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.
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. This notice describes
our privacy practices. You can request a copy of this notice
at any time. For more information about this notice or our
privacy practices and policies, please contact Tina Skidmore.
Treatment, Payment, Health
Care Operations
Treatment
We are permitted to use and disclose your medical
information to those involved in your treatment. For example,
the physician in this practice is a specialist. When we
provide treatment, we may request that your primary care
physician share your medical information with us. Also,
we may provide your primary care physician information about
your particular condition so that he or she can appropriately
treat you for other medical conditions, if any.
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.
Disclosures That Can Be Made
Without Your Authorization
There are situations in which we are permitted
by law to disclose or use your medical information without
your written authorization or an opportunity to object.
In other situations we will ask for your written authorization
before using or disclosing any identifiable health information
about you. If you choose to sign an authorization to disclose
information, you can later revoke that authorization, in
writing, to stop future uses and disclosures. However, any
revocation will not apply to disclosures or uses already
made or taken in reliance on that authorization.
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. We may
disclose medical information, if authorized by law, to a
person who may have been exposed to a disease or may be
at risk for contracting or spreading a disease or condition.
We may disclose your medical information to report reactions
to medications, problems with products, or to notify people
of recalls of products they may be using. We may also 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. We may disclose your medical
information to a health oversight agency for those activities
authorized by law. Examples of these activities are audits,
investigations, licensure applications and inspections which
are all government activities undertaken to monitor the
health care delivery system and compliance with other laws,
such as civil rights laws.
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.
If asked by a law enforcement
official, we may disclose your medical information under
limited circumstances provided that the information:
Is released pursuant to legal process,
such as a warrant or subpoena;
Pertains to a victim of crime and your are incapacitated;
Pertains to a person who has died under circumstances that
may be related to criminal conduct;
Is about a victim of crime and we are unable to obtain the
person's agreement;
Is released because of a crime that has occurred on these
premises;
or Is released to locate a fugitive, missing person, or
suspect. 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.
Workers' 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.
This release is permitted to allow the institution to provide
you with medical care, to protect your health or the health
and safety of others, or for the safety and security of
the institution.
Military, National Security
and Intelligence Activities, Protection of the President
We may disclose your medical information for specialized
governmental functions such as separation or discharge from
military service, requests as necessary by appropriate military
command officers (if you are in the military), 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.
Research, Organ Donation,
Coroners, Medical Examiners, and Funeral Directors
When a research project and its privacy protections
have been approved by an Institutional Review Board or privacy
board, we may release medical information to researchers
for research purposes. We may release medical information
to organ procurement organizations for the purpose of facilitating
organ, eye, or tissue donation if you are a donor. Also,
we may release your medical information to a coroner or
medical examiner to identify a deceased or a cause of death.
Further, we may release your medical information to a funeral
director where 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.
Your Rights Under Federal
Privacy Regulations
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). Those regulations create
several privileges that patients may exercise. We will not
retaliate against a patient that exercises their HIPAA rights.
Requested Restrictions
You may request that we restrict or limit how your
protected health information is used or disclosed for treatment,
payment, or healthcare 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.
To request a restriction, submit the following in writing:
(a) The information to be restricted, (b) what kind of restriction
you are requesting (i.e. on the use of information, disclosure
of information or both), and (c) to whom the limits apply.
Please send the request to the address and person listed
below. You may also request that we limit disclosure to
family members, other relatives, or close personal friends
that may or may not be involved in your care.
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. This request must be made in writing
to the person listed below. We are required to accommodate
only reasonable requests. Please specify in your correspondence
exactly how you want us to communicate with you and, if
you are directing us to send it to a particular place, the
contact/address information.
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. Please send your request to the
person listed below.
We can refuse to provide
some of the information you ask to inspect or ask to be
copied if the information:
• Includes psychotherapy notes.
• Includes the identity of
a person who provided information if it was obtained under
a promise of confidentiality.
• Is subject to the Clinical
Laboratory Improvements Amendments of 1988.
• Has been compiled in anticipation
of litigation.
• We can refuse to provide
access to or copies of some information for other reasons,
provided that we provide a review of our decision on your
request. Another licensed health care provider who was not
involved in the prior decision to deny access will make
any such review.
• Texas law requires that
we are ready to provide copies or a narrative within 15
days of your request. We will inform you of when the records
are ready or if we believe access should be limited. If
we deny access, we will inform you in writing.
• HIPAA permits us to charge
a reasonable cost based fee. The Texas State Board of Medical
Examiners (TSBME) has set limits on fees for copies of medical
records that under some circumstances may be lower than
the charges permitted by HIPAA. In any event, the lower
of the fee permitted by HIPAA or the fee permitted by the
TSBME will be charged.
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 to the person listed below. We will respond within
60 days of your request. We may refuse to allow an amendment
if the information:
• Wasn't created by this practice
or the physicians here in this practice.
• Is not part of the Designated
Record Set.
• Is not available for inspection
because of an appropriate denial.
• If the information is accurate
and complete.
• Even if we refuse to allow
an amendment you are permitted to include a patient statement
about the information at issue in your medical record. If
we refuse to allow an amendment we will inform you in writing.
If we approve the amendment, we will inform you in writing,
allow the amendment to be made and tell others that we know
have the incorrect information.
Accounting of Certain Disclosures
The HIPAA privacy regulations permit you to request,
and us to provide, an accounting of disclosures 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 to the person
listed below. 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 the list. If there is a charge we will notify
you and you may choose to withdraw or modify your request
before any costs are incurred.
Appointment Reminders, Treatment
Alternatives, and Other Health-related Benefits
We may contact you by telephone, mail, or both
to provide appointment reminders, information about treatment
alternatives, or other health-related benefits and services
that may be of interest to you.
Complaints
If you are concerned that your privacy rights have
been violated, you may contact the person listed below.
You may also send a written complaint to the United States
Department of Health and Human Services. We will not retaliate
against you for filing a complaint with the government or
us. The contact information for the United States Department
of Health and Human Services is:
U.S. Department of Health and Human
Services
HIPAA Complaint
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
Our Promise to You
We are required by law and regulation to protect
the privacy of your medical information, to provide you
with this notice of our privacy practices with respect to
protected health information, and to abide by the terms
of the notice of privacy practices in effect.
Questions and Contact Person
for Requests
If you have any questions or want to make a request
pursuant to the rights described above, please contact:
Tina Skidmore
P. O. Box 100,
Paris, TX 75461-0100
903.785.6029 (phone)
903.784.2810 (fax)
tskidmore@rrvr.net
(email)
This notice is effective
on the following date: April 14, 2003
We may change our policies and this
notice at any time and have those revised policies apply
to all the protected health information we maintain. If
or when we change our notice, we will post the new notice
in the office where it can be seen.
