Running late? Need to cancel or reschedule? Text the office: 702-996-3668
Main Office: 702.255.6647
St. George: 435.214.0399
At Vivida Dermatology, we are committed to treating and using protected health information about you responsibly. This notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective, and applies to all protected health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit VividaDermatology, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for the future care or treatment. This information, often referred to as your health or medical record, serves as a:
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of Vivida Dermatology, the information belongs to you. You have the right to:
Vivida Dermatology is required to:
We reserve the right to change our practices and to make the new provisions effective for all protected health information wemaintain. Should our information practices change, we will mail a revised notice to the address you have supplied us.We will not use or disclose your health information without your authorization, except as described in this notice. We will discontinue using or disclosing your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the practice’s Privacy Officer, Michael Borensteinat 702-255-6647. If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Ave. S.W., Room 509F, HHH Building, Washington, D.C. 20201.
Acknowledgement of Receipt of Privacy NoticeI hereby acknowledge that a copy of the “Notice of Privacy Practices” is available for my review, and I may receive a copy upon request.
I understand that this information shall be in effect following the date of the signature. However, I understand
that this authorization may be revoked at any time by giving oral or written notice to Vivida Dermatology
I understand that once my medical records have been released, Vivida Dermatology cannot retrieve them and
has no control over the use of the previously released copies.