Privacy
Notice of Privacy Practices
This Notice of Privacy Practices 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 or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice, at any time, which will be effective
for all protected health information that we maintain at that time.
Upon your request, we will provide you with any revised Notice of Privacy
Practices by calling the office and requesting that a revised copy be
sent to you in the mail or asking for one at the time of your next appointment.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information for Treatment,
Payment, and Health Care Operations
Following are examples of the types of uses and disclosures of your
protected health care information that Highland Pain Institute is permitted to make. These examples are not meant to be
exhaustive, but
to describe the types of uses and disclosures that may be made by
our office.
Treatment: We will use and disclose your protected health information
to provide, coordinate, or manage your health care and any related services.
This includes the coordination or management of your health care with
a third party provider. For example, we would disclose protected health
information to another physician or health care provider (e.g., a specialist
or laboratory) who, at the request of your physician, becomes involved
in your care.
Payment: Your protected health information will be used, as needed,
to obtain payment for your health care services. This may include providing
health information for making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you for medical
necessity, and undertaking utilization~ review activities.
Healthcare Operations: We may use or disclose, as-needed, your protected
health information in order to support the business activities of
Highland Pain Institute. These activities include,
but are not limited to, quality assessment activities, training of medical
students, licensing, and
auditing activities.
For example, we may use your protected health information to assess
the quality of care at Highland Pain Institute. We
may use or disclose your protected health information, as necessary,
for appointment reminders
or to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to
you.
You may contact our Privacy Office to request that these materials
not be sent to you.
Highland Pain Institute will strive to limit the use of health information
to the minimum necessary to perform the activity, and physicians or
employees whose job functions require review of health information will
be required to sign a confidentiality statement. In addition, third
party "business associates" that perform various activities
(e.g., billing, transcription services) may need to have access to certain
health information. Orthopedic Pain Management will have a written contract
with its business associates that contains terms that will protect the
privacy of your protected health information.
Uses and Information Authorization Disclosures of Protected Health
Based upon Your Written Authorization
Other uses and disclosures of your protected health information will
be made only with your written authorization, unless otherwise permitted
or required by law as described below. You may revoke this authorization,
at any time, in writing, except to the extent that we have taken an
action in reliance on the use or disclosure indicated in the authorization.
Uses and Disclosures That May Be Made Unless You Object
Unless you object, we may disclose protected health information to
a person present with you during your visit (such as a member of your
family, a relative, a close friend or any other person you identify),
or to your emergency contact if we determine that it is in your best
interest based on our professional judgment. We may use or disclose
protected health information 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 protected health information 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.
Other Permitted and Required Uses and Disclosures That May Be Made
Without Authorization
We may use or disclose your protected health information in the following
situations without your authorization. These situations include:
Required By Law: We may use or disclose your protected health information
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. You will be notified, as required
by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information to
the CDC, the Texas Department of Health, and other public health authorities
for public health activities as permitted by law. The disclosure will
be made for the purpose of controlling disease, injury or disability.
Communicable Diseases: We may disclose your protected health information,
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 protected health information to the
Texas Board of Medical Examiners, US Department of Health and Human
Services, or other health oversight agency for activities authorized
by law, such as audits, investigations, and inspections.
Abuse or Neglect: We may disclose your protected health information
to Child Protective Services, Adult Protective Services, or other governmental
body that is authorized by law to receive reports of abuse or neglect.
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 protected health
information 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.
Legal Proceedings: We may disclose protected health information 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 also disclose protected health information,
so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes include (1) legal processes
and otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to witnesses, defendants,
or victims of a crime, (4) suspicion that death has occurred as a result
of criminal conduct, (5) in the event that a crime occurs on the premises
of the practice, and (6) medical emergency (not on the Practice's premises)
and it is likely that a crime has occurred.
JPs. Coroners: We may disclose protected health information to a justice
of the peace, coroner or medical examiner for identification purposes,
determining cause of death or for the IP, coroner or medical examiner
to perform other duties authorized by law.
Research: We may disclose your protected health 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 protected health information.
Safety: Consistent with applicable federal and state laws, we may disclose
your protected health information, 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.
Military Activity and National Security: When the appropriate conditions
apply, we may use or disclose protected health information of individuals
who are Armed Forces personnel (1) for activities deemed necessary by
appropriate military command authorities; (2) for the purpose of a determination
by the Department of Veterans Affairs of your eligibility for benefits,
or (3) to foreign military authority if you are a member of that foreign
military services. We may also disclose your protected health information
to authorized federal officials for conducting national security and
intelligence activities, including for the provision of protective services
to the President or others legally authorized.
Workers' Compensation: Your protected health information may be disclosed
by us as authorized to comply with workers' compensation laws and other
similar legally established programs.
Required Uses and Disclosures: Under the law, we must make disclosures
to you and when required by the Secretary of the Department of Health
and Human Services to investigate or determine our compliance with the
requirements of federal law.
2. Your Rights
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights.
You have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information
about you that is contained in a designated record set for as long as
we maintain the protected health information. A "designated record
set" contains medical and billing records and any other records
that your physician and the practice use for making decisions about
you.
A physician may deny access to health information if he determines
that release of information could be harmful to the physical, mental,
or emotional health of a patient or could endanger a patient.
You have the right to request a restriction of your protected health
information. This means you may ask us not to use or disclose any part
of your protected health information for the purposes of treatment,
payment or healthcare operations. You may also request that any part
of your protected health information 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.
We are not required to agree to a restriction that you might request.
If we believe it is in your best interest to permit use and disclosure
of your protected health information, your protected health information
will not be restricted. If Highland Pain Institute
does agree to the requested restriction, we may not use or disclose
your
protected
health information in violation of that restriction unless it is
needed to provide emergency treatment. With this in mind, please
discuss any
restriction you wish to request with your physician or our office.
You may request a restriction by signing our restriction form available
from our office.
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 request an amendment of your protected health
information. 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 to determine if you have questions about amending
your medical record.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. 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 family members or
friends involved in your care, or for notification purposes. You have
the right to receive specific information regarding these disclosures
that occurred after April 14, 2003. You may request a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
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.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services
if you believe your privacy rights have been violated by us. We will
not retaliate against you for filing a complaint.
You may contact our office at (210) 520-5606
for further information
about the complaint process.
This notice was published and becomes effective on April 14, 2003.
|
