Notice of Privacy Practices
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 ask for
the administrator.
Treatment, Payment, Health Care Operations
Treatment
We are permitted to use and disclose your medical information to those
involved in your treatment. For example, your
care may require the involvement of a specialist. When we
refer you to a specialist, we will share some or all of your
medical information with that physician to facilitate the
delivery of care. Or, since our physicians are 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. Or, the physician
may consult with another physician to assist in providing
you the best health care possible.
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 you 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 Balcones Dermatology Associates,
P.A.
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 Balcones
Dermatology Associates. 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
Although you may not obtain the original record, 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 Balcones Dermatology
Associates.
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 Balcones Dermatology Associates. We
will respond within 60 days of your request. We may refuse
to allow an amendment if the medical 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.
- 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 of the amended 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 Balcones
Dermatology Associates. 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 e-mail 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 administrator for Balcones
Dermatology Associates. 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:
Administrator
Balcones Dermatology Associates, P.A.
(512) 459-4869 or
fax: (512) 453-2795
e-mail: clinic@balconesdermatology.com
This notice is effective starting 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.
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