Privacy Practices
Notice of Privacy Practices
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This notice (effective April 14, 2003) describes how
medical information about you may be used and disclosed and how
you can get access to this information. Please review it carefully.
If you have any questions about this Notice please contact our Privacy Officer, whose name is listed at the bottom of this Notice. |
This Notice of Privacy Practices describes how Texas Spine and Joint
Hospital and the physicians who provide services at this facility 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. The new
notice 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 facility and
requesting that a revised copy be sent to you in the mail or asking for
one at the time of your next appointment. Texas Spine and Joint
Hospital and the physicians who practice here are independent
contractors and do not hereby assume any liability for the services or
conduct of the other.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information without your Authorization.
Your protected health information may be used and disclosed by your
physician, our office staff and others outside of our facility that are
involved in your care and treatment for the purpose of providing health
care services to you. Your protected health information may also
be used and disclosed to pay your health care bills and to support the
operation of the facility.
Following are examples of the types of uses and disclosures of your
protected health care information that the facility is permitted to
make once you have signed our authorization form. These examples
are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our facility.
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 that
has already obtained permission to have access to your protected health
information. For example, we would disclose your protected health
information, as necessary, to a home health agency that provides care
to you. We will also disclose protected health information to
other facilities who may be treating you when we have the necessary
permission from you to disclose your protected health
information. For example, your protected health information may
be provided to a physician to whom you have been referred to ensure
that the physician has the necessary information to diagnose or treat
you.
In addition, we may disclose your protected health information from
time-to-time to another facility or health care provider (e.g., a
specialist or laboratory) who, at the request of your physician,
becomes involved in your care by providing assistance with your health
care diagnosis or treatment to your physician.
Payment: Your protected health information
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 we recommend 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 protected health information be
disclosed to the health plan to obtain approval for the hospital
admission.
Healthcare Operations: We may use or
disclose, as-needed, your protected health information in order to
support the business activities of this facility. These
activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students,
licensing, marketing and fundraising activities, and conducting or
arranging for other business activities.
For example, we may disclose your protected health information to
medical school students that see patients at our facility. In
addition, we may use a sign-in sheet at the registration desk where you
will be asked to sign your name and indicate your physician. We
may also call you by name in the waiting room when we are ready to see
you. We may use or disclose your protected health information, as
necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party
"business associates" that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement
between our office and a business associate involves the use or
disclosure of your protected health information, we will have a written
contract that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment alternatives
or other health-related benefits and services that may be of interest
to you. We may also use and disclose your protected health
information for other marketing activities. For example, your
name and address may be used to send you a newsletter about our
practice and the services we offer. We may also send you
information about products or services that we believe may be
beneficial to you. You may contact our Privacy Officer, listed at
the bottom of this Notice, to request that these materials not be sent
to you.
Uses and Disclosures of Protected Health Information 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
your physician or the facility has taken an action in reliance on the
use or disclosure indicated in the authorization.
Patient Directories: We may include your
name, location in this facility, general condition and religious
affiliation, in our patient directory for use by clergy and visitors
who ask for you by name, unless you object in whole or in part. A
form for objection can be obtained during the Admissions Process.
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 protected health
information 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 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 With/Without Your Authorization and/or Opportunity to Object
We may use and disclose your protected health information in the
following instances. You have the opportunity to agree or object
to the use or disclosure of all or part of your protected health
information in the facility directory, to clergy, to members of the
public, to your family and friends, and to disaster relief
organizations. If you are not present or able to agree or object
to the use or disclosure of the protected health information, then your
physician may, using professional judgment, determine whether the
disclosure is in your best interest. In this case, only the
protected health information that is relevant to your health care will
be disclosed. In other situations outlined below, we may use or
disclose your protected health information without informing you or
obtaining your consent or authorization.
Emergencies: We may use or disclose your
protected health information in an emergency treatment situation.
If this happens, your health care provider shall try to obtain your
authorization as soon as reasonably practicable after the delivery of
treatment.
Communication Barriers: We may use and
disclose your protected health information if your physician or another
physician in this facility attempts to obtain authorization from you
but is unable to do so due to substantial communication barriers and
the physician determines, using professional judgment, that you intend
to authorize to use or disclosure under the circumstances.
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 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 protected health information, 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
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 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
protected health information to a public health authority that is
authorized by law to receive reports of child abuse or neglect.
In addition, we may disclose your protected health information if we
believe that you have been a victim of abuse, neglect or domestic
violence to the 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 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 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.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information 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 protected health information to a
funeral director, as authorized by law, in order to permit the funeral
director to carry out their duties. We may disclose such
information in reasonable anticipation of death. Protected health
information may be used and disclosed for cadaveric organ, eye or
tissue donation purposes.
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.
Criminal Activity: 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. We may also disclose
protected health information 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 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 Section 164.500 et.
seq.
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 facility use for making
decisions about you.
Under federal law, however, you may not inspect or copy the
following records; psychotherapy notes; information compiled in
reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and protected health information
that is subject to law that prohibits access to protected health
information. Depending on the circumstances, a decision to deny
access may be reviewed. In some circumstances, you may have a
right to have this decision reviewed. Please contact our Privacy
Officer, listed at the bottom of this Notice if you have questions
about access to your medical record, or to arrange access to your
medical records.
You have the right to request a restriction of your protected health information.
This means 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.
Your physician is not required to agree to a restriction that you
may request. If physician believes 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 your
physician 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. You may request a restriction by filling out
t he appropriate form during your Admissions Process.
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
Privacy Officer (listed at the bottom of this Notice).
You may have the right to have your physician amend your protected health information.
This means you may request an amendment of protected health information
about you in a designated record set 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 Privacy Officer 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, for a
facility directory, 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. Privacy Complaints
You may make privacy complaints to us or to the Secretary of Health
and Human Services if you believe your privacy rights have been
violated by us. You may file a complaint with the Secretary of
Health and Human Services by phoning their Office of Civil Rights (OCR)
at: 1-866-627-7748, or 1-866-OCR-PRIV. You may file a complaint with us
by notifying our Privacy Officer of your complaint. We will not
retaliate against you for filing a complaint.
You may contact our Privacy Officer, (listed at the bottom of this Notice), for further information about the complaint process.
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Our Privacy Officer
Maggie Kelley, RHIA
At This Number 903-525-3450
At This Address Texas Spine & Joint Hospital 1814 Roseland Boulevard Tyler, Texas 75701 |
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