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.
Our Legal Duty: We are required by applicable federal and state law to maintain the privacy of your health information. This Notice took effect on October 22, 2021 and will remain in effect until we replace it. We reserve the right to make lawful changes to our practices and the terms of this Notice at any time. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. For more information about our privacy practices or for a copy of this Notice, please contact our Privacy Officer at email@example.com or 512-562-2473.
Uses and Disclosures of Health Information: We use and disclose health information about you for treatment, payment, and healthcare operations. We provide some services through contracts or arrangements with business associates, and in those cases, we require our business associates to appropriately safeguard your information.
Your Authorization: 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 affect any use or disclosures that were permitted by your authorization while it was in effect.
Persons Involved in Care: We may use or disclose health information to notify (or assist in notifying, including identifying or locating) a family member, your personal representative, or another person responsible for your care, of your location, general condition, or death.
Marketing: We will not use your health information for marketing communications without your written authorization.
As Required by Law: We may use or disclose your health information when we are required to do so by law.
To Report Abuse or Neglect: We may disclose health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence, or other crimes.
National Security & Law Enforcement: We may disclose health information of Armed Forces personnel to military authorities under certain circumstances. We may disclose health information to authorized state or federal officials when required for lawful intelligence, counterintelligence, and other certain law enforcement & national security activities.
Right to Access: You have the right to look at and/or receive copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. To request access, please contact our Privacy Officer at firstname.lastname@example.org or 512-562-2473.
Right to Accounting of Disclosures: 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 six (6) years.
Right to Amendments & Restrictions: You have the right to request in writing that we add to your record or place additional restrictions on our use or disclosure of your health information. We are not required to agree to these requests, but if we do, we will abide by our agreement (except in an emergency). You have the right to restrict certain disclosures of PHI to an insurance health plan when you or someone on your behalf pays 100% out of pocket for the health care item or service provided.
Right to 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.
Questions and Complaints
If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health information or our response to a request you made, you have a right to file a complaint with us or with the U.S. Department of Health and Human Services. We support your right to privacy and will not retaliate in any way if you choose to file a complaint.