Effective Date: January 2003
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.
Your Health Information & Rights
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment. This information is referred to as your health or medical record. This Notice of Privacy Practices describes how we may use or disclose your health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.
Although your health record is the property of this practice, the information belongs to you. You have the right to:
- Request restrictions on certain uses and disclosures of your information as provided by 45 CFR 164.522. We are not required to agree to any requested restriction. To request a restriction, please send a written request to the address listed below.
- Obtain a paper copy of this Notice of Privacy Practices, even if you have agreed to receive the Notice of Privacy Practices electronically. You may submit a request for a paper notice in writing to the address below.
- Inspect and request a copy of your medical record as provided for in 45 CFR 164.524. You must submit your request in writing to the address below. If you request a copy of your medical information we may charge you a fee for the cost of copying, mailing or other supplies. In certain circumstances, as allowed by law, we may deny your request to inspect or copy your medical information.
- Amend your health record as provided in 45 CFR 164.526. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your medical information if it is not in writing or does not provide a reason to support your request. We may also deny your request if:
- the information was not created by us, unless the person that created the information is no longer available to make the amendment;
- the information is not part of the medical information kept by or for us;
- the information is not part of the information you would be permitted to inspect or copy; or
- the information is accurate and complete
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528. You must submit a request in writing to the address below. Not all medical information is subject to this request. Your request must state a time period, no longer than 6 years and may not include dates before April 24, 2003. Your request must state how you would like to receive the report (paper or electronically). The first list you request within a 12 month period is free. For additional lists, we may charge you the cost of providing the list. We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred.
- Request communications of your health information by alternative means and locations. For example, you may request that we only contact you at work or by mail. To make such a request, please send a written request to the address listed below telling us how or where you wish to be contacted.
Attn: Privacy Officer
HWC of Texas Responsibilities:
- Maintain the privacy of your protected health information as required by law;
- Provide you with this notice of our legal duties and privacy practices with respect to your protected health information;
- Abide by the terms of this Notice of Privacy Practices; and
- Notify you if we are unable to agree to a requested restriction.
Changes to this Notice of Privacy Practices
We reserve the right to change our privacy practices described in this Notice of Privacy Practices and to make the new provisions effective for all protected health information we maintain. Any revision to our privacy practices will be described in a revised Notice of Privacy Practices document and posted prominently in our facility. In addition, you can obtain the current Notice of Privacy Practices by calling us and requesting a revised copy be sent to you in the mail. We will not use or disclose your health information without your authorization, except as described in this notice.
If you believe that your privacy rights have been violated, you can file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized in any way for filing a complaint.
Examples of Disclosures for Treatment, Payment, and Health Care Operations
In accordance with Federal law, we will not use or disclose your medical information without your authorization, except as described in this notice.
We will use your health information for treatment. For example: Information obtained by one of our staff including physicians, nurses and administrative staff will be recorded in your record and used to determine the course of treatment that should work best for you. We will also provide your physician or a subsequent healthcare provider, with copies of various reports that will assist them in treating outside of this office.
We will use your health information for payment. For example: A bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, tests and supplies used in the course of your care in our office.
Your health information may be released to other healthcare professionals for the purpose of health care operations to provide you with quality healthcare.
We may also use and disclose your personal health information for the following purposes:
- to contact you to remind you of an appointment for treatment,
- to describe or recommend treatment alternatives to you, or
- to furnish information about health-related benefits and services that may be of interest to you.
You understand that we are unable to take back any disclosure we have already made with your permission.
There are some services provided in our clinic through contracts with business associates. Examples may include transcription services and billing companies. Through a signed agreement, we require all business associates to comply with Health Insurance Portability and Accountability Act (“HIPAA”) laws and requirements to safeguard your health information.
Notification of Family:
We may use or disclose information to notify a family member, personal representative, or other person responsible for your care, your location and general condition.
Communication with Family:
Our staff, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care, [provided a durable power of attorney for healthcare, healthcare proxy or other legal notification of your wish to allow them to access the information in accordance with HIPAA regulations.]
Food and Drug Administration (“FDA”):
We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
We may disclose health information to the extent authorized to comply with applicable state laws relating to the workers compensation program.
As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. As such, we may disclose health information, as required by State law, to a person who may have been exposed to communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Threats to Public Health or Safety:
We may disclose or use health information when it is our good faith belief, consistent with ethical and legal standards, that it is necessary to prevent or lessen a serious and imminent threat or is necessary to identify or apprehend an individual.
Abuse or Neglect:
We may disclose health information to a health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the government agency authorized to receive such information.
We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral Director, Coroner, and Medical Examiner:
Consistent with applicable law we may disclose health information to funeral directors, coroners, and medical examiners to help them carry out their duties.
Organ Procurement Organizations:
Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
In order to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil rights laws for which health information is necessary to determine compliance, we may disclose health information for oversight activities authorized by law, such as audits and civil, administrative, or criminal investigations.
We may disclose health information in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.
Marketing & Patient Satisfaction Surveys:
We may contact you to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you. We may also contact you to obtain your opinion about our services.
Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Military & Veterans:
Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.