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.

Definitions

Throughout this document, the terms "you," "your," and "patient" refer to the

individual receiving care. The terms "we," "our," and "the practice" refer to Steel

City Dermatology, P.C. If you are reviewing or signing this document as a

parent, legal guardian, or authorized personal representative of the patient, all

rights and responsibilities outlined below apply to the patient and extend legally

to you on their behalf.

Our Legal Duties & Responsibilities

Steel City Dermatology, P.C. is required by federal and Pennsylvania law to

maintain the privacy and security of your Protected Health Information (PHI). We

are required to provide you with this detailed notice of our legal duties and

privacy practices, notify you without unreasonable delay following a data

breach of any unsecured PHI, and abide by the terms currently outlined in this

active notice. We reserve the right to change our privacy practices and make a

new notice effective for all PHI we maintain.

1. Routine Uses and Disclosures of PHI

Steel City Dermatology, P.C. may use or share your health information without

your explicit written authorization for the following routine healthcare purposes:

Version: 20260720

● For Treatment: Steel City Dermatology, P.C. uses your PHI to provide,

coordinate, or manage your dermatological care. For example, our

providers document your skin evaluations, charts, biopsies, and treatment

plans in our Electronic Medical Record system (Modernizing Medicine®).

This information is shared with laboratories, pathologists, or your other

practitioners to coordinate care.

● For Payment: Steel City Dermatology, P.C. uses your PHI to obtain

reimbursement from your insurance company or health plan. For

example, the bills sent to your insurer include information that identifies

you, your diagnosis, and your treatments or procedures.

● For Healthcare Operations: Steel City Dermatology, P.C. uses your PHI to

run our practice safely and efficiently. This includes utilizing your data

within Modernizing Medicine® for internal quality assessments, staff

training, compliance reviews, or practice audits.

● Digital Systems & Operations: To facilitate modern healthcare delivery, our

operations rely on secure, cloud-based vendors. Steel City Dermatology,

P.C. shares relevant PHI with our patient communication platform (Klara®)

to manage automated clinical updates, pre- or post-operative care

instructions, and secure photo requests for clinical skin triage.

2. Electronic Health Information Exchanges (HIEs)

Steel City Dermatology, P.C. actively participates in secure electronic data

sharing networks, including Health Information Exchanges (HIEs) natively linked

through Modernizing Medicine® (such as Carequality® and CommonWell®) as

well as the statewide Pennsylvania Patient & Provider Network (P3N).

● Care Coordination: These secure systems allow hospitals, emergency

rooms, and outside physicians involved in your care to securely query and

view your medical records to ensure safety and prevent duplicate testing.

● Right to Opt Out: Making your information available through an HIE is not a

condition of receiving care. Under Pennsylvania law, you have the right to

opt out of electronic sharing through our HIE/P3N activities at any time by

Version: 20260720

submitting a formal written HIE Opt-Out Form to our staff. Any opt-out

request will apply only to disclosures made after the date your form is fully

processed and cannot undo prior data transfers.

3. Special Protections for Highly Sensitive Records

● Pennsylvania State Law: Pennsylvania law provides stricter protections

than federal HIPAA rules for certain types of health data. Steel City

Dermatology, P.C. will explicitly obtain your specific written consent

before disclosing HIV/AIDS-related information (under PA Act 147) or

formal mental health treatment records.

● Federal Substance Use Disorder Records (42 CFR Part 2): If Steel City

Dermatology, P.C. receives or maintains any records about you from a

federally assisted substance use disorder treatment program, we protect

that information as required by federal law. These records will never be

used or disclosed in civil, criminal, or administrative proceedings against

you without your explicit consent or a specific court order.

● Reproductive Health Privacy: In compliance with federal privacy

standards, we apply enhanced protections to your reproductive health

information. We will not disclose PHI related to lawful reproductive

healthcare to investigate or impose liability on any person for seeking,

obtaining, providing, or facilitating such care.

4. Other Permitted Disclosures Without Your Consent

Steel City Dermatology, P.C. may disclose your PHI without your authorization in

specific situations mandated or permitted by law:

● Workers’ Compensation: Our practice does not participate in or accept

Workers' Compensation insurance for treatment. However, if you receive

care from us that is later determined to be related to a work-related injury

or illness, Steel City Dermatology, P.C. may disclose your PHI to the extent

authorized by and necessary to comply with Pennsylvania laws relating to

workers' compensation or other mandatory state reporting programs.

Version: 20260720

● Public Safety: To prevent or lessen a serious and imminent threat to your

health and safety, or the safety of the public or another person.

● Abuse or Neglect: If Steel City Dermatology, P.C. reasonably believes an

individual is a victim of child, dependent adult, or elder abuse, we are

required by law to report it to authorized State agencies.

● Judicial and Law Enforcement Proceedings: In response to a court order,

administrative order, or a lawful subpoena, or for law enforcement

purposes as required by due process.

5. Uses & Disclosures Requiring Explicit Written Authorization

The following uses and disclosures will be made only with your explicit written

authorization through a separate, specific release:

● Most uses and disclosures of psychotherapy notes (if applicable).

● Uses and disclosures of PHI for marketing purposes, including the use of

before-and-after clinical photos on social media or web galleries.

● Disclosures that constitute a sale of PHI.

● Fundraising: If the practice engages in fundraising communications, you

have the right to opt out of receiving such communications.

6. Your Fundamental Rights Regarding Your PHI

All formal requests regarding these rights must be submitted in writing to our

practice Privacy Officer:

● Right to Inspect and Copy: You have the right to view or receive an

electronic or paper copy of your medical and billing records compiled

within Modernizing Medicine®. Steel City Dermatology, P.C. may charge

a reasonable, cost-based fee for copies.

● Right to Request Restrictions: You may request that Steel City

Dermatology, P.C. limit how it uses or shares your PHI. We are not required

to agree, except if you request that we do not disclose PHI to a health

Version: 20260720

plan for payment or operations, and you have paid out-of-pocket in full

for that specific service or cosmetic procedure.

● Right to Confidential Channels: You can request that Steel City

Dermatology, P.C. communicate with you by alternative means or

locations (such as calling a specific cell phone number). We will

accommodate all reasonable requests.

● Right to Amend: If you believe your clinical chart is incorrect or

incomplete, you may request a written amendment. Steel City

Dermatology, P.C. may deny this if the record is determined to be

accurate and complete.

● Right to a Paper Copy: You have the right to obtain a paper copy of this

notice at any time upon request, even if you previously agreed to receive

it electronically.

7. Complaint Process

If you believe your privacy rights have been violated, you may file a formal

complaint with Steel City Dermatology, P.C. by contacting our Privacy Officer

listed below. You may also file a complaint with the Office for Civil Rights of the

U.S. Department of Health and Human Services (OCR) via their online Complaint

Portal, or by mail at OCRComplaint@hhs.gov. Steel City Dermatology, P.C. will

not take any retaliatory action against you for filing a complaint.

Practice Privacy Contact Info:

● Privacy Officer: Kara Yakish, MD, FAAD

● Address: 2585 Freeport Road, Suite 104, Pittsburgh, PA 15238

● Phone / Email: (412) 852-9313 / Privacy@SteelCityDermatology.com

Acknowledgment of Review & Legal Authority

By signing below, I acknowledge that I have been provided access to, and

have had the opportunity to review, Steel City Dermatology, P.C.’s detailed

Version: 20260720

Notice of Privacy Practices. I understand how my protected health information

may be used and shared for the treatment, payment, operational, and

electronic Health Information Exchange (HIE) activities outlined in this notice.

If I am signing this document as a Parent, Legal Guardian, or Authorized

Personal Representative of the patient, I certify that I hold the full legal authority

to execute this acknowledgment on the patient's behalf.

Your Rights and Protections Against Surprise Medical Bills 

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)? 

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. 

“Out-of-network” refers to providers and facilities that have not signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills can cost thousands of dollars depending on the procedure or service. 

You’re protected from balance billing for: 

• Emergency services  

  • If you have an emergency and get emergency services from an out-of network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You cannot be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. 

• Certain services at an in-network hospital or ambulatory surgical center 

  • When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist  services. 

These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.  

• If you get other types of services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections. 

When balance billing isn’t allowed, you also have these protections: 

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. 

• Generally, your health plan must: 

  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”). 

  • Cover emergency services by out-of-network providers. 

  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. 

  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit. 

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. 

You can choose a provider or facility in your plan’s network. 

Pennsylvania law generally provides protections against balance billing for services rendered at in-network facilities, consistent with federal requirements under the No Surprises Act. The Pennsylvania Insurance Department coordinates implementation of federal law for Pennsylvania patients.

If you have difficulty finding a provider or facility in your plan’s network, received a surprise medical bill or believe you’ve been wrongly billed for services provided in Pennsylvania, please contact the Pennsylvania Insurance Department:

Website: www.Insurance.PA.gov/NoSurprise 

Phone: 1-877-881-6388

TTY/TTD: 717-783-3898 

Additional information from a federal standpoint can be found on the following website: www.CMS.gov/NoSurprises/Consumers