NOTICE OF PRIVACY PRACTICES

Our Responsibilities:

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.

The facility and its medical staff members are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and healthcare operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatments as it may affect treatment at the time.

Uses and Disclosures

How we may use and disclose Medical Information about you.

The following categories describe examples of the way we use and disclose medical information:

For Treatment: We may use medical information about you to provide you treatment or services. We may disclose information about you to doctors, technicians, medical students or other personnel who are involved in taking care of you at the hospital. Different departments at the hospital also may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals and x-rays.

We may also provide your physician or subsequent health provider with copies of various reports that should assist him or her in treating you once you are discharged from the hospital.

For Payment: We may use and disclose medical information about your treatment and services to bill and collect payments from you, your insurance company, or a third-party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.

For Healthcare Operations: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care or treatment. We may disclose information to doctors, nurses and other students for educational purposes. And we may combine medical information we have with that of other hospitals to see where we can make improvements. We may remove information that identifies you from this set of medical information to protect your privacy.

We may also use and disclose medical information:

To business associates we have contracted with to perform the agreed upon service and billing for it;
To you remind you that you have an appointment for medical care;
To assess your satisfaction with our services;
To tell you about possible treatment alternatives;
To tell you about health-related benefits or services;

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory test, and a copy service we use when making copies of your health record. When the services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or the third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and establish protocols to ensure the privacy of your Health information has approved the research.

Future Communications: We may communicate to you via newsletter, mail outs or other means regarding treatment options, health related information disease management programs, wellness programs or other community-based initiatives or activities our facility is participating in.

Affiliated Covered Entity: Protected health information will be made available to hospital personnel at local HCA affiliated hospitals as necessary to carry out treatment, payment, and healthcare operations. Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time. Please contact the facility privacy official for further information on the specific sites included in this affiliated covered entity. As required by law we may also use and disclose health information for the following types of entities, including but not limited to:

Food and drug administration
Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability
Correctional Institutions
Workers Compensation Agents
Organ and Tissue Donation Organizations
Military Command Authorities
Health Oversight Agencies
Funeral Directors, Coroners and Medical Directors
National Security and Intelligence Agencies
Protective Services for the President and Others

Law-Enforcement/ Legal Proceedings: We may disclose health information for law-enforcement purposes as required by law or in response to a valid subpoena.

State Specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing healthcare cost. Some states have separate privacy laws that may apply legal requirements. If the State privacy laws are more stringent than Federal privacy laws, the State law preempts the Federal law.

Your Health Information Rights

Although your health record is the physical property of the healthcare practitioner or a facility that compiled it, you have the Right to:

Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital 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. You may receive copies of your records if your request is approved and after payment of applicable state approved charges for copies of records have been received.

Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
An Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of the disclosures we make of medical information about you for purposes other than treatment, payment or healthcare operations.
Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about the surgery you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

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 may ask that we contact you at work or by US mail. The facility will grant requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.
A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this 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.

CHANGES TO THIS NOTICE

We reserve the right to change this notice and the revised or change notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted in the hospital and include the effective data. In addition, each time you register at or are admitted to the hospital for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the clinic by contacting the main number and asking for the office manager or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures that we have made with your permission, and that we are required to retain our records of the care that we provided to you.

NOTICE OF PRIVACY PRACTICES

ABOUT OUR CLINIC

(940) 286-4344

[email protected]

1925 N Grand Ave, Gainesville, TX 76240