Privacy Policy

ADA DERMATOLOGY, P.A.

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 THIS NOTICE
CAREFULLY.

Ada Dermatology is required by law to protect the privacy and security of your protected health information (PHI) under the HIPAA Privacy, Security, and Breach Notification Rules. This Notice summarizes our legal duties and your rights regarding PHI. More complete information is available in 45 C.F.R. Part 164, and we will comply with the terms of the Notice currently in effect.

Uses and Disclosures — When We Do Not Need a Written Authorization

We may use or disclose your protected health information (PHI) without your written authorization for certain purposes permitted or required by law, including:

• Treatment: To provide, coordinate, or manage your healthcare and related services (for example, sharing information with other providers involved in your care or sending appointment reminders). 
• Payment: To obtain payment for healthcare services (for example, billing insurers or verifying coverage). 
• Health and Safety: To prevent or lessen a serious threat to your health or safety or the health or safety of others. 
• Legal Requirements: When required by federal, state, or local law (for example, reporting abuse, neglect, or other events that threaten safety). 
• Workers’ Compensation: As authorized by workers’ compensation or similar programs. 
• Public Health: For public health activities, such as reporting certain communicable diseases or adverse events. 
• Oversight Activities: For audits, investigations, inspections, licensure, or other public health oversight. 
• Legal Proceedings: In response to a court order, warrant, subpoena, or other lawful process. 
• Specialized Government Functions: When required for military, national security, or correctional institution purposes. 
• Research: For research purposes, when the use meets applicable legal and ethical requirements. 
• Law Enforcement: In limited circumstances, to assist law enforcement (for example, locating a missing person or reporting certain crimes). 
• Death-Related Uses: To coroners, medical examiners, funeral directors, or organ procurement organizations as necessary to carry out their duties.

If you have questions about any specific disclosure, please contact our Privacy Officer.

Uses and Disclosures — When We Need Your Written Authorization

Other uses and disclosures of your protected health information (PHI) not described elsewhere in this Notice will be made only with your written authorization. Examples include:

• Marketing and Sale of PHI: Uses that constitute marketing or any sale of your PHI. 
• Psychotherapy Notes and Substance Use Disorder Records (SUD): Disclosure of psychotherapy notes or SUD treatment records except as permitted by law. These records generally require a separate, specific authorization and may not be used in legal proceedings against you without your consent or a court order. 
• Other Sensitive Uses: Any other uses or disclosures not otherwise permitted by law or this Notice.

Even for treatment, payment, or health care operations (TPO), the above categories require your written authorization if they involve psychotherapy notes, SUD records, marketing, or sale.

Revocation of Authorization

You may revoke an authorization at any time by submitting a written revocation to the Privacy Officer Contact listed below. Revocation will not affect disclosures already made in reliance on the prior authorization.

Release to Family, Friends, or Others Involved in Your Care

Unless you instruct us otherwise, we may share PHI with a family member, friend, or other person who is involved in your care or payment for your care. We will limit disclosures to information relevant to that person’s involvement. You may object or limit such disclosures by notifying the Privacy Officer.

Other Permitted Uses and Disclosures

We may use or disclose PHI as allowed by 45 C.F.R. §164.512 and other applicable laws (for example, certain public health, law enforcement, and oversight activities). If you have questions about a specific use or need to request restrictions, contact the Privacy Officer below.

Your Rights Regarding Your Protected Health Information

You have the following rights concerning your protected health information (PHI). To exercise any right, submit a written request to the Privacy Officer listed below.

• Right to Request Restrictions: You may ask us to restrict how we use or disclose PHI for treatment, payment, or health care operations. We will consider your request, but we are not required to agree. If we do agree, we will honor the restriction except as required by law.
• Right to Confidential Communications: You may request that we communicate with you by alternative means or at an alternative location (for example, by secure email or at a different phone number). We will accommodate reasonable requests.
• Right to Inspect and Copy: You may inspect and obtain a copy of PHI used to make decisions about your care or payment, including electronic records. We may charge a reasonable, cost-based fee. In limited circumstances, we may deny access; if so, we will provide the reason and information on how to request a review.
• Right to Amend: You may request an amendment of PHI you believe is incorrect or incomplete. We may deny the request if the record was not created by us, is accurate and complete, or for other permitted reasons. If denied, you have the right to submit a statement of disagreement.
• Right to a Paper Copy of This Notice: You may request and receive a paper copy of this Notice at any time.

Changes to This Notice

We may change the terms of this Notice at any time and apply the revised Notice to all PHI we maintain. If we make any material changes, the updated Notice will be posted at our reception desk and will indicate the effective date. You may also request a copy from the receptionist or by contacting our Privacy Officer.

Complaints

If you believe your privacy rights have been violated, you may file a written complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file with us, submit a written complaint to our Privacy Officer. We will promptly investigate your complaint, document our findings, and respond to you. Filing a complaint will not affect your care, and we will not retaliate against you for exercising your rights.

Contact Us

For assistance or to submit a written request or complaint, contact the Privacy Officer:

04/2026