54B, Tailstoi Town 5238 MT,
La city, IA 522364
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE FEEL FREE TO SPEAK TO YOUR THERAPIST, CLINIC MANAGER OR FRONT DESK PERSON
Advance Therapy PC is committed to maintaining and protecting the confidentiality of your personal information. This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It will inform you about how we may use and disclose your health information, and the safeguards we have put into place to protect it. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information.
“Protected Health Information” is individually identifiable health information expressed in the form of oral, written or electronic communications. This information includes personal identifiers such as your age, address, email address, and other information that relates to your past, present or future health condition and related healthcare services. Advance Therapy PC, a healthcare entity is required by law to:
• Make sure your health information is kept private.
• Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
• Follow the terms of the notice currently in effect.
• Communicate any changes in this notice to you.
The following categories describe different ways that we use and disclose your health information. We will not use your confidential information or disclose it to others without your authorization, except for the following purposes:
Treatment: We may use and/or disclose your confidential health information to provide you with treatment and/or services. This includes your therapist’s recommendation(s), and those of other professionals/paraprofessionals including clerical, administrative and management staff.
Payment: Your protected health information will be used, as needed, to bill and collect payment for treatment and services provided to you. We may share information about a treatment and/or service you may receive to your health insurer or responsible party to receive approval for payment.
Health Care Operations: We may use and disclose health information about you for regular health care operations. The medical staff in this practice will use your health information to assess the care you received and the outcome of your case compared to others like it. Your information may be reviewed for risk management or quality assessment/improvement purposes in our efforts to continually improve the quality and effectiveness of the care and services we provide.
We will share your protected health information with third-party “business associates” who perform various activities for the practice. The business associates will also be required to protect your health information.
Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or care in our Practice. These reminders will not identify the purpose of your visit.
Required by Law: We will disclose health information about you when required to do so by federal, state or local laws.
Internet Exchanges: We may exchange, upload, and transfer your health and personal information over email, web portals, insurance company websites, medical record portals, or other forms of electronic communications when required and necessary for collecting payments, updating insurance companies, updating the responsible party, requesting information, responding to requests or while performing other healthcare operations.
Public Health Activities: We may disclose your confidential health information for the following public. ealth activities and purposes:
• To report health information to public health authorities that are authorized by law to receive such information to prevent or control disease, injury or disability;
• To report child abuse or neglect to a government authority that is authorized by law to receive such reports;
• To report information about a product or activity that is regulated by the US Food and Drug Administration (FDA) to a person responsible for the quality, safety or effectiveness of the product or activity;
• To conduct post-marketing surveillance, as required; and
• To alert a person who may have been exposed to a communicable disease, if we are authorized by law to give this notice.
Legal Proceedings: We may release protected health information about you in response to a court or administrative order if you are involved in a lawsuit or dispute. We may also disclose health information about you 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.
Law Enforcement: We may release health information if asked to do so by law enforcement officials:
• In response to a court order, subpoena, warrant, summons or similar process.
• To identify or locate a suspect, fugitive, material witness or missing person.
• About the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement.
• About the death we believe may be the result of criminal conduct.
• About criminal conduct at the Practice.
• In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Research: Under certain circumstances, we may use and disclose your confidential information for research purposes without authorization. Authorization would not be necessary if your identifying information was removed.
Workers’ Compensation: We may release your health information to comply with Workers’ Compensation Laws and other similar legally-established programs. The programs provide benefits for work-related illness or injury.
Criminal Activity: Under certain Federal and state laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Government Functions: We may disclose your health information to the U.S. Military or to authorized federal or state officials for purposes specified by federal law.
Coroners, Funeral Directors, and Organ Donation: We may disclose your health information to a coroner or medical examiner. This may be necessary to identify a deceased person or to determine the cause of death. We may also disclose protected health information to funeral directors as authorized by law to assist them in carrying out their duties. Protected health information may also be used and disclosed for organ eye and tissue donations if you have previously agreed to organ donation.
Parental Access: Various Texas State laws determine what protected health information can be disclosed to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law and will make disclosures only when necessary.
Individuals Involved in Your Care: Unless you object, we may use or disclose your health information to notify or assist in the notification of a family member or personal representative of your location, your general condition, or death. If you are present, you will have the opportunity to object to this type of use or disclosure. If you are unable to decide or if it is an emergency, we may disclose information that is directly relevant to the person’s involvement in your healthcare, if we determine that it is in your best interest to do so.
Although your health record is the physical property of Advance Therapy PC, the information belongs to you. You have the following rights regarding your protected health information. You may make any of the following requests by completing a “HIPAA Patient Rights Request Form” or by submitting a written request to our office.
Right to Inspect and Copy: You have the right to both inspect and obtain a copy of your protected health information that is contained in a “designated record set” for as long as we maintain your health information. This information is used to make health-related decisions about your care and typically includes professional treatment/progress notes, supplement programs, laboratory reports, prescriptions, and billing/financial records. This request does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to laws that prohibit access. If you request copies, we may charge you copying and mailing costs.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. While we consider all requests for restrictions carefully, we are not required to agree to your request.
Right To Request Amendment: If you believe the health information, we have about you is incorrect or incomplete, you may ask us to amend the information. You have a right to request an amendment as long as the information is kept by or for Advance Therapy PC, if we determine the record is inaccurate.
We may deny your request if it is not in the appropriate form or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
• Is not part of the information kept by or for Advance Therapy PC
• Is not part of the information which you would be permitted to inspect or copy
• Is accurate and complete
Right to Request Confidential Communications: You may request that we communicate with you using alternative means or at an alternative location. You may also ask that we mail information to you in a sealed envelope rather than a postcard. While we will consider this request carefully, we are not required to agree to all requests.
Right To Obtain a Copy of this Notice. You have the right to a paper copy of this notice. You may request a copy of this notice at any time. To obtain a copy of this, please contact the office.
We reserve the right to change our privacy practices and this notice. We reserve the right to make changed notice effective for health information we already have about you as well as any information we receive in the future. If we change the notice, we will provide each active patient with a new notice. You may also obtain a new notice by calling our office.
If you believe your privacy rights have been violated, you may file a complaint with Advance Therapy PC’s Practice Manager or his/her designee at the address below. No retaliation will occur against you for filing a complaint. All complaints must be submitted in writing. You may also file written complaints with the Secretary of the US Department of Health and Human Services.
Advance Therapy PC
HIPAA Privacy Officer
415 W Wheatland Rd #102, Duncanville, TX 75116
Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose your health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your health information for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission and we are required to maintain in our records of the care that we provided to you.
Our Notice of Privacy Practices remains in effect until modified by Advance Therapy PC.