Dr. Paul Revis

Dermatology • Skin Cancer Surgery • Laser

Specialist in treating diseases of the skin, hair, and nails

American Academy of Dermatology

Certified by American Board of Dermatology

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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 IT CAREFULLY.

This practice (Paul Revis M.D., S.C.) creates a medical record of your health information in order to treat you, receive payment for services delivered, and to comply with certain policies and laws. We are also required by law to provide you with this Notice of our legal duties and privacy practices. In addition, the law requires us to ask you to sign an Acknowledgment that you have received this Notice.

We are required by federal and state law to maintain the privacy of your medical information, and we take this responsibility very seriously. Medical information is called “protected health information” or “PHI”. We are also required by law to notify you if you are affected by a breach of your unsecured PHI.

The following is a list of some of the types of uses and disclosures of PHI that may occur legally:

Treatment: We obtain health information, or PHI, about you in order to properly treat you. We may also send your PHI to another physician, facility, or counselor to which we refer you for treatment, care, procedures, or testing. We may also use your PHI to contact you to tell you about alternative treatments, or other health related benefits we offer. If you have a friend or family member involved in your care, we may give them PHI about you.

Payment: We use PHI to obtain payment for the services that we render. For example, we send PHI to Medicare, Medicaid, and private insurance plans to obtain payment for our services.

Health Care Operations: We use PHI for our general operations. For example, we may use your PHI in determining whether we are providing adequate treatment to our patients. We use PHI to schedule appointment, take messages, and to remind you of an upcoming appointment.

Legal Requirements: We may use and disclose your PHI as required or authorized by law. For example, we may use or disclose your PHI for the following reasons:

Illinois Law: Illinois law has certain requirements that govern the use or disclosure of your PHI. In order for us to release information about mental health treatment, genetic information, your AIDS/HIV status, and alcohol or drug abuse treatment, you will be required to sign a separate Authorization form unless state law allows us to make the specific type of use or disclosure without your authorization.

Your Rights: You have certain rights under federal and state laws relating to your PHI. Some of these rights are described below:

We are required to abide with terms of this Notice currently in effect, however, we may change this Notice. If we materially change this Notice, you can get a revised Notice by stopping by our office to pick up a copy during business hours. Changes to the Notice are applicable to the health information we already have, unless stated otherwise.

EFFECTIVE DATE: 9/23/2013