NOTICE OF PRIVACY RIGHTS
THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Mobitz Heart and Rhythm, PLLC (“we” or “us”) is required by law to maintain the privacy of your protected health information; to provide you this Notice of our legal duties and privacy practices relating to your protected health information; to provide you with notice following a breach of your protected health information; and to abide by the terms of the Notice that are currently in effect. Note, when permitted to use or disclose your information, we may use, disclose and transmit such information in an electronic format.
I. USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
The following categories describe the different reasons that we typically use and disclose your health information. These categories are intended to be generic descriptions only, and not a list of every instance in which we may use or disclose your health information. Please understand that for these categories, the law generally does not require us to get your consent in order for us to release your health information.
For Treatment. We may use and disclose your protected health information to provide, coordinate, or manage your health care services. For example, we disclose your health information, as necessary, to your physicians or a hospital where you are being treated. For Payment. We may use and disclose your protected health information for billing and payment purposes. We may disclose your protected health information to your representative, or to an insurance or managed care company, Medicare or another party responsible for paying for services rendered to you. For example, we may send a claim for payment to your insurance company, or other party responsible for payment, and that claim may have a code on it that describes the services that were provided to you. We are required to restrict disclosure of your medical information to a health plan or third-party payor if the disclosure is for payment for a health care item or service that you paid for in full out-of-pocket.
For Health Care Operations. We may use and disclose your protected health information as necessary for health care operations, such as management of our practice, personnel evaluation, education and training and to monitor our quality of care. For example, we may use and disclose information to make sure the care you receive is of the highest quality.
Individuals Involved in Your Care or Payment for Your Care. We may release protected health information about you to a friend or family member who is involved in your medical care, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law, or in accordance with your prior authorization.
Emergencies. We may use or disclose your protected health information as necessary in emergency treatment situations.
As Required By Law. We may use or disclose your protected health information when required by law to do so.
Business Associates. We may disclose your protected health information to a contractor (also called a “business associate”)who needs the information to perform services for us. Our business associates are committed to preserving the confidentiality of this information, and have signed an agreement with us that holds them to certain privacy standards.
Public Health Activities. We may disclose your protected health information for public health activities. These activities may include, for example, reporting to a public health authority for preventing or controlling disease, injury or disability, and births and deaths. As a general rule, we are required by law to disclose certain types of information to public health authorities, such as the Texas Department of State Health Services.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your protected health information to notify a government authority, if authorized bylaw or if you agree to the report.
Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure actions or for activities involving government oversight of the healthcare system.
To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose protected health information to someone able to intervene in or prevent the threatened harm.
Judcial and Administrative Proceedings. We may disclose your protected health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts will be made to contact you about the request or to obtain an order or agreement protecting the information.
Law Enforcement. We may disclose your protected health information for certain law enforcement purposes, including, for example, to comply with reporting requirements or to answer certain requests for information concerning crimes.
Research. We may use or disclose your protected health information for research purposes if the privacy aspects of the research have been reviewed and approved, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your protected health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
Disaster Relief. We may disclose protected health information about you to a disaster relief organization.
Military, Veterans and other Specific Government Functions. If you are a member of the armed forces, we may disclose your protected health information as required by military command authorities. We may also disclose protected health information for national security purposes or as needed to protect the President of the United States or certain other officials or to conduct certain special investigations.
Workers’ Compensation. We may use or disclose your protected health information to comply with laws relating to workers’ compensation or similar programs.
Inmates/Law Enforcement Custody. If you are under the custody of a law enforcement official or a correctional institution, we may disclose your protected health information to the institution or official for certain purposes including the health and safety of you and others.
Treatment Alternatives and Health-Related Benefits and Services. We may use or disclose your protected health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.
II. USES AND DISCLOSURES WITH YOUR AUTHORIZATION
Except as described in this Notice, we will use and disclose your protected health information only with your authorization.You may revoke an authorization in writing at any time. If you revoke an authorization, we will no longer use or disclose your protected health information for the purposes covered by that authorization, except where we have already relied on theAuthorization.
Except for limited situations, we must obtain your written authorization prior to disclosure of psychotherapy notes. An example of a situation where we may disclose without your authorization is when we are required to do so by law, such as for state mandated reporting of abuse.
III. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Listed below are your rights regarding your protected health information. Each of these rights is subject to certain requirements, limitations and exceptions. Exercise of these rights may require you to submit a written request to us. At your request, we will supply you with the appropriate form to complete. If you have questions about how to exercise your rights, please contact us using the information listed below. You have the right to:
Request Restrictions. You have the right to request restrictions on our use or disclosure of your protected health information.You also have the right to request restrictions on the protected health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care. We are not required to agree to your requested restriction (except that if you are competent you may restrict disclosures to family members or friends), and in some situations we will not be able to agree to your request. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment or to comply with our legal obligations.
Access to Personal protected health information. You have the right to inspect and obtain a copy of your clinical or billing records or other written information that may be used to make decisions about your care, subject to some exceptions. Your request must be made in writing. In most cases we may charge a reasonable fee for our costs in copying and mailing your requested information. In certain limited circumstances allowed by law, we may deny your request to review or copy your medical information. If this occurs, you will be notified of the denial and you have the right to have your request and the denial reviewed by another licensed health care professional.
Request Amendment. You have the right to request amendments of your protected health information maintained by us if you believe it is incorrect or incomplete. Your request must be made in writing and must state the reason for the requested amendment. We may deny your request for amendment, but will inform you of the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Request an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your protected health information. This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations, disclosures made pursuant to your authorization, and certain other circumstances. To request an accounting of disclosures, you must submit a request in writing, stating a time period that is within six(6) years from the date of your request. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.
Request a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time.
Request Confidential Communications. You have the right to request that we communicate with you concerning your health matters in a certain manner. For example, you can ask that we contact you at home, not at work. We will accommodate your reasonable requests.Notification of a Breach. You have the right to be notified if your medical information is used or disclosed in a manner that is not permitted by law. In the event of a breach, we actively take steps to rectify the disclosure.
IV. FOR FURTHER INFORMATION OR TO FILE A COMPLAINT
If you have any questions about this Notice or would like further information concerning your privacy rights, please contact us using the information listed below. If you believe that your privacy rights have been violated, you may file a complaint in writing with us using the contact information listed below or with the Office for Civil Rights of the U.S. Department of Health and HumanServices. We will not retaliate against you if you file a complaint.
V. CHANGES TO THIS NOTICE We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all protected health information already received and maintained by the us as well as for all protected health information we receive in the future.We will provide a copy of the revised Notice upon request.