Effective Date: October 13, 2025

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Our Legal Duty
We are required by HIPAA (45 CFR Parts 160 and 164) and New York State law (Public
Health Law §§ 17 & 18, N.Y. Comp. Codes R. & Regs. Title 10 Part 50, NYS Civil Rights Law § 79-l) to:

• Maintain the privacy of your Protected Health Information (PHI).
• Provide you with this Notice.
• Follow the terms of this Notice.

Permitted Uses and Disclosures Without Written Authorization
Under 45 CFR §164.502(a) and §164.512, and NYS law, we may use or disclose your PHI
without written authorization for:

1. Treatment – 45 CFR §164.506
2. Payment – 45 CFR §164.506
3. Healthcare Operations – 45 CFR §164.506
4. Required by Law – 45 CFR §164.512(a)
5. Public Health Activities – 45 CFR §164.512(b)
6. Health Oversight Activities – 45 CFR §164.512(d)
7. Judicial and Administrative Proceedings – 45 CFR §164.512(e)
8. Law Enforcement Purposes – 45 CFR §164.512(f)
9.  Coroners, Medical Examiners, and Funeral Directors – 45 CFR §164.512(g)
10. Organ, Eye, or Tissue Donation – 45 CFR §164.512(h)
11. Research – 45 CFR §164.512(i)
12. To Avert a Serious Threat to Health or Safety – 45 CFR §164.512(j)
13. Specialized Government Functions – 45 CFR §164.512(k)
14. Workers’ Compensation – 45 CFR §164.512(l)

Uses and Disclosures Requiring Written Authorization
Any use or disclosure not listed above requires your prior written authorization under 45 CFR
§164.508, including:

• Marketing communications.
• Promotional use of photographs.
• Sale of PHI.

You may revoke authorization at any time in writing, except where we have already relied on it.

Your Rights Regarding PHI
Under 45 CFR §§164.520–164.528 and NYS Public Health Law §§17 & 18, you have the right
to:

• Access and obtain a copy of your medical record.
• Request corrections to your medical record.
• Receive an accounting of certain disclosures.
• Request restrictions on certain uses or disclosures.
• Request confidential communications.
• Obtain a paper copy of this Notice at any time.

Communication Risks
If you request communications via unencrypted email or text, you accept the associated risks under 45 CFR §164.522(b).

Changes to This Notice
We may change this Notice at any time under 45 CFR §164.520(b) and NYS law. Updated
versions will be posted on our website and in our office.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Privacy Officer – Kleydman Dermatology, PLLC, [2960 Ocean Avenue 2 nd Floor Brooklyn NY 11235] | [Phone: 718 676 6900] | [Email: info@kleydmandermatology@.com]

Or with the U.S. Department of Health & Human Services, Office for Civil Rights.
You will not face retaliation for filing a complaint (45 CFR §160.316).

By opting into SMS communications from Kleydman Dermatology, you agree to receive text messages related to your interactions with our practice.

Depending on your preferences, you may receive text messages regarding:

• Appointment confirmations
• Appointment reminders
• Scheduling updates
• Treatment instructions
• Follow-up care
• Practice announcements
• Promotional offers and marketing communications (only if you have separately opted in)

Message Frequency:

Message frequency varies based on your interactions with our office.

Message and Data Rates:

Message and data rates may apply according to your mobile carrier plan.

Opt-Out:

You may opt out at any time by replying:

STOP, After opting out, you will no longer receive SMS messages unless you opt in again.

Help

Reply: HELP for assistance.

You may also contact us directly at:

(718) 934-6900

or

info@kleydmandermatology.com

Carrier Disclaimer

Wireless carriers are not liable for delayed or undelivered messages.

Eligibility

You confirm that you are the authorized user of the mobile number provided and that you consent to receive text messages from Kleydman Dermatology.

Privacy

Your privacy is important to us. Please review our Privacy Policy for information regarding how your personal information is collected, used, and protected. SMS consent is not shared with third parties or affiliates for marketing purposes.

Changes

Kleydman Dermatology reserves the right to modify these SMS Terms & Conditions at any time. Continued participation in the SMS program constitutes acceptance of any updates.

Contact

Kleydman Dermatology

(718) 934-6900

info@kleydmandermatology.com