THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). HIPAA requires us to make sure that medical information that identifies you is kept private, provide you with this notice of our legal duties and privacy practices with respect to medical information about you, and follow the terms of the Privacy Notice that is currently in effect.
This Privacy Notice 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. This notice also describes your rights and certain obligations we have regarding the use and disclosure of protected health information. This Privacy Notice applies to all of the records of your care generated by our office, including records made by office personnel or your physician. It also describes your right to access and control your protected health information. Your protected health information means any written or oral information about you, including demographic data that can be used to identify you, created or received by your health care provider, which relates to your past, present, or future physical or mental health or condition. We understand that medical information about you and your health is personal. We are committed to protecting medical information about you.
We reserve the right to change the terms of this Privacy Notice and to make any new provisions effective to all of the protected health information that we maintain about you. If you have any questions about this notice, please contact the Privacy Officer.
Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operation.
We may use your protected health information for the purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless we have obtained your authorization or the use or disclosure is permitted or required by the HIPAA regulations or other law. We will collect the following information about you from the following sources: information that we obtain directly from you, in conversations or on applications or other forms that you fill out; information that we obtain as a result of our transactions with you; information that we obtain from your medical records or from health care professionals; and information that we obtain from other entities, such as health care providers or other insurance companies, in order to service your policy or carry out other insurance-related needs. Disclosures of your protected health information for the purposes described in this Privacy Notice may be made in writing, orally, or by electronic means.
The following categories describe different ways that we use and disclose protected health information. For each category of uses or disclosures we will explain what we mean and provide some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
For Treatment: We will use and disclose your protected healthcare information to provide, coordinate, or manage your health care and related services, including coordination and management with third parties for treatment purposes. The following are some examples of how we may use or disclose your protected health information for treatment:
- We may disclose your protected health information to a laboratory to order tests.
- We may disclose your protected health information to other physicians or health care professional that may be treating you or consulting with us regarding your care.
- We may disclose your protected health information to those who may be involved in your care after you leave our office, such as family members, and we will ask for your authorization and note this in your chart.
For Payment: We will use your protected health information so that the treatment and services you receive at our office may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to send your protected health information, such as your name, address office visit date, and codes identifying your diagnosis and treatment to your insurance company for payment. We may also disclose your protected health information to another provider involved in your care for their payment activities. The following are some examples of how we may use or disclose your protected health information for payment:
- We may communicate with your health insurance company to get approval for the services we render, to verify your health insurance coverage, to verify that particular services are covered under your insurance plan, and to demonstrate medical necessity.
- We may disclose your protected health information to anesthesia care providers involved in your care so they can obtain payment for the services provided to you.
For Health Care Operations: We may use and disclose your protected health information to facilitate our own health care operations and to provide quality care to all of our patients. Health care operations include such activities as: quality assessment and improvement; employee review activities; conducting or arranging for medical review; and auditing functions, including without limitation, regulatory compliance reviews, business planning and development, and business management and general administrative activities. In certain situations, we may also disclose your protected health information to another provider or health plan for their health care operations. The following are some examples of how we may use or disclose your protected health information for health care operations:
- We may use your protected health information to review our treatment and services and to evaluate the performance of our staff in caring for you.
- We may combine protected health information about many patients to decide what additional services we should offer and whether certain new treatments are effective.
- We may also disclose information to physicians, nurses, technicians, medical students, and other personnel for review and learning purposes.
Uses and Disclosures of Protected Health Information That Can Be Made Without Your Consent or Authorization
The HIPAA regulations enable us to use or disclose your protected health information without your consent or authorization in certain circumstances including:
Appointment Reminders: We may use and disclose information to send you mailings reminding you that you have an appointment for treatment at our office. We may also leave telephone appointment messages on your home or office answering system, unless you advise us otherwise.
Treatment Alternatives: We may use and disclose your protected health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services: We may use your protected health information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care of Payment for Your Care: If we see the need to release protected health information about you to a friend or family member who is involved in your care or pays for your care, we will ask for oral consent or authorization from you to do so, depending on the circumstances.
When Required By Law. We will disclose your protected health information when we are required to do so by federal, state or local law.
For Public Health Reasons: We may disclose your protected health information as permitted or required by law for the following public health reasons:
- For the prevention, control, or reporting of disease, injury or disability;
- To report child, elder or domestic abuse or neglect;
- To report reactions to medications or problems with products;
- For the reporting of vital events such as birth or death;
- For public health surveillance, investigations, or interventions;
- To notify people or patients of recalls of products they may be using; and
- For purposes related to the quality, safety, or effectiveness of FDA regulated products or activities.
For Health Oversight Activities" We may disclose your protected health information to a health oversight agency for oversight activities authorized by law. These health oversight activities may include: audits; investigations; inspections; licensure or other activities necessary for appropriate oversight. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
For Judicial or Administrative Proceedings: We may disclose your protected health information in the course of a judicial or administrative proceeding in response to a court or administrative order. We may disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
For Law Enforcement Purposes: We may disclose your protected health information to a law enforcement official for law enforcement purposes, including without limitation:
- To report a wound or physical injury, as required by law;
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
To Coroners, Medical Examiners, and Funeral Directors: We may disclosed protected health information to a coroner or medical examiner for the purpose of identifying a deceased person or to determine the cause of death. We may disclose protected health information to funeral directors, pursuant to applicable law.
For Organ or Tissue Donation: We may use or disclose protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating donation and transplant.
For Research Purposes: We may use or disclose your protected health information for research purposes when an institutional review board has reviewed the research proposal and protocols and has safeguarded the privacy of your protected health information.
National Security and Intelligence Activities: We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
For Workers' Compensation: We may release medical information about you for Workers' Compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your protected health information to the correctional institution or law enforcement official. This release would be necessary for (1) the institution to provide you with medical care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Your Rights Regarding Your Protected Health Information
You have the following rights regarding your medical information that we maintain:
Right to Inspect and Copy: You have the right to inspect and copy your protected health information that may be used to make decisions about your care. Usually this includes medical and billing records but does not include psychotherapy notes, information compiled for use in a civil, criminal, or administrative action or proceeding, and protected health information to which access is prohibited by law. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, and other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by SpineTeamTexas will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the office. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. Additionally, we may deny your request if you ask us to amend information that:
- Was not created by us;
- Is not part of the medical information kept by or for SpineTeamTexas;
- Is not part of the information you would be permitted to inspect and copy; or
- Which we deem to be accurate and complete.
If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement, and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept on file and sent out with any future authorized requests for information which pertains to the appropriate portion of your record.
Right to an Accounting of Disclosures: You have the right to request a list of the disclosures we made of your protected health information. This is a list of the disclosures which relates to medical information about you, and is not related to treatment, payment, and health care operations of the office, which you did not specifically authorize. To request this list, you must submit your request in writing to the Privacy Officer. Your request must state a time period, which may not be longer than six (6) years, and may not include dates before April 14, 2003. Your request should indicate in what form you would like the list. After the first list which is requested and provided to you in a twelve (12) month period, we reserve the right to charge you for the cost of providing additional lists.
Right to Request Restrictions: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations or to someone who is involved in your care or the payment of your care. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must submit your request in writing to the Privacy Officer. In your request, you must tell us: (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We reserve the right to deny a request if it imposes an unreasonable burden on the practice.
Right to a Paper Copy of this Notice: You have the right to a paper copy of this Privacy Notice. You may ask us to give you a copy of this Privacy Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a paper copy of this notice by contacting the Privacy Officer.
Changes to This Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer or the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or discriminated against for filing a complaint.
Other Uses and Disclosures of Medical Information: Other uses and disclosures of your protected health information not covered by this Privacy Notice or the laws that apply to us will be made only with your written authorization. If you give us authorization to use or disclose medical information about you, you may revoke that authorization, in writing at any time. If you revoke your authorization, we will thereafter no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain our records of the care we have provided you.
Contact the Privacy Officer for Obtaining Further Information or Filing a Complaint:
Spine Team Texas
1545 E. Southlake Blvd., Ste. 100
Southlake, TX 76092
This Privacy Notice is effective April 14, 2003.