Notice
of Health Information Practices
[For Bee Caves Pediatrics, PA]
Effective Date: 4/15/03
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.
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Understanding
Your Health Record/ Information
Each time you visit our
Office, or another physician or health care provider contacts us
concerning your medical needs or history a record is made by our Office.
This record contains medical information generated during your visits to
our Office, received by our Office from other health care providers, or
provided by you. In this “Notice of Health Information Practices,” we
shall refer to the information contained in your record as your “health
information.” This term
shall have the same meaning as “protected health information” defined
in the Health Insurance Portability and Accountability Act of 1996, as
amended (“HIPAA”).
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Your Health Information Rights
Within the limits provided
by federal and state law, you have the right to:
·
Request restrictions on
certain uses and disclosures of your health information;
·
Receive confidential
communications of your health information. You may request that we
communicate with you about your health information by alternative means or
at an alternative location;
·
Inspect and obtain a copy of
your health information, except with regard to psychotherapy notes or
information compiled in reasonable anticipation of certain civil, criminal
or administrative proceedings;
·
Request an amendment to your
health information that we have created, except with regard to those
portions of your health information that you are precluded from inspecting
and copying as set forth above.
·
Obtain an accounting of
certain disclosures of your health information; and
·
Receive a paper copy of this
Notice in addition to any electronic copy you may receive.
You may exercise any of the above
rights by submitting a signed letter detailing your request and mailing or
delivering the letter to our Office
Manager. However, we
encourage you to call first so that we can help you be as specific
as possible with your request. We
will promptly provide you with any forms needed to process your request.
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Our Responsibilities
This Office is required by
law to:
·
Maintain the privacy of your
health information;
·
Provide you with this Notice
of our legal duties and privacy practices with respect to health
information we collect and maintain about you;
·
Abide by the terms of this
Notice, currently in effect, and as amended from time to time;
·
Notify you if we are unable
to honor your request to restrict a use or disclosure of, or to amend,
your health information; and
·
Accommodate reasonable
requests you may have to communicate your health information by
alternative means or at alternative locations.
We reserve the right to
change our privacy practices and to make the new provisions effective for
all of your health information we already have, as well as any health
information we receive or create in the future. Should our privacy
practices change, we will post a copy of the revised Notice in our waiting
area, which indicates the effective date of the amended Notice.
You may request and obtain a copy of our Notice of Privacy
Practices anytime you visit our office.
If a use or disclosure of
your health information is not permitted under law without a written
authorization, we will not use or disclose your health information without
that written authorization. You
may at any time revoke a written authorization in writing, except to the
extent that we have already taken action in reliance of your
authorization.
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For More Information or to Report a Problem
If you have questions
and would like additional information concerning this Notice, please call
any of our Office Manager at 328-7666.
If you believe that we
have violated any of your privacy rights, you may file a written complaint
with our Office Manager, or mail your written complaint to 2499 S. Capital
of Texas Hwy. B-100, Austin, Texas 78746. You
may also file your complaint with the Secretary of Health and Human
Services. There will be no penalty or retaliation for filing a complaint.
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Examples of Uses and Disclosures for
Treatment, Payment and Health Operations
The following are examples
of uses and disclosures of your health information which are permitted by
law:
We will use your health
information for treatment.
We will use your health information to provide medical services to
you. Any of our staff
involved in your care will have access to your health information.
We may also provide your health information to other health care
providers involved in your care to assist them in providing services to
you.
We will use your health
information for payment.
Your health plan or health insurer will require certain information
about your condition and the services you receive from us, before payment
will be made, or for pre-authorization purposes.
Accordingly, for billing purposes, we may disclose your health
information to your health plan or health insurer.
We also may disclose health information to your health plan or
health insurer when they require pre-authorization of a recommended
procedure.
We will use your health
information for regular health care operations.
Members of our staff may review and use health information from
your record to assess the care and outcomes in your case and others like
it. This information will
then be used by us in an effort to continually improve the quality and
effectiveness of our services.
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Additional
Uses and Disclosures
Business Associates:
Certain of our business operations may be performed by other businesses.
We refer to these companies as “business associates.” In order
for these business associates to perform the required service (billing,
accounting services, etc.), we may need to disclose your health
information to them so that they can perform the job we’ve asked them to
do. To protect you, we require our business associates to appropriately
safeguard your health information.
Communication with Persons
Involved in Your Care: We
may disclose your health information that is directly relevant to your
care to individuals you wish to receive such information, including family
members, relatives, close personal friends, or other persons you identify.
Before we do so, we will ask you, and follow your instructions, as
to whether or not to make such disclosures.
If you are incapacitated, or involved in an emergency, we may use
or make disclosures of your health information that we believe in our
professional judgment are in your best interests, but only to the extent
that such health information is directly relevant to the recipients’
involvement in your care.
Required by Law:
We may use or disclose your health information to the extent such
use or disclosure is required by law and is limited to the relevant
requirements of such law.
Public Health, Health
Oversight and the Food and Drug Administration (FDA): As required by law, we may disclose your health information to public
health or legal authorities charged with preventing or controlling
disease, injury, or disability. We
may also be required by law to disclose your health information to health
oversight agencies responsible for regulating the health care system,
government benefit programs, and civil rights laws, so that they may
conduct, among other things, audits, investigations, and inspections.
For the purpose of activities relating to the quality, safety or
effectiveness of a FDA-regulated product or activity, we may disclose to
the FDA your health information relating to adverse events with drugs,
supplements, and other products, as well as information needed to enable
product recalls, repairs, or replacements.
Victims of Abuse, Neglect
or Domestic Violence:
If we reasonably believe that you are the victim of abuse, neglect
or domestic violence, we may disclose your health information to a
governmental authority responsible for receiving these types of reports,
to the extent the disclosure is required by law, or you agree to the
disclosure. If the disclosure
is authorized by law, but not required, we may disclose your information
if we determine that disclosure is necessary to prevent serious harm to
you or others.
Judicial and Administrative
Proceedings:
If you are involved in a judicial or administrative proceeding, we
may, in response to an order of a court or administrative tribunal, or in
response to a subpoena, discovery request, or other lawful process,
disclose the specific portions of your health information that are
requested. If the subpoena,
discovery request or other lawful process is not accompanied by a court or
administrative tribunal order, we may disclose your health information
only after we are assured that reasonable efforts have been made to notify
you of the request, and the time for you to raise objections to the
request has expired, or reasonable efforts have been made by the requestor
to seek a protective order concerning the requested health information.
Law Enforcement:
We may disclose your health information to a law enforcement official for
law enforcement purposes as required by law, a court ordered subpoena or
summons, a grand jury subpoena or summons, or an administrative subpoena
or summons, under certain circumstances.
In specific situations, the
law also permits us to disclose limited pieces of your health information,
when the information is needed by law enforcement officials to: 1)
identify a suspect, fugitive, material witness, or missing person; 2)
identify a victim of a crime; 3) alert law enforcement officials
concerning your death; 4) notify law enforcement officials when a crime
has been committed on our premises; or 5) in an emergency, when necessary
to alert law enforcement officials about a crime, its location, or the
identity of a perpetrator.
Coroners Medical Examiners
and Funeral Directors: We
may disclose your health information to a coroner or medical examiner for
the purpose of identifying you upon your passing, or to determine a
cause of death.
We may also disclose your health information to your funeral
director if needed to complete his or her authorized duties.
Organ, Eye or Tissue
Donation:
If you are an organ, eye or tissue donor, we may release your
health information to organizations that procure, bank or transplant
organs for the purpose of facilitating organ, eye or tissue donation and
transplantation.
Research:
We may disclose your health information to researchers when their research
has been approved by an institutional review board or privacy board that
has reviewed the research proposal and established protocols to ensure the
privacy of your health information, thereby meeting the requirements under
HIPAA. We may also disclose
your health information for the purposes of research, public health or
health care operations pursuant to a Data Use Agreement protecting that
information as specified by HIPAA.
Avert a Serious Threat to
Health or Safety: Consistent with applicable law and standards of ethical
conduct, we may, in limited circumstances, use or disclose your health
information if we, in good faith, believe such use or disclosure is
necessary to prevent or lessen a serious and imminent threat to health or
safety of a person or the public.
Military Personnel:
If you are a member of the United States Armed Services, we may
disclose your health information to the appropriate military command
authority when such information is deemed necessary to assure the proper
execution of the military mission.
National Security and
Presidential Protective Services:
We may disclose your health information to authorized federal officials
for the conduct of lawful intelligence and national security activities,
as well as the provision of protective services to the President and other
protected individuals.
Inmates and Individuals in
Custody: If you are an
inmate or otherwise in custody, we may disclose your health information to
the correctional facility or law enforcement official having lawful
custody of you.
Workers’ Compensation:
We may disclose your health information to the extent authorized and
necessary to comply with laws relating to workers’ compensation or other
similar programs established by law.
Appointment Reminders and
Information on Treatment Alternatives: We may contact you to provide appointment reminders, information
concerning treatment alternatives or other health-related benefits,
alternatives and services that may be of interest to you.
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Our Pledge
We will endeavor to protect
the privacy of your health information.
If you have any questions, comments, or concerns regarding the
policies set forth above, please do not hesitate to discuss such matters
with one of our Physicians [Alternative: with our Office Manager].
INSTRUCTION:
The terms contained in this Notice are intended to promote compliance with
the privacy provisions set forth in HIPAA.
Individual State and/or other applicable laws may prohibit or
materially limit certain of the uses and disclosures set forth above.
It is imperative that you review these disclosures with an attorney
who is familiar with your State’s health care and other laws and rules
governing privacy, and amend this Notice accordingly.
This Notice must not be considered complete until such review and
any necessary revisions have been made.
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