NOTICE
OF PRIVACY PRACTICES
As Required by the
Privacy Regulations Created as a Result
of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES
HOW HEALTH INFORMATION ABOUT YOU (AS
A PATIENT OF THIS PRACTICE) MAY BE
USED AND DISCLOSED, AND HOW YOU CAN
GET ACCESS TO YOUR PROTECTED HEALTH
INFORMATION.
PLEASE
REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT
TO YOUR PRIVACY
Our practice is
dedicated to maintaining the privacy
of your protected health information
(PHI). In conducting our business,
we will create records regarding you
and the treatment and services we
provide to you. We are required by
law to maintain the confidentiality
of health information that identifies
you. We also are required by law to
provide you with this notice of our
legal duties and the privacy practices
that we maintain in our practice concerning
your PHI. By federal and state law,
we must follow the terms of the notice
of privacy practices that we have
in effect at the time.
We realize
that these laws are complicated, but
we must provide you with the following
important information:
- How we may use
and disclose your PHI
- Your privacy
rights in your PHI
- Our obligations
concerning the use and disclosure
of your PHI
The terms of this
notice apply to all records containing
your PHI that are created or retained
by our practice. We reserve the right
to revise or amend this Notice of
Privacy Practices. Any revision or
amendment to this notice will be effective
for all of your records that our practice
has created or maintained in the past,
and for any of your records that we
may create or maintain in the future.
Our practice will post a copy of our
current Notice in our offices in a
visible location at all times, and
you may request a copy of our most
current Notice at any time.
B. IF YOU
HAVE QUESTIONS ABOUT THIS NOTICE,
PLEASE CONTACT: Ernest Howerton, M.D.
at (512) 444-0701.
CONTACT
C. WE MAY USE AND
DISCLOSE YOUR PROTECTED HEALTH INFORMATION
(PHI) IN THE FOLLOWING WAYS
The following
categories describe the different
ways in which we may use and disclose
your PHI.
- Treatment. Our
practice may use your PHI to treat
you. For example, we may ask you
to have laboratory tests (such as
blood or urine tests), and we may
use the results to help us reach
a diagnosis. We might use your PHI
in order to write a prescription
for you, or we might disclose your
PHI to a pharmacy when we order
a prescription for you. Many of
the people who work for our practice
– including, but not limited
to, our doctors and nurses –
may use or disclose your PHI in
order to treat you or to assist
others in your treatment. Additionally,
we may disclose your PHI to others
who may assist in your care, such
as your spouse, children or parents.
Finally, we may also disclose your
PHI to other health care providers
for purposes related to your treatment.
- Payment. Our
practice may use and disclose your
PHI in order to bill and collect
payment for the services and items
you may receive from us. For example,
we may contact your health insurer
to certify that you are eligible
for benefits (and for what range
of benefits), and we may provide
your insurer with details regarding
your treatment to determine if your
insurer will cover, or pay for,
your treatment. We also may use
and disclose your PHI to obtain
payment from third parties that
may be responsible for such costs,
such as family members. Also, we
may use your PHI to bill you directly
for services and items. We may disclose
your PHI to other health care providers
and entities to assist in their
billing and collection efforts.
- Health Care
Operations. Our practice may use
and disclose your PHI to operate
our business. As examples of the
ways in which we may use and disclose
your information for our operations,
our practice may use your PHI to
evaluate the quality of care you
received from us, or to conduct
cost-management and business planning
activities for our practice. We
may disclose your PHI to other health
care providers and entities to assist
in their health care operations.
- Appointment
Reminders. Our practice may use
and disclose your PHI to contact
you and remind you of an appointment.
- Treatment Options.
Our practice may use and disclose
your PHI to inform you of potential
treatment options or alternatives.
- Health-Related
Benefits and Services. Our practice
may use and disclose your PHI to
inform you of health-related benefits
or services that may be of interest
to you.
- Release of Information
to Family/Friends. Our practice
may release your PHI to a friend
or family member that is involved
in your care, or who assists in
taking care of you. For example,
a parent or guardian may ask that
a babysitter take their child to
the pediatrician’s office
for treatment of a cold. In this
example, the babysitter may have
access to this child’s medical
information.
- Disclosures Required
By Law. Our practice will use and
disclose your PHI when we are required
to do so by federal, state or local
law.
D. USE AND DISCLOSURE
OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories
describe unique scenarios in which
we may use or disclose your identifiable
health information:
- Public Health
Risks. Our practice may disclose
your PHI to public health authorities
that are authorized by law to collect
information for the purpose of:
- maintaining
vital records, such as births
and deaths
- reporting
child abuse or neglect
- preventing
or controlling disease, injury
or disability
- notifying
a person regarding potential
exposure to a communicable disease
- notifying
a person regarding a potential
risk for spreading or contracting
a disease or condition
- reporting
reactions to drugs or problems
with products or devices
- notifying
individuals if a product or
device they may be using has
been recalled
- notifying
appropriate government agency(ies)
and authority(ies) regarding
the potential abuse or neglect
of an adult patient (including
domestic violence); however,
we will only disclose this information
if the patient agrees or we
are required or authorized by
law to disclose this information
- notifying
your employer under limited
circumstances related primarily
to workplace injury or illness
or medical surveillance.
- Health Oversight
Activities. Our practice may disclose
your PHI to a health oversight agency
for activities authorized by law.
Oversight activities can include,
for example, investigations, inspections,
audits, surveys, licensure and disciplinary
actions; civil, administrative,
and criminal procedures or actions;
or other activities necessary for
the government to monitor government
programs, compliance with civil
rights laws and the health care
system in general.
- Lawsuits and
Similar Proceedings. Our practice
may use and disclose your PHI in
response to a court or administrative
order, if you are involved in a
lawsuit or similar proceeding. We
also may disclose your PHI in response
to a discovery request, subpoena,
or other lawful process by another
party involved in the dispute, but
only if we have made an effort to
inform you of the request or to
obtain an order protecting the information
the party has requested.
- 4. Law Enforcement.
We may release PHI if asked to do
so by a law enforcement official:
- Regarding
a crime victim in certain situations,
if we are unable to obtain the
person’s agreement
- Concerning
a death we believe has resulted
from criminal conduct
- Regarding
criminal conduct at our office
- In response
to a warrant, summons, court
order, subpoena or similar legal
process
- To identify/locate
a suspect, material witness,
fugitive or missing person
- In an emergency,
to report a crime (including
the location or victim(s) of
the crime, or the description,
identity or location of the
perpetrator)
- Deceased Patients.
Our practice may release PHI to
a medical examiner or coroner to
identify a deceased individual or
to identify the cause of death.
If necessary, we also may release
information in order for funeral
directors to perform their jobs.
- Organ and Tissue
Donation. Our practice may release
your PHI to organizations that handle
organ, eye or tissue procurement
or transplantation, including organ
donation banks, as necessary to
facilitate organ or tissue donation
and transplantation if you are an
organ donor.
- Research. Our
practice may use and disclose your
PHI for research purposes in certain
limited circumstances. We will obtain
your written authorization to use
your PHI for research purposes except
when an Institutional Review Board
or Privacy Board has determined
that the waiver of your authorization
satisfies the following: (i) the
use or disclosure involves no more
than a minimal risk to your privacy
based on the following: (A) an adequate
plan to protect the identifiers
from improper use and disclosure;
(B) an adequate plan to destroy
the identifiers at the earliest
opportunity consistent with the
research (unless there is a health
or research justification for retaining
the identifiers or such retention
is otherwise required by law); and
(C) adequate written assurances
that the PHI will not be re-used
or disclosed to any other person
or entity (except as required by
law) for authorized oversight of
the research study, or for other
research for which the use or disclosure
would otherwise be permitted; (ii)
the research could not practicably
be conducted without the waiver;
and (iii) the research could not
practicably be conducted without
access to and use of the PHI.
- Serious Threats
to Health or Safety. Our practice
may use and disclose your PHI when
necessary to reduce or prevent a
serious threat to your health and
safety or the health and safety
of another individual or the public.
Under these circumstances, we will
only make disclosures to a person
or organization able to help prevent
the threat.
- Military. Our
practice may disclose your PHI if
you are a member of U.S. or foreign
military forces (including veterans)
and if required by the appropriate
authorities.
- National Security.
Our practice may disclose your PHI
to federal officials for intelligence
and national security activities
authorized by law. We also may disclose
your PHI to federal officials in
order to protect the President,
other officials or foreign heads
of state, or to conduct investigations.
- Inmates. Our
practice may disclose your PHI to
correctional institutions or law
enforcement officials if you are
an inmate or under the custody of
a law enforcement official. Disclosure
for these purposes would be necessary:
(a) for the institution to provide
health care services to you, (b)
for the safety and security of the
institution, and/or (c) to protect
your health and safety or the health
and safety of other individuals.
- 12. Workers’
Compensation. Our practice may release
your PHI for workers’ compensation
and similar programs.
E. YOUR RIGHTS REGARDING
YOUR PHI
You have
the following rights regarding the
PHI that we maintain about you:
- Confidential
Communications. You have the right
to request that our practice communicate
with you about your health and related
issues in a particular manner or
at a certain location. For instance,
you may ask that we contact you
at home, rather than work. In order
to request a type of confidential
communication, you must make a written
request to Ernest Howerton, M.D.
specifying the requested method
of contact, or the location where
you wish to be contacted. Our practice
will accommodate reasonable requests.
You do not need to give a reason
for your request.
- Requesting Restrictions.
You have the right to request a
restriction in our use or disclosure
of your PHI for treatment, payment
or health care operations. Additionally,
you have the right to request that
we restrict our disclosure of your
PHI to only certain individuals
involved in your care or the payment
for your care, such as family members
and friends. We are not required
to agree to your request; however,
if we do agree, we are bound by
our agreement except when otherwise
required by law, in emergencies,
or when the information is necessary
to treat you. In order to request
a restriction in our use or disclosure
of your PHI, you must make your
request in writing to Ernest Howerton,
M.D. Your request must describe
in a clear and concise fashion:
- (a) the information
you wish restricted;
- (b) whether
you are requesting to limit
our practice’s use, disclosure
or both; and
- (c) to whom
you want the limits to apply.
- Inspection and
Copies. You have the right to inspect
and obtain a copy of the PHI that
may be used to make decisions about
you, including patient medical records
and billing records, but not including
psychotherapy notes. You must submit
your request in writing to Ernest
Howerton, M.D. in order
to inspect and/or obtain a copy
of your PHI. Our practice may charge
a fee for the costs of copying,
mailing, labor and supplies associated
with your request. Our practice
may deny your request to inspect
and/or copy in certain limited circumstances;
however, you may request a review
of our denial. Another licensed
health care professional chosen
by us will conduct reviews.
- Amendment. You
may ask us to amend your health
information if you believe it is
incorrect or incomplete, and you
may request an amendment for as
long as the information is kept
by or for our practice. To request
an amendment, your request must
be made in writing and submitted
to Ernest Howerton, M.D.
You must provide us with a reason
that supports your request for amendment.
Our practice will deny your request
if you fail to submit your request
(and the reason supporting your
request) in writing. Also, we may
deny your request if you ask us
to amend information that is in
our opinion: (a) accurate and complete;
(b) not part of the PHI kept by
or for the practice; (c) not part
of the PHI which you would be permitted
to inspect and copy; or (d) not
created by our practice, unless
the individual or entity that created
the information is not available
to amend the information.
- Accounting of
Disclosures. All of our patients
have the right to request an “accounting
of disclosures.” An “accounting
of disclosures” is a list
of certain non-routine disclosures
our practice has made of your PHI
for non-treatment, non-payment or
non-operations purposes. Use of
your PHI as part of the routine
patient care in our practice is
not required to be documented. For
example, the doctor sharing information
with the nurse; or the billing department
using your information to file your
insurance claim. In order to obtain
an accounting of disclosures, you
must submit your request in writing
to Ernest Howerton, M.D.. All requests
for an “accounting of disclosures”
must state a time period, which
may not be longer than six (6) years
from the date of disclosure and
may not include dates before April
14, 2003. The first list you request
within a 12-month period is free
of charge, but our practice may
charge you for additional lists
within the same 12-month period.
Our practice will notify you of
the costs involved with additional
requests, and you may withdraw your
request before you incur any costs.
- Right to a Paper
Copy of This Notice. You are entitled
to receive a paper copy of our notice
of privacy practices. You may ask
us to give you a copy of this notice
at any time. To obtain a paper copy
of this notice, contact Ernest
Howerton, M.D.
- Right to File
a Complaint. If you believe your
privacy rights have been violated,
you may file a complaint with our
practice or with the Secretary of
the Department of Health and Human
Services. To file a complaint with
our practice, contact Ernest
Howerton, M.D. All complaints
must be submitted in writing. You
will not be penalized for filing
a complaint.
- Right to Provide
an Authorization for Other Uses
and Disclosures. Our practice will
obtain your written authorization
for uses and disclosures that are
not identified by this notice or
permitted by applicable law. Any
authorization you provide to us
regarding the use and disclosure
of your PHI may be revoked at any
time in writing. After you revoke
your authorization, we will no longer
use or disclose your PHI for the
reasons described in the authorization.
Please note, we are required to
retain records of your care.
Again, if you have
any questions regarding this notice
or our health information privacy
policies, please contact Ernest Howerton,
M.D.
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