Privacy Policy

Privacy Policy

Last Updated: March 14th, 2025

IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911

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.

During your treatment at Tareen Dermatology, P.A. (“Tareen Dermatology” or “we”), doctors, nurses,
and other caregivers may gather information about your medical history and your current health. This
Notice of Privacy Practices explains how we may use this information and share it with others. It also
explains your privacy rights regarding this kind of information.
The terms of this Notice of Privacy Practices apply to the protected health information about you that is
created or received by Tareen Dermatology (your “protected health information” or “information about
you”). We are required by law to: maintain the privacy of your protected health information; give you
this Notice of Privacy Practices, which explains our legal duties and privacy practices with respect to
information about you; follow the terms of our Notice of Privacy Practices that is currently in effect; and
promptly notify you if there is a breach of your unsecured protected health information.
Your protected health information may be used and disclosed for the following purposes:
 Treatment: We may use and disclose information about you to provide, coordinate, and manage
your care and treatment. For example, your provider may share information about you with another
provider during a consultation or when making a referral.
 Payment: We may use and disclose information about you when billing or collecting payment for
the treatment and services provided to you, and for other payment purposes. For example, we may
give your health insurer information about a treatment that you received at Tareen Dermatology so
the insurer will pay us, or reimburse you, the cost of the treatment.
 Health Care Operations: We may use and disclose information about you for our health care
operations. Health care operations are those activities that are necessary to run Tareen Dermatology
and help ensure that all our patients receive quality care. For example, we may use and disclose
information about you when: working with an outside organization that certifies or licenses our
clinics or providers; reviewing the quality of your treatment and services; conducting business
planning and management activities; and evaluating and working to improve the performance of the
providers and staff who are responsible for the services provided to you and our other patients.
 To People Assisting in Your Care. We may disclose information about you to your family
members, close friends or others identified by you who are involved in your care or helping you pay
for your care, to the extent permitted by law. If you can make your own health care decisions, we
will ask your permission before disclosing your information to these individuals. If you are unable
to make your own health care decisions, we will disclose relevant information to your family
members or other responsible persons if we believe, in our professional judgment, that it is in your

best interest to do so. For example, we may disclose limited medical information about you to a
your family member so that they can pick up a prescription for you, or in an emergency when the
disclosure is necessary to help protect your health and wellbeing.
 Research: We may use and disclose information about you for research purposes, subject to the
confidentiality provisions of state and federal law. For example, we may disclose information about
you to an external researcher when you specifically authorize this disclosure in writing or when the
research study’s privacy protections have been reviewed and approved by an Institutional Review
Board or other authorized body. In some cases, external researchers may be permitted to use
information about potential research participants in a limited way to evaluate the proposed study’s
merit or the potential participants’ suitability for the study. When required by law, we will make a
good faith effort to obtain your consent or refusal to participate in a research study before releasing
any identifiable information about you to external researchers.
 As Required by Law: We will disclose information about you when required to do so by federal,
state or local law.
 To Avert a Serious Threat to Health or Safety: We may use and disclose information about you
when necessary to prevent or lessen a serious and imminent threat to the health and safety of you,
another person, or the public. Any such disclosure may only be made to someone who is able to
help prevent the threat, and will be made in accordance with applicable state and federal law. These
laws include, but are not limited to, the laws imposing a “duty to warn” on certain types of health
care providers.
 To Business Associates: Some services and activities of Tareen Dermatology are provided through
contracts with business associates. Examples of business associates include Tareen Dermatology’s
attorneys and accountants, medical record and practice management software vendor, management
consultants, quality assurance reviewers, and billing and collection agencies. We may disclose
information about you to our business associates so they can perform the job we have contracted
with them to do. To protect the disclosed information, each business associate must sign a privacy
agreement that requires them to appropriately safeguard the disclosed information.
Your protected health information may be released in the following special situations:
 Organ and Tissue Donation: We may release limited information about you to organizations that
help locate, procure, and transplant organs and tissue, as necessary to facilitate organ or tissue
donations that you agreed to make, if any.
 Military and Veterans: If you are a member of the armed forces, we will release information about
you to military command authorities or foreign military personnel when required to do so by law or
with your written consent.
 Workers’ Compensation: Workers’ compensation programs provide benefits for work-related
injuries and illnesses. We may release information about you to your employer or your employer’s
workers’ compensation insurer without your specific consent, so long as the released information is
related to a workers’ compensation claim and made in accordance with applicable law.

 Public Health: We may release information about you to public health authorities or other
authorized persons or entities to help carry out certain activities relating to public health, including
the following activities:
– To prevent or control disease, injury, disability, birth, or death;
– To report child abuse or neglect, or the abuse of a vulnerable adult;
– To report reactions to medications or problems with regulated products or devices, or other
activities related to the quality, safety, or effectiveness of regulated products or devices, to the
FDA and other responsible authorities;
– To locate and notify persons of recalls of products they may be using; or
– To locate and notify persons who may have been exposed to a communicable disease or may be
at risk for contracting or spreading a disease or condition.
 Health Oversight Activities: We may disclose information about you to a health oversight agency
for health oversight activities that are authorized by law. These activities are necessary for the
government to monitor the health care system, government programs, and compliance with certain
laws. Examples of these activities include government audits, investigations, inspections, and
licensure and disciplinary activities.
 Lawsuits and Other Disputes: We may use and disclose information about you when required by a
court or administrative tribunal order. We may also use and disclose information about you in
response to a subpoena, discovery request, or other legal process, when required by law, or with your
written consent.

 Law Enforcement: We may release your medical information to a law enforcement official in
response to a valid court order or with your written consent. We may also release information to law
enforcement that is not a part of the health record (in other words, non-medical information) for the
following reasons:
– To identify or locate a suspect, fugitive, material witness, or missing person;
– If you are the victim of a crime and we are unable to obtain your agreement, to the extent
permitted by law;
– About a death we believe may be the result of criminal conduct;
– About a crime or suspected crime committed at our offices or clinics; and
– In emergency circumstances, to report: a crime, the location of the crime or victims, or the
identity, description or location of the person believed to have committed the crime.
We are also required to report certain types of wounds, such as gunshot wounds and some burns. In
most cases, such reports will include only the fact of injury, and any additional disclosures would
require a valid court order or your written consent.

 Coroners, Medical Examiners, and Funeral Directors: We may release information about you to
a coroner or medical examiner in the case of certain types of death, and in response to an authorized
request by a coroner or medical examiner. For example, we may release certain information to a
coroner or medical examiner to help identify a decedent or the cause of death. We may also release
the fact of death and certain demographic information to funeral directors, as necessary for them to
carry out their professional duties.

 National Security and Intelligence Activities; Protective Services for the President and Others:
We will disclose information about you to authorized federal officials for intelligence,

counterintelligence, and other national security activities only as required by law or with your
written consent. We will also disclose information about you to authorized federal officials so they
may protect the President, other authorized persons, or foreign heads of state, or conduct special
investigations only as required by law or with your written consent

 Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement
official, we will release information about you to a correctional institution or law enforcement
official only as required by law or with your written consent.

 Marketing and Sale of Private Medical Information: We will not use, disclose, or sell
information about you for marketing purposes without your written consent.
You have the following rights regarding the protected health information that we maintain about
you:

 Right to Access, Inspect and Copy: You have the right to access, inspect and receive a copy of the
health information that is used to make decisions about your care. Typically, this includes the
medical and billing records maintained by Tareen Dermatology, but does not include psychotherapy
notes or information gathered or prepared for a civil, criminal, or administrative proceeding.
All access, inspection, and copy requests must be made in writing and sent to our Privacy Officer,
whose contact information is included at the end of this Notice of Privacy Practices. If you request a
copy of your protected health information, we may charge you for a reasonable fee for the supplies,
postage and labor used to meet your request, to the extent permitted by state and federal law. If we
maintain this information in an electronic health record, you have the right to receive your copy in
electronic form. You may also direct us to provide your protected health information directly to an
entity or person designated by you in writing.

We may deny your request to inspect and copy your protected health information in certain very
limited circumstances. For example, we may deny you access to this information if your provider
believes this access will be harmful to your health, or could cause a threat to others. In such cases,
we may supply the information to a third party who may release the information to you. If you are
denied access to your protected health information, you may request a review of this denial, and
another licensed health care professional will review your request and the denial. This professional
will be chosen by Tareen Dermatology and will not be the person who denied your request. We will
comply with the outcome of the review.

 Right to Request Amendment: If you believe the health information that we maintain about you is
inaccurate or incomplete, you have the right to ask us to amend that information for as long as it is
kept by Tareen Dermatology. All amendment requests must be submitted to our Privacy Officer in
writing, and must include a reason for why you believe the information is inaccurate or incomplete.
The contact information for our Privacy Officer is included at the end of this Notice of Privacy
Practices.

We may deny your request if it is not made in writing or does not include a reason to support your
request. We may also deny your request if the information you would like amended: was not created
by Tareen Dermatology (unless the person or entity that created the information is no longer
available to make the amendment); is not kept by or for Tareen Dermatology; is not part of the information you would otherwise be permitted to inspect and copy; or is already accurate and
complete.

 Right to an Accounting of Disclosures: You have the right to request an “accounting” or list of
certain disclosures of your information made by Tareen Dermatology. This list will not include
disclosures: made for treatment, payment, and health care operations purposes; that you authorized
or made on your own behalf; made for certain notification purposes (including national security,
intelligence, correctional, and law enforcement purposes); and certain other disclosures.
All accounting of disclosures requests must be made in writing and sent to our Privacy Officer,
whose contact information is included at the end of this Notice of Privacy Practices. In your written
request, you must state the time period covered by your request, which may be up to six years from
the date of your request. The first accounting that you request in a 12-month period will be free, but
we may charge you for the reasonable costs incurred by us when providing an additional
accounting(s) within the same 12-month period. We will tell you about the costs in advance, and
you may choose to cancel your request at any time before we incur these costs.
 Right to Request Restrictions: You have the right to request a restriction or limitation on the
medical information we use or disclose about you. All restriction requests must be made in writing
and sent to our Privacy Officer, whose contact information is included at the end of this Notice of
Privacy Practices. In your request, you must tell us (1) the information you want to restrict; (2) how
you want to restrict the information (for example, restricting use to this office, only restricting
disclosure to persons outside this office, or restricting both); and (3) to whom you want the
restrictions to apply. If we agree to your request, we will comply with your request unless the
disclosure is needed to provide you with emergency treatment.
You also have the right to request that we restrict the information about you that we disclose to
health plans for payment or health care operation purposes when you have paid out-of-pocket, in full
for the care you are requesting restriction on. We are required to agree with such a request.
However, we are not required to agree to any other request.
 Right to Request Confidential Communications: You have the right to request that we
communicate with you in a certain way or at a certain location. For example, you can ask that we
contact you only at work, rather than at home.
All requests for confidential communications must be made in writing and sent to our Privacy
Officer, whose contact information is included at the end of this Notice of Privacy Practices. Your
request must specify how or where you wish to be contacted, and we may require you to provide
information about how payment will be handled. We will not ask you the reason for your request,
and will accommodate all reasonable requests.
 Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice of
Privacy Practices at any time, even if you previously agreed to receive this Notice electronically. To
obtain a paper copy of this Notice, please contact our Privacy Officer using the contact information
included at the end of this Notice.

Changes to This Notice
The original effective date of this Notice of Privacy Practices was September 23, 2013, and it was most
recently updated on [INSERT DATE]. We reserve the right to change this Notice at any time. We
reserve the right to make the revised or changed Notice effective for information we already have about
you, as well as any information we receive in the future. If the terms of this Notice are changed, we will
provide you with a copy of the revised Notice upon request, and will post the revised Notice on our
website ( www.tareendermatology.com ) and in designated locations at Tareen Dermatology’s practice
locations.

Compliance with State Law
We provide services to patients in Minnesota and Wisconsin. When applicable, Tareen Dermatology
will comply with the privacy laws of these states in addition to applicable federal privacy laws. For
example:

Treatment, Payment and Health Care Operations. If you receive services in Minnesota, we will obtain
your written consent before releasing your health information for treatment, payment or health care
operations purposes to anyone outside of Tareen Dermatology unless (i) the disclosure is to a related
provider for current treatment, (2) we cannot obtain your consent due to a medical emergency, or (iii)
the release is specifically authorized by Minnesota law. If you receive services in Wisconsin, we will
obtain your written consent before releasing your health information for payment purposes to anyone
outside of Tareen Dermatology.

External Research. If you receive services in Minnesota, you may object to the release of your health
information for research purposes, and we will use reasonable efforts to obtain your general
authorization (consent) to such releases in accordance with applicable law.

Health Oversight Activities. If you receive services in Minnesota or Wisconsin, we may be required to
remove certain identifying information (for example, your name, social security number, etc.) before
making a disclosure for a health oversight activity. Examples of health oversight activities are provided
above.

Other Uses of Medical Information
Except as described above, we will not use or disclose your protected health information without a
specific written authorization from you. If you provide us with this written authorization to use or
disclose medical information about you, you may revoke that authorization, in writing, at any time. If
you revoke your authorization, we will no longer use or disclose medical information about you for the
reasons covered by your written authorization, except to the extent we have already relied on your
authorization. We are unable to take back any disclosures we have already made with your permission,
and we are required to retain our records of the care that we provided to you.

Complaints or Questions
If you believe your privacy rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services. To file a complaint with Tareen

Dermatology, or to ask a question about this Notice, please contact our Privacy Officer. All complaints must be submitted in writing.

You will not be retaliated against or penalized for filing a complaint. Tareen Dermatology’s Privacy Officer

The contact information for our Privacy Officer is as follows:
ATTN: Privacy Officer
Tareen Dermatology, P.A.
2720 Fairview Ave N Suite 200, Roseville, MN 55113

#85229785 (rev Feb. 2025)

ACKNOWLEDGMENT OF RECEIPT OF NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain
rights regarding the use and disclosure of your protected health information. These rights are more fully
described in Tareen Dermatology’s Notice of Privacy Practices, which is also available on Tareen
Dermatology’s website ( www.Tareen Dermatologyhealth.com ). Tareen Dermatology is permitted to
revise its Notice of Privacy Practices at any time. We will provide you with a copy of the Notice of
Privacy Practices upon request.