Our dermatology practice, Sheard & Drugge, PC, has the responsibility to treat all patient information with the utmost discretion, and confidentiality, and to prohibit improper release in accordance with the confidentiality requirements of the state and federal laws and regulations. Protected health information includes information related to claims, medical records and other personally identifiable records. Disclosure of your protected health information within our dermatology practice is on a need-to-know basis. All employees are required to sign a confidentiality agreement as a condition of employment whereby they agree not to request, use or disclose protected health information of our dermatology practice patients unless necessary to perform their job. Disclosure of your protected health information to persons outside our dermatology practice is done only pursuant to authorization from you or in conjunction with appropriate nondisclosure agreements.

Your Rights

Under our dermatology practice's confidentiality policy, you have the right:

• To inspect and copy records containing patient identifiable health information.
• To approve the release of protected health information about you beyond the uses authorized at the time of enrollment.
• To request our dermatology practice's written procedures regarding your rights to confidentiality.

Providing Consent to Release Protected Health Information

The written authorization you provide at the time of enrollment is valid for all dependents covered by your plan. This authorization allows our dermatology practice to use protected health information for the purposes listed below:

• Submitting Insurance Claims.
• Quality Assurance Reviews.
• Administering your Health Care.
• Complying with government requirements, research, and education.

You may authorize our dermatology practice to release protected health information to a third party for all other purposes by signing a written authorization which you may revoke at any time. Examples of other purposes include: release of information to your attorney or release of information requested by a third party to process a workers' compensation or automobile insurance claim.

If you lack the ability to consent to the release of your protected health information, your legally appointed representative may authorize release of the information and may have access to the information.

Use of Information for Quality Assurance and Outcomes Assessment Activities

Internal use and disclosure of protected health information for quality assurance purposes is limited to those with a need to know based on their job functions. Any disclosure of protected health information to external peer review panels or consultants is done so only after the external party signs a confidentiality agreement.

Inspecting Your Health Information

If you wish to inspect or obtain copies of your protected health information, please send your written request to Sheard and Drugge, PC, 50 Glenbrook Road Suite 1C, Stamford, CT 06902. We will arrange a convenient time for you to visit our office for inspection. We will provide copies to you for a nominal fee. If your request for inspection or copying of your protected health information is denied, we will provide you with the specific reasons and an opportunity to appeal our decision. We are committed to protecting the confidentiality of your health information.

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