Notice of Privacy Practices
THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.
Your Health Information Rights
Although your health record is the physical property of the practitioner who wrote it, the information belongs to you. You have the following rights
- You can look at or get a copy of the health information that we have about you. An exception to this rule is that a psychotherapist may keep separate psychotherapy notes apart from the client or patient chart. Such notes are not part of the patient record and may not be released to anyone. There are some reasons why we will not let you see or get a copy of your health information, and if we deny your request, we will tell you why. You can appeal our decision in some situations. You can choose to get a summary of your health information instead of a copy You will be charged a fee for the summary or copy of your health information unless the records are being provided for the purpose of applying for government disability benefits.
- You can ask us to correct information in your records if you think the information is wrong. We will not destroy or change our records, but we will add the correct information to your records and make a note in your records that you have provided the Information.
- You can get a list of when we have given health information about you to other people in the last six years. The list will not include disclosures for treatment, payment, heath care operations, national security, law enforcement, or disclosures where you gave your permission. The list will not include disclosures made before April 14, 2003. There will be no charge for one list par year.
- You can ask us to limit some of the ways we use or share your health information. We will consider your request, but the law does not require us to agree to it if we do agree, we put the agreement in writing and follow it, except in case of emergency. We cannot agree to limit the uses or sharing of information that are required by law.
- You can ask us to contact you at a different place or in some other way. We will cure to your request as long as reasonable.
- You can get a copy of this notice any time you ask for it.
- The law requires us to protect the privacy of your health information. This means that we will not use or let other people see your health information without your permission except in the ways we tell you in the notice. We will not tell anyone you sought, are receiving, or have ever received services from anyone in this office, unless the law allows us to disclose that information.
- We are required to give you this notice of our legal duties and privacy practices, and we must do what this notice says, We can change the contents of this notice and, if we do, we will have copes of the revised notice available to you at our office.
- We are required to notify you if we are unable to agree to a requested restriction We are required to accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We will not use or disclose your health information without your authorization, except as described in this notice. We will not disclose information about you related to HIV/AIDS without your specific written permission
Disclosures for Treatment, Payment, and Health Operations
We will use your health information for treatment.
We may use health information about you to provide you with medical treatment or services. This includes providing care to you, consulting with another heath care provider about you, and referring you to another heath care provider. For example, we can use your health information to prescribe medication for you. Unless you ask us not to, we may also contact you to remind you of an appointment or to offer treatment alternatives or other health-related information that may interest you.
We will use your health information for payment.
We can use or disclose your health information to obtain payment for providing health care to you or to provide benefits to you under health plans such as Medicaid or Medicare. For example, we can use your health information to bill your insurance company for health care provided to you. Applicants for and recipients of financial assistance or payments under federal benefit programs are advised that any information provided by you may be subject to verification through matching programs.
We will use your health information for regular health operations
We can also use your health information for health care operations; for activities to improve health care, evaluating programs, and developing procedures: reviewing the competence qualifications, performance of health care professionals and others; conducting accreditation certification, licensing, or credentialing activities; providing medical review, legal services, or audit functions, and engaging in business planning and management or general administration.
UNLESS YOU ARE RECEIVING TREATMENT FOR ALCOHOL OR DRUG ABUSE, WE ARE PERMITTED TO USE OR DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR PERMISSION FOR THE FOLLOWING PURPOSES:
Business associates: There are some services provided in our organization through contracts with business associates. Examples include inpatient mental health services at certain hospitals, certain clinical laboratories, and private providers of medication management. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established rules to ensure the privacy of your health information.
Medical Examiners/Coroners: We may disclose heath information to Medical Examiners or Coroners consistent with applicable law to carry out their duties.
Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Correctional Institution: Should you be an inmate of a correctional institution; we may disclose to the institution or agents thereof heath Information necessary for your heath and the health and safety of other individuals.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid court order. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
NOTICE FOR ALCOHOL IDRUG PATIENT RECORDS:
Confidentiality of Alcohol and Drug Abuse Patient Records The confidentiality of alcohol and drug abuse patient records maintained by this office is protected by Federal law and regulations. Generally, we may not disclose any information identifying a patient as an alcohol or drug abuser unless one of the following conditions is met:
- The patient consents in writing.
- The disclosure is allowed by a court order.
- The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.
Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.
Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime.
Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.
FOR MORE INFORMATION OR TO REPORT A PROBLEM:
I have questions and would like additional information; you may contact our Privacy Officer at 817-496-7524. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
U.S. Department of Health and Human Services: (800) 3684018 (toll free) 200 Independence Avenue. S.W.
Washington, DC. 20201 Effective Date April 14, 2003 Acknowledgement of Notice of Privacy Practices Hawkins Psychiatry I understand that I have certain nights to privacy, regarding my protected health information. I understand that this information can and will be used to:
- Conduct, plan, and direct my treatment and follow-up among the multiple health care providers who may be involved in that treatment directly and indirectly
- Obtain payment from third-party payers
- Conduct normal health care operations such as quality assessments and physician certifications.