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HIPAA
NOTICE OF PRIVACY PRACTICES
Effective Date: April 16, 2003
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
us by clicking here.
This notice describes the privacy practices at our office.
We are
required by law to:
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Maintain the privacy of protected health information.
-
Give you this notice of our legal duties and privacy practices
regarding your health information.
-
Follow the terms of the notice currently in effect.
HOW
WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Described as
follows are the ways we may use and disclose your health information.
Except for the following purposes we will use and disclose your health
information only with your written permission. You may revoke such
permission at any time by writing to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
Treatment
We
may use and disclose your health information for your treatment and to
provide you with treatment-related health care services. For example, we
may disclose your health information to doctors, nurses, technicians, or
other personnel, including people outside our office, who are involved
in your medical care and need the information to provide you with
medical care.
Payment
We
may use and disclose your health information so that others or we may
bill and receive payment from you, an insurance company, or a third
party for the treatment and services you received. For example, we may
give information to your health plan so that they will pay for your
treatment.
Health
Care Operations
We
may use and disclose your health information to evaluate and improve our
medical care and to operate and manage our office. For example, we may
use and disclose information to a peer review organization or a health
plan that is evaluating our care. We may also share information with
others that have a relationship with you for their health care operation
activities.
Appointment
Reminders, Treatment Alternatives, and Health-Related Benefits and
Services
We
may use and disclose your health information to contact you and remind
you of your appointment, to tell you about treatment alternatives or
health-related benefits and services you could use.
Individuals
Involved in Your Care or Payment for Your Care
When
appropriate, we may share your health information with a person involved
in, or paying for, your care (such as your family or a close friend). We
may notify your family about your location or condition or disclose such
information to an entity assisting in disaster relief.
Research
We
may use and disclose your health information for research. For example,
a research project may involve comparing the health of patients who
received one treatment to those who received another for the same
condition. Before we do so, the project needs to go through a special
approval process. Even without special approval, we may permit
researchers to look at records to help identify patients who may be
included in their research, as long as they do not remove or copy any of
your health information.
As
Required by Law
We
will disclose your health information when required to do so by
international, federal, state or local law.
To
Avert a Serious Threat to Health or Safety
We
may use and disclose your health information when necessary to prevent a
serious threat to the health and safety of you, another person, or the
public. Disclosures will be made only to someone who can prevent the
threat.
Business
Associates
We
may disclose your health information to our business associates that
perform functions on our behalf or provide us with services if
necessary. For example, we may use another company to perform billing
services on our behalf. All of our business associates are obligated to
protect the privacy of your information and are not allowed to use or
disclose the information for any other purpose than appears in their
contract with us.
Military
and Veterans
If
you are a member of the armed forces, we may release your health
information as required by military command authorities. If you are a
member of a foreign military we may release your health information to
the foreign military command authority.
Worker's
Compensation
We
may release your health information for worker's compensation or similar
programs that provide benefits for work-related injuries or illness.
Public
Health Risks
We
may disclose your health information for public health activities to
prevent or control disease, injury or disability. We may use your health
information in reporting births or deaths, suspected child abuse or
neglect, medication reactions or product malfunctions or injuries, and
product recall notifications. We may use your health information to
notify someone who may have been exposed to a disease or may be at risk
for contracting or spreading a disease or condition. If we are concerned
that a patient may have been a victim of abuse, neglect, or domestic
violence we may ask your permission to make a disclosure to an
appropriate government authority. We will make that disclosure only when
you agree or when required or authorized to do so by law.
Health
Oversight Activities
We
may disclose your health information to a health oversight agency for
activities authorized by law. These may include audits, investigations,
inspections, and licensure. These activities are necessary to for the
government to monitor the health care system, government programs, and
compliance with civil rights laws.
Lawsuits
and Disputes
If
you are involved in a lawsuit or dispute, we may disclose your health
information in response to a court or administrative order. We may
disclose your health information in response to a subpoena, discovery
request, or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested.
Law
Enforcement
We
may release your health information request by law enforcement official
if 1) there is a court order, subpoena, warrant, summons or similar
process; 2) if the request is limited to information needed to identify
or locate a suspect, fugitive, material witness, or missing person; 3)
the information is about the victim of a crime even if, under certain
very limited circumstances, we are unable to obtain your agreement; 4)
the information is about a death that may be the result of criminal
conduct; 5) the information is relevant to criminal conduct on our
premises; and 6) it is needed in an emergency to report a crime, the
location of a crime or victims, or the identity, description, or
location of the person who may have committed the crime.
Coroners,
Medical Examiners, and Funeral Directors
We
may release your health information to a coroner, medical examiner, or
funeral director to identify a deceased person or cause of death, or
other similar circumstance.
National
Security and Intelligence Activities
We
may disclose your health information to authorized federal officials for
intelligence and other national security activities authorized by law.
Inmates
or Individuals in Custody
If
you are an inmate of a correctional institution or in custody we may
disclose your information 1) for the institution to provide you with
health care, 2) to protect your health and safety or that of others, and
3) for the safety and security of the institution.
YOUR
RIGHTS REGARDING YOUR HEALTH INFORMATION
Right
to Inspect and Copy
You
have the right to inspect and copy your medical and billing records by
written request to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
Right
to Amend
You
have the right to request an amendment to your records by written
request to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
Right
to an Accounting Of Disclosures
You
have a right to an accounting of certain disclosures by written request
to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
Right
to Request Restrictions
You
have the right to request restriction or limitation on your health
information used for treatment, payment or health care operations. You
may request us to limit disclosure to someone involved in your care or
in payment for your care such as a spouse) by written request to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
We are not
required to agree with your request, but we will try to comply.
Right
to Request Confidential Communication
You
have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. You can ask, for
example, that we contact you only by mail or at work. Your written
request must specify how or where you wish to be contacted and be
addressed to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
We will
accommodate reasonable requests.
CHANGES
TO THIS NOTICE
We
may change this notice and make it effective for medical information we
already have about you as well as new information. The current notice
will be posted and available at all times. You have a right to request a
paper copy of the current notice at any visit or by written request to:
Village
Family Practice
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
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