Notice of Privacy Practices


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that our office offers patients a copy of the Notice of Privacy Practices regarding their Protected Health Information (PHI). This Notice describes how Salar Hazany MD may use and disclose information about you (as a patient of Salar Hazany MD) and how you can access your individually identifiable health information. Please review this Notice carefully. 


A. Our Commitment to Your Privacy: 

Salar Hazany MD strives to maintain the privacy of your individually identifiable health information (i.e., your protected health information or PHI). In conducting our practice, we will create records of your treatment and the services we provide to you. By law, we are required to maintain the confidentiality of health information that personally identifies you. We also are legally required to provide you with this Notice of our legal duties and the privacy practices that our practice upholds concerning your PHI. Federal and state law mandates we follow the terms of the Notice of Privacy Practices.


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


  • How our practice may use and disclose your PHI, 
  • Your privacy rights concerning your PHI,
  • And, our obligations concerning the use and disclosure of your PHI. 


This Notice's terms apply to all records that our practice creates or retains that contain your PHI. Salar Hazany MD reserves the right to amend or revise this Notice of Privacy Practices. Any amendment or revision to this Notice applies to all of your records that our practice has created or maintained in the past and for future records that we may create or maintain. Our practice will post a copy of our most current Notice in a visible location in our office at all times. You may request a copy of our most current Notice at any time. 


B. For Questions About This Notice, Please Contact:

Salar Hazany, M.D. at drsalar@hazanyderm.com


C. Our Practice May Use and Disclose Your PHI in the Following Ways:

The following categories outline the different ways in which we may use and disclose your PHI: 


1. Treatment. Salar Hazany MD may use your PHI to inform your treatment plan, provide you treatment, or provide you with information about treatment. For example, our practice may request you undergo laboratory tests (e.g., blood work or urine tests), and we may use the results to facilitate a proper diagnosis. Our practice may use your PHI to write a prescription for you, or we may disclose your PHI to a pharmacy to order a prescription on your behalf. Many staff members who work for Salar Hazany MD – including, but not limited to, our doctors, physician assistants, medical assistants, back-office managers, and front office managers – may use or disclose your PHI to provide treatment or facilitate your treatment. Our practice may also disclose your PHI to others who may assist in your medical treatment, including, but not limited to, your spouse, children, or parents. Lastly, we may disclose your PHI to other healthcare providers who are not employees of Salar Hazany MD to facilitate your treatment. 


2. Payment. Salar Hazany MD may use and disclose your PHI to collect payment and bill you for the services and items we may provide to you. For instance, we may contact your insurance to certify your eligibility for benefits; we may provide your insurer with details about your treatment to determine if your insurance will cover your treatment costs. Additionally, our practice may use and disclose your PHI to collect payment from third parties that may be financially responsible (e.g., family members or guardians). Moreover, we may use your PHI to bill you for items, services, or treatment directly. Our practice also may disclose your PHI to other healthcare entities to facilitate their billing efforts.


3. Healthcare Operations. Salar Hazany MD may use and disclose your PHI to operate our practice. For example, our practice may use and disclose your PHI, including, but not limited to, the evaluation of our quality of care, the facilitation of business operation evaluations, and the facilitation of future business planning. Lastly, Salar Hazany MD may disclose your PHI to other healthcare providers to assist and inform their healthcare operations.


4. Appointment Reminders. Salar Hazany MD may use and disclose your PHI to contact you to remind you about future appointments. 


5. Treatment Options. Salar Hazany MD may use and disclose your PHI to provide you with information about potential treatment plans. 


6. Health-related Benefits and Services. Salar Hazany MD may use and disclose your PHI to provide you with information about health-related benefits or services that might be of particular interest to you. 


7. Release of Information to Family, Friends, or Other Individuals. Salar Hazany MD may release your PHI to friends, family members, or other individuals involved in patient care or assist in providing care. For instance, a parent or guardian may ask that a babysitter takes their child to the pediatrician's office to treat an infection. In this example, the babysitter may be granted access to the child's PH. 


8. Disclosures Required by Law. Our practice will use and disclose your PHI when federal, state, or local law requires us to do so.


D. Use and Disclosure of Your PHI in Particular and Special Circumstances:

The following categories describe unique circumstances in which our practice may use or disclose your identifiable health information:

 

1. Risks to Public Health. Salar Hazany MD may disclose your PHI to authorities of public health institutions or agencies that are legally authorized to collect PHI information for:


  • Maintaining vital records, including births and deaths, 
  • Notifying the appropriate government agencies and authorities regarding the potential abuse or neglect of adult patients (including, but not limited to, domestic violence); however, Salar Hazany MD will only disclose this information if the patient gives consent or if the law requires the disclosure of such information to a governmental entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with California law,
  • Reporting child abuse or neglect, 
  • Notifying people who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading disease,
  • Reporting potential drug reactions or defects concerning products or devices (including third-party products or devices),
  • Notify people if a product or device has a recall,
  • Preventing, control, or mitigate disease, injury, or disability,
  • Notifying your employer under particular circumstances related to a workplace injury, workplace illness, or medical surveillance.


2. Health Oversight Activities. For activities that are legally authorized, Salar Hazany MD may disclose your PHI to health oversight agencies. Oversight activities include, but are not limited to, investigations, inspections, audits, surveys, licensure, or disciplinary actions; civil, administrative, or criminal procedures or actions; or other government activities necessary to monitor government programs, to evaluate the healthcare system in general, and ensure civil rights law compliance.


3. Lawsuits and Similar Proceedings. In response to a court or administrative order, Salar Hazany MD may use and disclose your PHI if you are involved in a lawsuit or a similar legal proceeding. Salar Hazany MD may also disclose your PHI in response to a discovery request, subpoena, other lawful processes; we will only disclose your PHI in such instances if we have made an effort to inform you of the information request or to obtain an order to protect the requested information.


4. Law enforcement. Salar Hazany may release or disclose PHI if requested by a law enforcement official, including, but not limited to, the following circumstances:


  • With regard to a crime victim in certain circumstances,
  • With regard to a death that is suspected to involve criminal conduct, 
  • With regard to criminal conduct at our office, 
  • In response to warrants, court orders, subpoenas, or other similar legal processes,
  • To identify or locate a suspect, a fugitive, a missing person, or a material witness,
  • Or, in an emergency situation, to report a crime (including, but not limited to, disclosing the location of the crime, the victims of the crime, or the description, the identity, or the location of the suspected perpetrator). 


5. Deceased Patients. Salar Hazany MD may release PHI to a medical examiner or coroner to identify a deceased individual or determine the cause of death. If it is necessary, Salar Hazany MD may also release information to assist funeral directors in performing their duties. 


6. Organ and Tissue Donation. If you are an organ donor, Salar Hazany MD may release your PHI to institutions or organizations that manage organ, eye, or tissue procurement or transplantation, including but not limited to organ donation banks to facilitate organ or tissue donation and transplantation. 


7. Research. Salar Hazany MD may use and disclose your PHI for research in circumstances where we obtain your written authorization. We will obtain your written consent to use your PHI for research purposes except when an Internal Review Board or Privacy Board determines that the waiver of your authorization satisfies each of the following conditions:


(A) The use or disclosure entails no more than a minimal risk to your privacy based on the following conditions: (i) an adequate plan to protect identifiers from improper use and disclosure; (ii) an adequate plan to destroy identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (iii) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted;


(B) The research could not practicably be conducted without the waiver;


(C) The research could not practicably be conducted without access to and use of the PHI. 


8. Serious Threats to Personal or Public Safety or Health. Salar Hazany MD may use and disclose your PHI to reduce or prevent serious health threats to yourself, another individual, or the public. Under exigent circumstances, we will only disclose PHI to a person or organization that can reduce or prevent such health threats.

 

9. Military. Salar Hazany MD may disclose your PHI if you are a member of the U.S. military or foreign military forces (including veterans) and if the appropriate authorities require your PHI. 


10. National Security. Salar Hazany MD may use and disclose your PHI to federal intelligence or national security officials when legally authorized. Salar Hazany MD may also disclose your PHI to federal officials to protect government officials, including the president, other officials, or foreign heads of state, or conduct investigations pertaining to national security.

 

11. Inmates. Salar Hazany MD may use and disclose your PHI to law enforcement officials or correctional institutions if you are an inmate or under the custody of a law enforcement official. It would be necessary to disclose for the aforementioned purposes if: (a) the designated institution provides healthcare services to you, (b) the safety and security of the institution is jeopardized or under a threat that can be addressed by disclosing your PHI, and/or (c) your safety or health, or the safety or health of other individuals can be addressed or protected by the disclosure of your PHI.

 

12. Workers' Compensation. Salar Hazany MD may use and disclose your PHI for workers' compensation and similar programs when necessary.


E. Your Rights Regarding Your PHI:

As a patient of Salar Hazany MD, you have the following rights concerning the PHI that our practice maintains about you:


1. Confidential Communications. You retain the right to request that our practice communicates with you in a particular manner or at a certain location. For example, you may request that we contact you on your mobile phone, rather than on your home phone. To request a certain manner of confidential communication, you must submit a written request to Salar Hazany, MD, that specifies your requested method of contact or the location where you desire to be contacted. Our practice will accommodate requests we deem reasonable. You may but are not required to provide a reason or justification for your request. 


2. Requesting Restrictions. You retain the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or healthcare operations. Additionally, you retain the right to request that we restrict our PHI disclosure to only certain individuals who are involved in your care or involved in the payment for your care, (e.g., family members, friends, or guardians). Our practice is not required to agree to your request; however, if we agree, we are bound by our agreement unless we are otherwise required by law, in emergencies, or when the information is necessary. To request a restriction in our practice's use or disclosure of your PHI, you must make your request in writing to Salar Hazany, MD. Your request must clearly and concisely describe the following information: 


  • The information you want to restrict, 
  • Whether your request entails a limiting our practice's use, disclosure, or both, 
  • And, the circumstances in which, and the individuals to whom, the limits apply.


3. Inspection and copies. You retain the right to inspect and obtain a copy of the PHI that our practice may use to make decisions about your treatment and healthcare, including patient medical records and billing records. To access a copy of your PHI, you must submit your request in writing to Salar Hazany, MD. Salar Hazany MD may charge a fee for the costs associated with your request, including, but not limited to, the costs of copying, mailing, labor, and supplies. Our practice retains the right to deny your request to inspect or receive a copy of PHI in certain limited circumstances; however, you may request to review our denial. Another healthcare professional selected by our practice will conduct any review.


4. Amendment. You may ask our practice to amend your health information if you believe it is incorrect or incomplete. You may request an amendment for the duration your information is kept by or for Salar Hazany, MD. Your amendment request must be written and submitted to Salar Hazany, MD. You must provide us with reasoning that supports your amendment request. If you do not submit your request and reasons supporting your request in writing, our practice will deny your request. Additionally, we may deny your request if you ask us to amend information that we deem (a) accurate; (b) complete; (c) not contained in the PHI held and maintained by or for our practice; (d) not contained in the PHI which you would be permitted to inspect and copy; or (e) not written or created by our practice, unless the individual or entity that created the information is unavailable to amend your information.

 

5. Accounting of Disclosures. All our patients retain the right to request an "accounting of disclosures," which is a list of particular non-routine disclosures our practice has made of your PHI for purposes unrelated to treatment, payment, or operations. The use of your PHI as part of the routine patient care in our practice is not mandated to be documented – for instance, the doctor using your information to discuss treatment with a nurse or medical assistant or sharing information with an insurer to file your insurance claim. You must submit a written request to Salar Hazany, MD to obtain an accounting of disclosures. All accounting of disclosures requests must indicate a time period, which must not be longer than six (6) years from the date of disclosure. The first accounting of disclosures you request within 12 months is $25, and our practice may bill for additional lists within the same 12-month period. We will notify you about the costs of additional requests, and you may withdraw your request before incurring any costs. 


6. Right to a Copy of this Notice. You are entitled to receive either an electronic or a paper copy of this Notice of privacy practices. You may ask our practice to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, please contact Salar Hazany, MD.


7. Right to File a Complaint. If you believe our practice has violated your privacy rights, you may file a complaint with our practice or the Department of Health and Human Services Secretary. To file a complaint with our practice, please contact Salar Hazany, MD with a written submission. You will not be penalized for filing a complaint. 


8. Right to Provide an Authorization for Other Uses and Disclosures. Salar Hazany, MD, will obtain your written authorization for uses and disclosures that are not detailed or identified by this Notice or permitted by law. Any authorization you provide to our practice concerning the use and disclosure of your PHI may be revoked at any time by written submission. Once you revoke authorization, our practice will no longer use or disclose your PHI for reasons outlined in the authorization. Note: our practice is required to retain records of your care.


Please contact Salar Hazany, MD, if you have any questions regarding this Notice or our health information privacy policies.