Our Promise to You
We understand your information is personal and private and we will treat it with the respect that is required to ensure your information is protected. We take our privacy obligations seriously and follow all required laws and regulations with respect to protected health information.
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 United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA).
This notice describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health and related health care services. We will not retaliate against patients who exercise their HIPAA rights.
Treatment, Payment, Health Care Operations
This practice uses and discloses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.
Treatment: We are permitted to use and disclose your medical information to those involved in your treatment. For example, your care may require the involvement of a specialist. When we refer you to that specialist, we will share some or all of your medical information with that provider to facilitate the delivery of care.
Payment: We are permitted to use and disclose your medical information to bill and collect payment for the services provided to you. For example, we may complete a claim form to obtain payment from your insurer or HMO. The form will contain medical information, such as a description of the medical service provided to you, that your insurer or HMO needs to approve payment to us.
Health Care Operations: We are permitted to use or disclose your medical information for the purposes of health care operations, which are activities that support this practice and ensure that quality care is delivered. For example, we may engage the services of a professional to aid this practice in its compliance programs. This person will review billing and medical files to ensure we maintain our compliance with regulations and the law. We may use or disclose your protected health information to contact you regarding your appointments, requesting you to contact the office, or other information related to your care and/or overall health.
Disclosures that Can Be Made Without Your Authorization
We are permitted by law to disclose or use your medical information without your written authorization or the opportunity to object in certain situations. We have briefly described those situations below.
Public Health, Abuse or Neglect, and Health Oversight: We may disclose your medical information for public health activities. Public health activities are mandated by federal, state, or local government for the collection of information about disease, vital statistics (like births and death), or injury by a public health authority.
Abuse or Neglect: We may disclose medical information to a public agency authorized to receive reports of child abuse or neglect. Texas law requires physicians to report child abuse or neglect. Regulations also permit the disclosure of information to report abuse or neglect of elders or the disabled.
Legal Proceedings and Law Enforcement: We may disclose your medical information in the course of judicial or administrative proceedings in response to an order of the court (or the administrative decision-maker) or other appropriate legal process. Certain requirements must be met before the information is disclosed.
We may also release information if we believe the disclosure is necessary to prevent or lessen an imminent threat to the health or safety of a person.
Additionally military personnel’s medical information may be disclosed for specialized government functions, authorized national security and intelligence activities, as well as authorized activities for the provision of protective services for the President of the United States, other authorized government officials, or foreign heads of state.
Worker’s Compensation: We may disclose your medical information as required by the Texas Workers’ Compensation law.
Inmates: If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official.
Research, Organ Donation, Coroners, Medical Examiners, and Funeral Directors: We may disclose your medical information to researchers when a research project and it’s privacy protections have been approved by an Institutional Review Board. If you are a donor, we may release medical information to organ procurement organizations. Also, we may release your medical information to a coroner or medical examiner for identification purposes or determining a cause of death. Further, we may release your medical information to a funeral director when such a disclosure is necessary for the director to carry out his duties.
Required by Law: We may release your medical information where the disclosure is required by law.
You have certain rights by law regarding your protected health information which are detailed below.
Requested Restrictions: You may request that we restrict or limit how your protected health information is used or disclosed for treatment, payment, or health care operations. We do not have to agree to this restriction, but if we do agree, we will comply with your request except under emergency circumstances.
You may also request that we limit disclosure to family members or friends who may or may not be involved in your care. To request a restriction, submit the following in writing: (a) state the specific restriction and, (b) to whom the limits apply.
Receiving Confidential Communications by Alternative Means: You may request that we send communications of protected health information by alternative means or to an alternative location. We will only accommodate reasonable requests.
Inspection and Copies of Protected Health Information: You may inspect and/or copy health information that is within the designated record set, which is information that is used to make decisions about your care. Texas law requires that requests for copies be made in writing, and we ask that requests for inspection of your health information also be made in writing.
We may ask that a narrative of that information be provided rather than copies. However, if you do not agree to our request, we will provide copies at your cost. HIPAA permits us to charge a reasonable cost-based fee.
We can refuse to provide some of the information you ask to inspect or ask to be copied if the information includes: psychotherapy notes, the identity of a person who provided information under a promise of confidentiality, or is subject to the Clinical Laboratory Improvements Amendments of 1988l, or has been compiled in anticipation of litigation.
We can refuse to provide access to or copies of some information for limited reasons, and you have the right to have that refusal reviewed.
Amendment of Medical Information: You may request an amendment of your medical information in the designated record set. Any such request must be made in writing. We may refuse to allow an amendment.
If we refuse to allow an amendment, you are permitted to submit a statement of disagreement. If we refuse to allow an amendment, we will inform you in writing.
Accounting of Certain Disclosures: HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures, if any, that are other than for treatment, payment, health care operations, or made via an authorization signed by you or your representative. Please submit any request for an accounting in writing. Your first accounting of disclosures (within a 12-month period) will be free. For additional requests within that period, we are permitted to charge for the cost of providing you the list.
Complaints: If you are concerned that your privacy rights have been violated, you may contact the person listed at the end of this document. You may also send a written complaint to the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
Questions and Requests
If you have any questions or want to make a request pursuant to the information described above, please contact:
1600 W. 38th St. Suite 406
Austin, TX 78731(512) 394-7377
– Effective March 4, 2019