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.

If you have any questions about this notice, please contact the Texas Spine Consultants Privacy Officer at (214) 370-3535.

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal statute that requires that all protected health information used or disclosed by Texas Spine Consultants, L.L.P. (“Practice”) in any form, whether electronically, on paper, or orally, are kept confidential.  Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services (“PHI”).  As required by HIPAA, this Notice of Privacy Practices (“Notice”) describes how the Practice is required to maintain the privacy of your PHI and how it may use and disclose PHI.  It also describes your rights to access and control your PHI.

Use and Disclosures of PHI
Your PHI is subject to use or disclosure by the Practice’s physicians, office staff, employees or other third parties that are involved in your care and treatment, including electronic disclosures.  It is the Practice’s responsibility to ensure that all uses or disclosures are made in accordance with HIPAA and as further detailed below in this Notice.

Required Disclosures: The Practice is required to disclose PHI to you directly when requested in accordance with your rights described below or the Department of Health and Human Services when investigating or determining the Practice’s compliance with HIPAA. Family Members:  The Practice may disclose relevant PHI with family members involved in your health care if you do not object to sharing of the information (i.e. appointment reminders).

No Authorization Required
Treatment: The Practice will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party, consultation between physicians relating to your care, or your referral for health care to another physician.  For example, the Practice may share results of diagnostic imaging in consultation with its staff or other healthcare professionals to develop a treatment plan.

Payment: The Practice will use and disclose your PHI, as needed, as it relates to payment for your health care services.  This may include obtaining reimbursement information for the health care services you are receiving, confirming coverage or co-pay amounts under your health plan, billing and collecting from you, an insurance company, or a third party for your health care services, or obtaining precertification or preauthorization for specific health care services.  For example, the Practice may send a claim for payment to your insurance company and that claim may contain PHI such as a code describing your diagnosis or medical treatment.

Health care Operations: The Practice will use and disclose your PHI, as needed, in order to support the business operations of the Practice.  These activities include, but are not limited to, quality assessment and improvement activities, auditing functions, cost-management analysis, or training.  For example, the Practice may disclose your PHI to medical school students that see patients at the office.  In addition, the Practice may use a sign-in sheet at the registration desk where you will be asked to sign your name.  The Practice may also call you by name in the waiting room when your physician is ready to see you.  The Practice may use or disclose your PHI, as necessary, to contact you to remind you of your appointment (including to family members).

Business Associates: The Practice will use and disclose your PHI, as needed, to business associates.  There are some services provided in the Practice through contracts with business associates (i.e., the Practice may disclose PHI to a company who bills insurance companies on the Practice’s behalf to enable that company to assist in obtaining payment for the healthcare services provided). To protect your PHI the Practice will require its business associates to appropriately safeguard the information.

Other Uses or Disclosures:  The Practice may also disclose your PHI for the following additional purposes without your authorization: when required by law (statute, law enforcement, judicial or administrative order); for public health activities (to public health or legal authorities charged with preventing or controlling disease, injury, disability, child abuse or neglect, etc., as required by law); when there is a belief you are a victim of abuse, neglect, or domestic violence; for health oversight activities (to public agencies or legal authorities charged with overseeing the health care system, government programs in which health information is necessary to determine eligibility or compliance, or to enforce civil rights); for judicial or administrative proceedings (pursuant to court order or subpoena if assurances are received); for law enforcement purposes; to funeral directors, coroners, or organ procurement organizations; for research; if there is a belief of a serious threat to health and safety; for certain essential government functions (national security, military, etc.); disaster relief efforts; to comply with workers’ compensation; and as part of a limited data set pursuant to a data use agreement for research, public health or health care operations.

Authorization Required
Any uses or disclosures outside the scope described above will be made only with your written authorization.  Most uses or disclosures of psychotherapy notes, and of PHI for marketing purposes and the sale of PHI require an authorization.  You may revoke such authorization in writing at any time and the Practice is required to honor and abide by that revocation, except to the extent that it has already taken actions relying on your authorization.

Your Rights for PHI
You have the right to obtain a paper copy of this Notice and you may exercise any of the rights described below by contacting the Practice and requesting to speak with the Privacy Officer.

You have the right to make reasonable requests to receive confidential communications of your PHI from the Practice by alternative means or at alternative locations.

You have the right to request restrictions on uses and disclosures of PHI for treatment, payment or healthcare operations, or disclosures to family members, other relatives, close personal friends, or any other person identified by you.  Generally, the Practice is not legally required to agree to a requested restriction.  However, if the request is made to restrict disclosure to a health plan for purposes of carrying out Payment or Health Care Operations and the PHI pertains solely to a health care item or service for which you have paid out of pocket in full, the Practice is legally required to agree to the requested restriction.

You have the right to read or obtain a copy of your PHI or choose to get a summary of your PHI in lieu of a copy.  There are some reasons why the Practice may deny such a request which will be delivered to you in writing stating the reason.  If a summary or a copy of your PHI is provided, you may have to pay a reasonable fee.

You have the right to request the Practice to amend or correct your PHI to the extent legally and ethically permissible.  If the Practice denies the request, it will do so in writing and you will have the ability to file a statement of disagreement.

You have the right to receive an accounting of the disclosures of PHI by the Practice in the last six years but it will not include certain disclosures including those made for treatment, payment, healthcare operations or where you specifically authorized a use or disclosure.

Complaints
You have recourse if you feel that the privacy of your PHI has been violated.  If you feel there has been a violation, you have the right to file a complaint by submitting your complaint in writing by mail to the address above or by fax at the number above.  You may also contact the Practice directly by telephone.  For all complaints, please ask for or direct attention to the Privacy Officer. There will be no retaliation for filing a complaint.  You may also file a complaint with or contact the Department of Health and Human Services, Office for Civil Rights at:  Office of Civil Rights, DHHS, Region VI – Dallas by mail at 1301 Young Street, Suite 1169, Dallas, Texas 75202, by telephone at (214) 767-4056 or (214) 767-8940 (TDD), or by facsimile at (214) 767-0432.

Effective Date

The Practice is required by law to maintain the privacy of your PHI, to provide you with notice of its legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI.  This Notice is effective as of February 7,2019   The Practice reserves the right to change the terms of this Notice and to make any such changes or amendments effective for all PHI that it maintains.  The Practice will periodically post from time to time, and you may request a written copy of, any updated versions of this Notice.