NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
About This Notice
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” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to main the privacy of your PHI; give you this notice of our legal duties and privacy practices with respect to your PHI; and follow the terms of our notice that are currently in effect. We may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at the time as well as any information we receive in the future. You can obtain any revised Notice of Privacy Practices by contacting our office.
How We May Use and Disclose Your Protected Health Information
We may use and disclose your Protected Health Information in the following circumstances:
For Treatment
We will use and disclose your PHI to provide, coordinate, or manage your health care treatment and any related services. We may also disclose PHI to other physicians who may be treating you. For example, your PHI may be provided to a physician or other health care provider (e.g. a specialist or laboratory) to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you or provide you with a service.
For Payment
Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services recommended for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant PHI to be disclosed to your health plan to obtain approval for hospital admission.
For Health Care Operations
We may use and disclose your PHI for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use your PHI to review the treatment and services you receive to check on the performance of our staff in caring for you. We also may disclose information to doctors, nurses, technicians, medical students, and other personnel for educational and learning purposes. The entities and individuals covered by this notice also may share information with each other for purposes of our joint health care operations. We will share your PHI with third party “business associates” that perform various activities on our behalf (e.g., billing and collection companies, computer consulting company, law firm or other consultants). Our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Appointment Reminders/Treatment Alternatives/Health-Related Benefits and Services
We may use and disclose your PHI to contact you to remind you that you have an appointment for treatment or medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
Plan Sponsors
If your coverage is through an employer sponsored group health plan, we may share PHI with your plan sponsor.
Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Required by Law
We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Public Health
We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
Communicable Diseases
We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect
We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to a governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration
We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required by law.
Legal Proceedings
We may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement
We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
Coroners, Funeral Directors, and Organ Donation
We may disclose your PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose your PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. PHI may be used and disclosed to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
Research
We may disclose your PHI to researchers when their research has been approved by an institutional review that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Criminal Activity
Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security
When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel for authorized military purposes, as required by law, or to authorized federal officials for intelligence or counterintelligence activities, or as authorized by federal officials to protect the President or other persons or foreign leaders, or to conduct special investigations.
Workers’ Compensation
Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.
Inmates
We may use or disclose your PHI if you are an inmate of a correctional facility and your physician created or received your PHI in the course of providing care to you.
For Data Breach Notification Purposes
We may use or disclose your PHI to provide legally required notices of unauthorized acquisition, access, or disclosure of your health information. We may send notice directly to you or provide notice to the sponsor of your plan, if applicable, through which you receive coverage.
Required Uses and Disclosures
Under the law, we must make disclosures to you and when required by the Secretary of the U.S. Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
Uses and Disclosures of PHI Based Upon Your Written Authorization
Uses and disclosures of your PHI that involve the release of psychotherapy notes (if any), marketing, sale of your PHI, or other uses or disclosures not described in this notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization. Additionally, if a use or disclosure of PHI described above in this notice is prohibited or materially limited by other laws that apply to use, it is our intent to meet the requirements of the more stringent law.
Your Rights Regarding Health Information About You
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of your PHI that is contained in a designated file for as long as the PHI is maintained. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in a reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and PHI that is subject to law that prohibits access to PHI. You must make a written request to inspect and copy your designated file. We may charge a reasonable fee for any copies.
Additionally, if we maintain an electronic health record of your designated file, you have the right to request that we send a copy of your PHI in an electronic format to you or to a third that you identify. We may charge a reasonable fee for sending the electronic copy of your PHI.
Depending on the circumstances, we may deny your request and/or copy your PHI. A decision to deny access may be reviewable. Please contact our office if you have questions about access to your designated file.
You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom you want the restriction to apply. In most circumstances, your physician is not required to agree to any restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of you PHI, this information will not be restricted.
You have a right to restrict your PHI sent to your third party payer if you fully pay for the services out of your pocket. If you pay in full for services out of your own pocket, you can request that the information regarding the services not be disclosed to your third party payer since no claim is being made against the third party payer.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our office.
You may have the right to have your physician amend your PHI. This means you may request an amendment of PHI about you in your designated file for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our office if you have questions about amending your designated file. Your request must be in writing and provide the reasons for the requested amendment.
You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to a facility directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. Additionally, limitations are different for electronic health records.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You have the right to receive notice of a security breach. Where there has been an improper disclosure or use of your PHI, we will notify you of the facts surrounding such breach, what we have done or are doing about it and how to best protect yourself in our opinion.
Organized Health Care Arrangement
If you are an inpatient or outpatient of a hospital or other health care facility where our health care professionals perform services, our practice is part of an organized health care arrangement (OHCA) with the hospital or other health care facility and the Notice of Privacy Practices of the hospital or other health care facility controls the use and disclosure of your information. The participants in the OHCA will share your information as necessary to carry out treatment, payment, and healthcare operations, and as permitted by law.
Complaints or Questions
You may complain to us or to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by us. The U.S. Department of Health and Human Services can be reached at 200 Independence Avenue, S.W., Washington, D.C. 20201 or by visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
You may file a written complaint with us by notifying our office of your complaint. We will not retaliate against you for filing a complaint. You may reach our office by contacting our Chief Compliance and Privacy Officer by phone at 214-687-0001, via e-mail at [email protected], or mail at 6225 State Highway 161 #200, Irving, TX 75038.
Effective Date: This notice is effective as of October 22, 2021.
Download Notice of Privacy Practices (PDF)
