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HIPPA Notice

City of Angels Dermatology, its physicians and staff is committed to protecting the privacy of our patients’ protected health information (PHI). We are committed to treating, protecting and using your health information responsibly.

City of Angels Dermatology Inc
Postal mailing address

4712 Admiralty Way #665
Marina del Rey, CA 90292
tel 310 651 8240

This notice describes how your medical information may be used and disclosed and how you may gain access to your medical information. Please review the following carefully so that you will understand your rights as a patient under the federal Health Insurance Portability and Accountability Act (HIPAA).


City of Angels Dermatology documents each medical encounter in your medical record. Your medical record typically contains your medical history as well as history of skin examinations, biopsy/excision results, test/lab results, prescriptions, diagnoses, treatments, and plans for future care. Understanding what is in your medical record and how this information is used and shared will help you to ensure its accuracy and assist you in making decisions about authorizing disclosure of this information to others. If you ever have any questions about your medical record, please feel free to contact our office, or Privacy Officer.

How Your Protected Health Information is Used and Disclosed

We use your medical record on a regular basis in the following ways:

For Treatment: In order to coordinate treatment for surgical services, we may disclose medical information to other healthcare personnel outside this office.
For example: When you are referred to a surgeon for removal of a skin cancer, we will relay details of your pathology to the referring physicians’ office, as well as office notes from your encounter. In order to coordinate care, we will also communicate with your Primary Care Physician and possibly other specialists involved in your care. This communication will be in the form of dictated letters, faxes or verbal communication. The information shared will be the results of surgical procedures and skin exams performed in our office or surgical center. We also share information about you with your pharmacy in order to refill prescriptions, Surgical Center for surgical procedures and pathology and laboratory service providers we use to process skin specimens to give us specific diagnosis to assist us in your care.

For Payment: We provide the minimum health information necessary to bill and collect payment for the health care services we provide. The information is shared with our billing agency Dermatology Solutions.

For Healthcare Operations: In our efforts to run the office smoothly and ensure quality care, we may use your medical information for internal procedures, to train staff. Some disclosures may be made to outside parties, who must agree to protect your privacy in the information they receive from us. An example of an outside party includes, but is not limited to: Compliance programs and Auditing activities from Health Plans.

Appointment Reminders: Our practice may use and disclose the minimum health information necessary to contact you and remind you of an appointment.

Release of Information to Family/Friends: City of Angels Dermatology may release your health information to a friend or family member that is involved in your care, or who assists in taking care of you. For example: A parent or guardian may ask that a babysitter bring their child to our office for treatment of a rash. The babysitter may have access to the child’s medical information.

Without Prior Consent: There are some situations under which we may share information without your prior consent. These include cases of public health risk (e.g. contagious disease such as Small Pox), melanoma tracking (as may be requested by the state registries), personal safety (e.g. suicide risk with certain drugs), or legal action (as requested by law enforcement or court subpoena).

Military: Our practice may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

National Security: City of Angels Dermatology may disclose your health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates: Our practice may disclose your health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Workers’ Compensation: City of Angels Dermatology may release your health information for workers’ compensation and similar programs.

If you would like for us to disclose health information to other parties, for your protection, we will need a separate authorization from you. To inquire about that procedure, contact our office. Regardless of the situation, please be assured that our staff/physicians will always handle your information respectfully. Your Rights Regarding Your Medical Information, even though your medical record is the physical property of City of Angels Dermatology, it is your information. You are entitled to access and control your medical record in the following ways:

  1. You have the right to obtain a paper copy of this notice of privacy practices.
  2. You have the right to request a copy of your medical record.
  3. You have the right to request an amendment if you believe that your information is inaccurate or incomplete.
  4. You have the right to a list of the disclosures we have made of your medical information.
  5. You have the right to restrict which parties have access to your medical information.

To make a specific request or to learn more about these rights, please contact our Privacy Officer.

How to file a complaint if you believe that your privacy rights have been violated.

If you have questions or would like additional information, please contact our Privacy Officer. If you believe your privacy has been violated, in any way, you may file a complaint with our Compliancy Officer. You may also contact the Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201. We will not take any retaliatory action against you if you file a complaint about our privacy practices.

City of Angels Dermatology is required by law to maintain the privacy of our patients’ protected health information (PHI) and to provide our patients with a notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of the notice currently in effect. This notice takes effect on April 14, 2003, and remains in effect until we replace it. We reserve the right to change the policies laid out in this notice. We will post a summary of the current notice in the office with its effective date in the center. You are entitled to a copy of the notice currently in effect.

While you have certain rights in regards to your medical record (the right to request restrictions on access, amend information, and specify certain forms of communication), we are not obligated to fulfill all requests. All such requests will be reviewed by our staff and, if the situation requires, your physician. We welcome all requests, which should be directed to the Privacy Officer.

This notice was published and becomes effective on March 1, 2005.

You may also download a printable version of our HIPAA Notice of Privacy Practices as well.