AMARILLO DIAGNOSTIC CLINIC, P.A.
NOTICE OF PRIVACY PRACTICES
Effective Date: September 1, 2015
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.
Protected health information is stored electronically and is subject to electronic disclosure
If you have any questions about this notice, please contact BSA Health System Privacy Officer, at 806-212-2000.
WHO WILL FOLLOW THIS NOTICE
This notice describes our clinic’s practices and that of:
- Any medical staff member and any health care professional who participates in your care
- Any volunteer we allow to help you while you are here; and All employees of any hospital, clinic, laboratory, or other facility affiliated with BSA Health System
- All of those people follow the terms of this notice. They may also share health information that identifies you (also known as "protected health information") with each other for treatment, payment or health care operations as described in this notice.
All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or clinic operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that health information about you and your health is personal. We are committed to protecting health information about you. This notice will tell you about the ways that we may use and disclose health information about you. This notice also describes your rights and certain obligations we have regarding the use and disclosure or protected health information. We are required to comply with any state laws that offer a patient/plan member additional privacy protections.
We are required by law to:
- maintain the privacy of health information that identifies you;
- give you and other individuals this notice of our legal duties and privacy practices with respect to protected health information;
- Follow the terms of the notice that is currently effective; and
- Notify affected individuals in the event of a breach involving unsecured protected health information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and give 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 the categories.
- For Treatment: We may use and disclose your health information to provide you with medical treatment or services and to coordinate your care. For example, a health care provider, such as a physician, nurse, or other person providing health services will access your health information to understand your medical condition and history. To assist in your treatment and care coordination, we may share information with other providers and with accountable care organizations (known as "ACOs") in which you participate, including notifying them that you have received care from us.
- For Payment: We may use and disclose your health information for purposes of receiving payment for treatment and services that you receive. For example, we may disclose your information to health plans or other payers to determine whether you are enrolled with the payer or eligible for health benefits or to submit claims for payment. The information on our bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment. We may provide health information to entities that help us submit bills and collect amounts owed, such as a collection agency.
- For Health Care Operations: We may use and disclose your health for operational purposes. For example, your health information may be used by, and disclosed to, members of the medical staff, risk or quality personnel, and others to evaluate the performance of our staff, to assess the quality of care and outcomes in your case and similar cases, to learn how to improve our facilities and services, for training, to arrange for legal or risk management services and to determine how to continually improve the quality and effectiveness of the health care we provide.
- Facility Directory: Unless you object, we may include you in the facility directory. This information may include your name, location in the facility, general condition (e.g. fair, stable, etc.) and religious affiliation. We may give your directory information, except for religious affiliation to people who ask for you by name. Unless you object, your religious affiliation and other directory information may be released to members of the clergy even if they do not ask for you by name.
- Others Involved In Your Care: Others Involved In Your Care. We may disclose relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your care or payment related to your care. We may also disclose health information to those assisting in disaster relief efforts so that others can be notified about your condition, status and location.
- Fund Raising: We may use and disclose your health information to contact you about fundraising, consistent with legal requirements. You have the right to opt out of receiving these communications.
- Required By Law: We may use and disclose information about you as required by law. For example, we may disclose information to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
- Public Health: Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (e.g. state health department, Center for Disease Control, etc.) to prevent or control disease, injury, or disability, or for other public health activities. Texas law contains some reporting requirements, including population-based activities relating to improving health or reducing health care costs.
- Law Enforcement Purposes: Subject to certain restrictions, we may disclose information needed or requested by law enforcement officials.
- Judicial And Administrative Proceedings: We may disclose information in response to an appropriate subpoena, discovery request or court order.
- Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections to monitor the health care system.
- Decedents: Health information may be disclosed to funeral directors, medical examiners or coroners to enable them to carry out their lawful duties.
- Organ/Tissue Donation: Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
- Research: We may use or disclose your health information for research purposes after a receipt of authorization from you or when an institutional review board (IRB) or privacy board has waived the authorization requirement, by its review of the research proposal and has established protocols to ensure the privacy of your health information. We may also review your health information to assist in the preparation of a research study.
- Health and Safety: Your health information may be disclosed to avert a serious threat to the health and safety of you or any other person pursuant to applicable law.
- Government Functions: Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.
- Workers' Compensation: Your health information may be used or disclosed in order to comply with laws and regulations related to Workers' Compensation.
- Business Associates: We may disclose your health information to business associates (individuals or entities that perform functions on our behalf) provided they agree to safeguard the information.
- Other Uses and Disclosures: We may contact you to provide appointment reminders or for billing or collections and may leave messages on your answering machine, voice mail or through other methods. We may disclose your health information through Health Information Exchanges (HIEs) in which we participate for treatment, payment or other purposes described above as permitted by law. A HIE is a computer based information system that helps providers securely share medical information for purposes permitted by law such as coordinating care. Patients are generally included in the HIE unless they choose to opt out. To opt out of future disclosures through HIEs in which we participate, contact our Privacy Officer at the address at the end of this notice so that you can complete the HIE opt out form.
Except for uses and disclosures described above, we will only use and disclose your health information with your written authorization. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your health information for marketing purposes or sell your health information, unless you have signed an authorization. You may revoke an authorization by notifying us in writing, except to the extent we have taken action in reliance on the authorization
YOUR HEALTH INFORMATION RIGHTS
You have the right to:
- Obtain a paper copy of this notice of information practices upon request, even if you have previously agreed to receive this notice electronically;
- Inspect and obtain a copy of your health information that we maintained;
- Request an amendment to your health information under certain circumstances;
- Request a confidential communication of your health information by alternative means or at alternative locations. Please be advised that this request for alternative means or locations of communications applies only to this provider or location;
- Receive an accounting of certain disclosures made of your health information; and
- Request a restriction on certain uses and disclosures of your information. We are not required to agree to a requested restriction, except for requests to limit disclosures to your health plan for purposes of payment or health care operations when you have paid for the item or service covered by the request out-of-pocket and in full and when the uses or disclosures are not required by law.
To exercise any of these rights, please contact our Privacy Officer at the address at the end of this notice.
This document shall provide notice to patients that the Texas Department of State Health Services, Texas Healthcare information Collection program (THCIC) receives patient claim data regarding services per formed by the named Provider. The patients claim data is used to help improve the health of Texas, through various methods of research and analysis. Patient confidentiality is upheld to the highest standard and is not subject to public release. THCIC follows strict internal and external guidelines as outlined in Chapter 108 of the Texas Health and Safety Code and the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
For further information regarding the data being collected, please send all inquiries to:
Dept. of State Health Services
Center for Health Statistics, MC 1898
PO Box 149347
Austin, Texas 78714-9347
Moreton Building, M-660
II 00 West 49th Street
Austin, Texas 78756
Changes To This Notice:
We reserve the right to change the terms of this notice and make the new terms effective for all protected health information kept by BSA Health System. We will post a copy of the current notice in our facility and on our website, http://www.bsahs.org. You may also get a current copy by contacting our Privacy Officer at the address at the end of this notice. The effective date of the notice is in the top right-hand comer of the page.
If you believe your privacy rights have been violated, you may file a complaint with BSA Health System or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with BSA Health System, submit your written complaint to our Privacy Officer at the address at the end of this notice. You will not be penalized for filing a complaint.
Contact Information For Questions Or To File A Complaint
If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to file a complaint, please contact the BSA Health System Privacy Officer at:
BSA Health System
Attn: Privacy Officer
1600 Wallace Blvd.
Amarillo, Texas 79106