Notice of Privacy Practices

for Up North Dermatology's Website

Effective Date: August 17, 2026

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.

Up North Dermatology is committed to protecting the privacy of your health information. We are required by law to maintain the privacy and security of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

Your Rights

When it comes to your health information, you have certain rights.

Get a Copy of Your Medical Record

You may ask to see or receive an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary of your health information as required by law. We may charge a reasonable, cost-based fee when permitted.

Ask Us to Correct Your Medical Record

You may ask us to correct health information that you believe is incorrect or incomplete. We may deny your request in certain circumstances, but we will explain the reason in writing as required by law.

Request Confidential Communications

You may ask us to contact you in a specific way, such as at your home or office phone, or to send mail to a different address. We will accommodate reasonable requests.

Ask Us to Limit What We Use or Share

You may ask us not to use or share certain health information for treatment, payment, or our healthcare operations.

We are generally not required to agree to your request. However, if you pay for a healthcare service or item out-of-pocket in full and ask us not to share information about that service with your health insurer for payment or healthcare operations, we will honor the request unless disclosure is required by law.

Get a List of Certain Disclosures

You may request a list, or “accounting,” of certain disclosures of your health information made during the period allowed by law. This does not include all disclosures, such as many disclosures made for treatment, payment, and healthcare operations.

Get a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Choose Someone to Act for You

If you have given someone medical power of attorney or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your rights and make choices about your health information as permitted by law.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with Up North Dermatology using the contact information below.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your preferences about what we share.

In certain situations, you may tell us whether you want us to:

  • Share information with your family, close friends, or others involved in your care.

  • Share information in a disaster-relief situation.

  • Include your information in a facility directory, if applicable.

If you are unable to tell us your preference, such as if you are unconscious, we may share information when we believe it is in your best interest and as permitted by law.

We will obtain your written authorization before using or disclosing your health information for purposes that require authorization under applicable law. You may revoke an authorization in writing, except to the extent we have already acted in reliance on it.

How We May Use and Share Your Health Information

We may use or disclose your health information for purposes permitted or required by law, including:

Treatment

We may use and share your health information with healthcare professionals who are treating you.

Example: We may share information about your dermatologic condition with another healthcare provider involved in your care.

Payment

We may use and share your health information to bill and receive payment from health plans or other entities.

Example: We may provide information to your health insurance company so it will pay for dermatology services you received.

Healthcare Operations

We may use and share your health information to operate our practice, improve your care, and contact you when necessary.

Example: We may use health information to review the quality of care provided within our practice.

Other Uses and Disclosures

We may also use or disclose your information when permitted or required by law, including for:

  • Public health and safety activities.

  • Reporting suspected abuse, neglect, or domestic violence as required or permitted by law.

  • Health oversight activities.

  • Workers' compensation matters.

  • Responding to lawsuits and legal proceedings.

  • Law enforcement purposes when legally permitted or required.

  • Medical examiners, coroners, and funeral directors.

  • Organ and tissue donation.

  • Research when applicable legal requirements are satisfied.

  • Preventing or reducing a serious threat to health or safety.

  • Other disclosures required by federal or state law.

Certain categories of health information may receive additional protection under federal or Michigan law. When another law provides greater privacy protection, we will follow the more protective law.

Our Responsibilities

Up North Dermatology is required by law to:

  • Maintain the privacy and security of your protected health information.

  • Notify you following a breach of unsecured protected health information when required by law.

  • Follow the duties and privacy practices described in this Notice.

  • Provide you with a copy of this Notice upon request.

  • Not use or share your information other than as described here unless you authorize us in writing or another use or disclosure is permitted or required by law.

If you authorize us to use or disclose your information, you may change your mind and revoke your authorization in writing, subject to applicable law.

Changes to This Notice

We may change the terms of this Notice, and the changes may apply to all health information we maintain about you.

If we make a material change, the revised Notice will be available at our office and on our website.

Questions or Complaints

If you have questions about this Notice, would like to exercise your privacy rights, or believe your privacy rights have been violated, please contact:

Up North Dermatology
Privacy Officer
1951 S. Otsego Avenue
Gaylord, MI 49735
989-732-3284

You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.

Up North Dermatology will not retaliate against you for filing a complaint.