Home

Dermatology & Surgery Center

Homeopathic Dermatology

Mohs Skin Cancer Center

Ohio Holistic Medicine

The Boutique at Trillium Creek

Doctors & Providers

News, Events & Promotions

New! Trillium Creek Blog

Videos

Current Topics In Skin Care

About Trillium Creek

Employment Opportunities

Contact Trillium Creek

>	>	>

Trillium Creek Dermatology and Surgery Center

Patient Notice of Privacy Practices for Protected Health Information In Relation to the Health Insurance Portability and Accountability Act of 1996 and the Office of Civil Rights

Trillium Creek Dermatology and Surgery Center treats your patient privacy rights in the utmost regard. To ensure this, your medical and protected health information (PHI) will only be disclosed outside of this establishment in these cases:


1.	To your insurance provider(s), including supplemental insurers and for pre-authorizations/referrals.
2.	To your referring physician(s) and to physicians to whom this office refers you.
3.	Only to the phone numbers and contacts you designate, including power of attorney.
4.	Only to entities/persons you authorize with your signature.
5.	For law enforcement and court order purposes, in conjunction with Office of Civil Rights (OCR) mandates.
6.	To law enforcement/medical examiner/coroner in the event of death and in conjuction with OCR mandates.

Furthermore, to make sure that your information remains up to date, Trillium Creek Dermatology and Surgery Center offers this document to you and reviews HIPAA information with all patients at their first appointments and continues to review patient HIPAA profiles periodically.

Minors’ parents are to sign the HIPAA profiles for the patients. If the parents do not present for a minor’s initial visit, Trillium Creek Dermatology and Surgery Center will mark the patient’s account for completion at the next date of service. Once, the minor turns 18 years old, the office will complete HIPAA again, this time with the patient.

You have the right to obtain your entire medical record at any time with your signature allowing Trillium Creek Dermatology and Surgery Center to release your medical record. Note that the office’s authorizations are valid for 90 days from date of signature.

Trillium Creek Dermatology and Surgery Center is required by law to maintain the privacy of your protected health information.

This document will always be available on Trillium Creek Dermatology and Surgery Center’s website, and at the Check-In desk for all patients to review and take home as they choose.

For more information regarding the Health Insurance Portability and Accountability Act of 1996 and your right to file a complaint, please visit http://www.hhs.gov/ocr/privacy/ and the Office for Civil Rights’ homepage, http://www.hhs.gov/ocr/.

For more information regarding Trillium Creek Dermatology and Surgery Center’s privacy policies or to complain regarding this matter, please contact:

Tim Torok, Billing Supervisor
Trillium Creek Dermatology and Surgery Center
5783 Wooster Pike
Medina, Ohio 44256
(330) 725-0569 extension 175
timtorok@tcohio.com