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.
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. HIPAA gives you significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes: treatment, payment and healthcare operations.
· Treatment. Treatment means providing, coordinating, or managing healthcare and related services by one or more healthcare providers. An example of this would include consultations among our physicians or a referral for health care from our physicians to another health care provider.
· Payment. Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be obtaining patient co-pay amounts.
· Healthcare Operations. Healthcare Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be conducting patient surveys.
We may also contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:
· The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are not, however, required to agree to a requested restriction, unless the request is made to restrict disclosure to the insurer for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment), and the protected health information pertains solely to a healthcare item or service for which you have paid out of pocket in full. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
· The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
· The right to inspect and copy your protected health information.
· The right to amend your protected health information.
· The right to receive an accounting of non-routine disclosures of protected health information.
· The right to obtain a paper copy of this notice.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of January 1, 2011 and we are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated. You have the right to a formal, written complaint with us at the address below, or with the Department of Health and Human Services, Office for Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
Please contact us for more information:
Tina Storey, Privacy Officer
1600 Coit Road, Suite 104
Plano, TX 75075
Toll Free: (855) 205-1211
For more information about HIPAA or to file a complaint:
Office of Civil Rights, DHHS
1301 Young Street, Suite 1169
Toll Free: (855) 205-1211