiring your consent:
San Diego Family Dermatology may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment and healthcare purposes. These include, but are not limited to:
Providing, coordinating, or managing healthcare and related services by one or more healthcare providers
Referrals to other providers or health agencies for treatment
Activities undertaken by San Diego Family Dermatology to obtain reimbursement for services provided to you
Contacting healthcare providers and patients with information about treatment alternatives
Protocol development, case management, or care coordination.
When required by law, for example reporting abuse, neglect, domestic violence, or injuries believed to occur as
the result of a crime.
For public health reasons. We are required to report certain infectious diseases to public health authorities.
Workers compensation: we may disclose your health information to insurance or government agencies.
It is our practice to use your information to contact you with appointment reminders. You must notify us if you do not wish to receive appointment reminders or contact in regards to certain treatment alternatives and services.
You have the right to examine your own health record within 3 working days of our receipt of your written request. You have the right to obtain a copy of your own health record within 7 working days of our receipt of your written request and payment. You also have the right to request corrections in your medical record. We may not disclose your protected health information to family members or friends who may be involved with your care without your written permission. Health information may be released without written permission to a parent, guardian, or legal custodian of a child, guardian of an incompetent adult, the healthcare agent designated power of attorney for an incapacitated patient, or the representative or spouse of a deceased patient.
By signing below and giving us your email, you allow us to provide you with access to your electronic Patient Health Record.
PROVIDE PATIENT'S INFO BELOW (if pt is a minor, provide info of parent/guardian)