The
HIPAA Rule and Patient Rights
NOTICE OF PRIVACY PRACTICES
A. Treatment, Payment, Health Care
Operations
1. Treatment
We are permitted to use and disclose your medical information
to those involved in your treatment. For example, the physician
in this practice is a specialist. When we provide treatment
we may request that your primary care physician share your
medical information with us.
2. Payment
We are permitted to use and disclose your medical information
to bill and collect payment for the services we provide
to you. For example, we may complete a claim form to obtain
payment from your insurer or HMO.
3. 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 ask another physician
to review this practice's charts and medical records to
evaluate our performance so that we may ensure that this
practice provides only the best health care.
B. Disclosures That Can Be Made Without Your Authorization
There are situations in which we are permitted 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 that rely on that
authorization.
1. Public Health, Abuse or Neglect,
and Health Oversight
2. 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.
3. Workers' Compensation
4. Inmates
5. Military, National Security and Intelligence Activities,
Protection of the President
6. Research, Organ Donation, Coroners, Medical Examiners,
and Funeral Directors
7. Required by Law
C. Your Rights Under Federal Law
The U.S. 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
patient may exercise. We will not retaliate against patients
who exercise 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 health care 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 restrictions 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
the address and person listed at the end of this document.
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 the person listed below. We are required to accommodate
only reasonable requests.
Inspection and Copies of Protected
Health Information
You may inspect and/or copy health information
that is used to make decisions about your care. Texas law
requires that requests for copies be made in writing. Please
send your request to the person listed at the end of this
document.
We can refuse to provide some of the information
you ask to inspect or ask to be copied for various reasons.
Texas law requires us to be ready to provide
copies or a narrative within 15 days of your request. We
will inform you 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.
Amendment of Medical Information
You may request an amendment of your medical information.
Any such request must be made in writing to the person listed
at the end of this document. We will respond within 60 days
of your request. We may refuse to allow an amendment for
various reasons.
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 approve the amendment, we will allow
the amendment to be made and tell others that we now have
the correct information.
Accounting of Certain Disclosures
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.
D. Appointment Reminders, Treatment
Alternatives, and Other Benefits
We may contact you by (telephone, mail, or both)
to provide appointment reminders, information about treatment
alternatives, or other health-related benefits and services
that may be of interest to you.
E. Complaints
If you are concerned that your privacy rights have
been violated, you may contact the person listed below.
You may also send a written complaint to the U.S. Department
of Health and Human Services. We will not retaliate against
you for filing a complaint with us or the government. 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
F. 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:
John H. Roff, MD, PA
18220 Tomball Parkway, Suite 320
Houston, TX 77070
Telephone: 281.807.6676
Fax: 281.807.6677
This notice is effective April 14, 2003. |
