NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION
ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain
the privacy of your health information. We are also required
to give you this Notice about our privacy practices, our
legal duty, and your rights concerning your health information.
We must follow the privacy practices that are described
in this Notice while it is in effect. This Notice takes
effect 03/01/03, and will remain in effect until we replace
it.
We reserve the right to change our privacy practices and
the terms of this Notice at any time, provided such changes
are permitted by applicable law. We reserve the right to
make the changes in our privacy practices and the new terms
of our Notice effective for all health information that
we maintain, including health information we created or
received before we made the changes. Before we make a significant
change in our privacy policy practices, we will change this
Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more
information about our privacy practices, or for additional
copies of this Notice, please contact us using the information
listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment,
payment , and healthcare operations. For Example:
Treatment: We may use and disclose your health information
to a physician or other healthcare provider providing treatment
to you.
Payment: We may use and disclose your health information
to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your
health information in connection with our healthcare operations.
Healthcare operations include quality assessment and improvement
activities, reviewing the competence or qualifications of
healthcare professionals, evaluating practitioner and provider
performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization: In addition to our use of your
health information for treatment, payment or healthcare
operations, you may give us written authorization to use
your health information or to disclose it to anyone for
any purpose. If you give us an authorization, you may revoke
it in writing at any time. Your revocation will not effect
any use or disclosures permitted by your authorization while
it was in effect. Unless you give us a written authorization,
we cannot use or disclose your health information for any
reason except those described in this Notice.
To Your Family and Friends: We must disclose your
health information to you to notify, as described in the
Patient Rights sections of this Notice. We may disclose
your health information to a family member, friend or other
person to the extent necessary to help with your healthcare
or with payment for your healthcare, but only if you agree
that we may do so.
Persons Involved In Care: We may use or disclose
health information to notify, or assist in the notification
of (including identifying or locating) a family member,
your personal representative or another person responsible
for your care, of your location, your general condition,
or death. If you are present, then prior to use or disclosure
of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the
event of your incapacity or emergency circumstances, we
will disclose health information based on a determination
using our professional judgement disclosing only health
information that is directly relevant to the person’s
involvement in your healthcare. We will also use our professional
judgement and our experience with common practice to make
reasonable inferences of your best interest in allowing
a person to pick up filled prescriptions, medical supplies,
x-rays, or other similar forms of health information.
Marketing Health-Related Services: We will not use
your health information for marketing communications without
your written authorization.
Required by Law: We may use or disclose your health
information when we are required to do so by law.
Abuse or Neglect: We may disclose your health information
to appropriate authorities if we reasonably believe that
you are a possible victim of abuse, neglect, or domestic
violence or the possible victim of other crimes. We may
disclose your health information to the extent necessary
to avert a serious threat to your safety or the health of
safety of others.
National Security: We may disclose to military authorities
the health information of Armed Forces personnel under certain
circumstances. We may disclose to authorized federal officials
health information required for lawful intelligence, counterintelligence,
and other national security activities. We may disclose
to correctional institution or law enforcement officials
having lawful custody of protected health information of
inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your
health information to provide you with appointment reminders
(such as voicemail messages, postcards, or letters).
PATIENT RIGHTS
Access: You have the right to look at or get copies
of your health information, with limited exceptions. You
may request that we provide copies in a format other than
photocopies. We will use the format you request unless we
cannot practicably do so. (You must make a request in writing
to obtain access to your health information. You may obtain
a form to request access by using the contact information
listed at the end of this Notice. We will charge you a reasonable
cost-based fee for expenses such as copies and staff time.
You may also request access by sending us a letter to the
address at the end of this Notice. If you request copies,
we will charge you $0.75 for each page, $15.00 per hour
for staff time to locate and copy your health information,
and postage if you want the copies mailed to you. If you
request an alternative format, we will charge a cost-based
fee for providing your health information in that format.
If you prefer, we will prepare a summary or an explanation
of your health information for a fee. Contact us using the
information listed at the end of this Notice for a full
explanation of our fee structure.)
Disclosure Accounting: You have the right to receive
a list of instances in which we or our business associates
disclosed your health information for purposes, other than
treatment, payment, healthcare operations and certain other
activities, for the last 6 years, but not before April 14,
2003. If you request this accounting more than once in a
12-month period, we may charge you a reasonable, cost-based
fee for responding to these additional requests.
Restriction: You have the right to request that
we place additional restrictions on our use or disclosure
of your health information. We are not required to agree
to these additional restrictions, but if we do, we will
abide by our agreement (except in an emergency).
Alternative Communication: You have the right to
request that we communicate with you about your health information
by alternative means or to alternative locations. (You must
make your request in writing.) Your request must specify
the alternative means or location, and provide satisfactory
explanation how payments will be handled under the alternative
means or location you request.
Amendment: You have the right to request that we
amend your health information. (Your request must be in
writing, and must explain why the information should be
amended.) We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice on
our Web site or by electronic mail (e-mail), you are entitled
to receive this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices
or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy
rights, or you disagree with a decision we made about access
to your health information or in response to a request you
made to amend or restrict the use or disclosure of your
health information or to have us communicate with you by
alternative means or at alternative locations, you may complain
to us using the contact information listed at the end of
this Notice. You also may submit a written complaint to
the U.S. Department of Health and Human Services. We will
provide you with the address to file you complaint with
the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your health information.
We will not retaliate in any way if you choose to file a
complaint with us or with the U.S. Department of Health
and Human Services.
Contact Officers: Kay Harness and Ann Overton
Telephone: 512-346-9771 Fax: 512-794-8157
Address: 9015 Mountain Ridge Dr, Ste 320, Austin, TX 78759
