Notice of Privacy Practices
As required by the Privacy Rule, created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this Notice describes how medical information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your individually identifiable medical information. Please review this Notice carefully.
Effective Date of the Notice: August 1, 2009
OUR COMMITMENT TO YOUR PRIVACY
We understand that medical information about you and your health is personal, and we are committed to protecting the privacy of that medical information. We create a record of the care and services you receive at our medical practice. We need this record to provide you with quality care and treatment and to comply with certain legal requirements.
This Notice applies to all of the records of your care and treatment generated and retained by our medical practice. This Notice explains the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.
OUR LEGAL OBLIGATIONS
We are required by law to:
- make sure that medical information that identifies you is kept private;
- give you this Notice of our legal duties and privacy practices with respect to your medical information;
- and follow the terms of the Notice that is currently in effect.
We will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any that we may create or maintain in the future.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION:
The following categories describe the different ways in which we may use and disclose your medical information.
- Treatment. We may use your medical information to provide medical care and treatment to you. For example, we may ask you to have laboratory tests and we may use the results to help us in your diagnosis and treatment. We may use your medical information in order to write a prescription for you, or we may disclose your medical information to a pharmacy when we order a prescription for you. Many of the people who work for our practice, including, but not limited to our healthcare providers and medical assistants, may use or disclose your medical information in order to treat you or to assist others in your treatment. We may disclose your medical information to other healthcare providers to whom we refer you for specialty treatment or consultation. Additionally we may disclose your medical information to others who may assist in your care, such as your spouse, children or parents.
- Payment. We may use and disclose your medical information in order to bill and collect payment for the services you may receive from us. For example, we may contact your health insurance company to certify that you are eligible for benefits, and we may provide your insurer with details regarding your treatment. We may use and disclose your medical information to obtain payment from third parties, such as family members, who may be responsible for such costs. We may also use your medical information to bill you directly for services.
- Health Care Operations. We may use and disclose your medical information to operate our business. We may use your medical information to review the care you received and to evaluate the performance of our staff in caring for you; to help us decide what additional services to offer; to determine how we can improve the quality and efficiency of our services or whether certain treatments are effective. We may also use your medical information to resolve any complaints you may have and to help ensure your satisfaction with the care you receive.
- Appointment Reminders. We may use and disclose your medical information to contact you and remind you of an appointment.
- Treatment Options. We may use and disclose your medical information to inform you of potential treatment options or alternatives.
- Treatment Options. We may use and disclose your medical information to inform you of potential treatment options or alternatives.
- Health-Related Benefits and Services. We may use and disclose your medical information to inform you of health-related benefits or services that may be of interest to you.
- Family and Friends. Unless you notify us that you object, we may release your medical information to family members or friends who are involved in your care, or who help pay for your care. We may also release your medical information by allowing another person, as approved by you, to pick up medical records, reports of lab/diagnostic studies, or prescriptions at our clinic facilities.
The following are additional special circumstances under which we may release your medical information:
- Workers' Compensation. We may disclose your medical information to insurance carriers, the Texas Dept. of Insurance / Division of Workers’ Compensation and other healthcare providers for purposes of treatment for work-related injuries and illnesses under workers' compensation.
- Disclosures Required By Law. We will disclose your medical information when we are required to do so by federal, state or local law.
- Public Health Risks. We may disclose your medical information to public health authorities that are authorized by law to collect information for the purpose of:
- reporting births and deaths;
- reporting suspected child abuse or neglect;
- preventing or controlling disease, injury or disability;
- notifying a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition;
- reporting reactions to medications or problems with medical products or devices.
- notifying appropriate government agencies and authorities if we believe a patient has been a victim of abuse, neglect, or domestic violence; however, we will only disclose this information if the patient agrees or we are required or authorized by law to do so.
- Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law; including, for example, investigations, inspections, audits, surveys, and licensure actions. Such activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes. We may disclose your medical information in response to a court or administrative order if you are involved in a lawsuit or a dispute. We also may disclose your medical information in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information requested.
- Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
- regarding a crime victim if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- concerning a death we believe may have been the result of criminal conduct;
- regarding criminal conduct at our offices;
- in response to a warrant, summons, court order, subpoena or similar legal process;
- to identify or locate a suspect, material witness, fugitive or missing person;
- in an emergency to report a crime; the location of the crime or victims; or the description, identity or location of the perpetrator;
- in an emergency when necessary to maintain the safety and security or our personnel and patients.
- Coroners, Medical Examiners and Funeral Directors. We may release medical information to a medical examiner or coroner to identify a deceased individual or to determine the cause of death. We also may release medical to information funeral directors in order for them to perform their duties.
- Organ and Tissue Donation. If you are an organ donor, we may release your medical information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation.
- Research. We may use and disclose your medical information for research purposes in certain limited circumstances. We will obtain your written authorization to use your medical information for research purposes. In any case, your name or identity will not be published or made public.
- Serious Threats to Health or Safety. We may use and disclose your medical information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances we will only make disclosures to a person or organization able to help prevent the threat.
- Military Services and Veterans. We may disclose your medical information if you are a member (or veteran) of the U. S. or foreign military forces as required by military command authorities.
- National Security, Intelligence and Protective Services. We may disclose your medical information to federal officials for intelligence, counterintelligence and other national security activities authorized by law; including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special investigations.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your medical information to the correctional institution or law enforcement official as necessary for: the institution to provide you with health care; to protect your and other persons’ health and safety; and for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding your medical information that we maintain:
- Right to Confidential Communications. You have the right to request that we communicate with you about your health and related issues in a particular manner or at a certain location. For example you may ask that we contact you at work rather than at home, or by mail. To request a type of confidential communication you must make a written request to our Privacy Officer, specifying the requested method of contact and/or the location where you wish to be contacted. We will accommodate reasonable requests, and you do not need to give a reason for your request. If your request could result in our not being able to collect payment for services, we reserve the right to require you to provide additional information about how payment for services will be handled.
- Right to Request Restrictions. You have the right to request a restriction or limitation on our use or disclosure of your medical information for treatment, payment or health care operations. You have the right to request that we restrict our disclosure of your medical information to certain individuals involved in your care or the payment for your care, such as family members and friends. For example, you may ask that we not use or disclose information about a surgery you had, a laboratory test ordered or a medical device prescribed for your care.
To request a restriction in our use or disclosure of your medical information, you must make your request in writing to our Privacy Officer. Your request must describe in a clear and concise fashion:
- the information you wish restricted;
- whether you are requesting to limit our use, disclosure or both;
- and to whom you want the limits to apply (for example disclosures to your spouse).
We will carefully consider all requests; however ,we may not be able to accommodate all requests nor are legally required to agree to your request. However, if we do agree we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
- Right to Inspect and Copy. You have the right to inspect and obtain a copy of your medical information, including medical and billing records maintained and used by us to make decisions about your care. In certain situations where providing access may be detrimental to your health, we are permitted by state and federal law to withhold access. To inspect or obtain a copy of your medical information you must submit your request in writing to our Privacy Officer. We may charge a reasonable fee for the costs of copying, mailing, labor and supplies associated with your request.
On rare occasions we may deny a request to inspect or obtain a copy of some medical information if, in the professional judgment of your physician/provider, the information could cause a threat to you or others. If you are denied access to information, you may request a review of the denial. Another licensed healthcare professional, who was not involved in the original decision by us, will independently review both the original request and denial. You may contact our Privacy Officer for more information.
- Right to Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request for an amendment. We will deny your request if it is not in writing or does not include a reason supporting your request.
We may deny your request if you ask us to amend information that, in our opinion:
- is accurate and complete;
- is not part of the medical information kept by or for the practice;
- is not part of medical information which you would be permitted to inspect and copy; or
- was not created by our practice unless the individual or entity who created the information is not available to amend the information.
- Right to Accounting of Disclosures. You have the right to request an "accounting of disclosures." This list would provide you with a summary of all disclosures we have made of your medical information that you would not otherwise expect or already know about. This list would not include any of the following disclosures:
- made for treatment, payment and healthcare operations;
- made directly to you or your personal representative;
- that you have specifically authorized;
- made for national security or intelligence purposes;
- made to correctional institutions or law enforcement having custody of the patient;
- made prior to the effective date of this Notice.
A request for an accounting of disclosures must be in writing , dated and signed and sent to our Privacy Officer. All requests for an accounting of disclosures must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before August 1, 2009. The first list you request within a 12-month period is free of charge, but we may charge you for the cost of providing additional lists within the same 12-month period. We will notify you of the costs involved with the additional request, and you may withdraw your request before you incur any costs.
- Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of this Notice of Privacy Practices, and you may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice on our website, www.MaxHealthMed.com. You may obtain a paper copy of this Notice at any of our facilities, or by calling the Privacy Officer at 817.355.8000.
- Right to Provide an Authorization for Other Uses and Disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your medical information may be revoked at any time in writing. If you revoke your authorization we will no longer use or disclose your medical information for the reasons described in your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain records of the care and treatment that we have provided to you.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with MaxHealth Family Medicine or with the Secretary of the Department of Health and Human Services. Complaints must be submitted in writing to our Privacy Officer. You will not be penalized for filing a complaint.
If you have questions about this Notice or our medical information privacy policies, or wish to submit a request or complaint, as described in this Notice, please contact:
Privacy Officer
MaxHealth Family Medicine
5207 Heritage Ave
Colleyville, TX 76034
Tel 817.355.8000
Fax 817.283.0400
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