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.
Southern Surgical Arts is committed to providing quality healthcare services to you. An important part of that is protecting your medical information according to applicable law. This Notice describes your rights and our duties under federal law, as well as other pertinent information. We are happy to answer any questions you may have regarding this Notice.
Federal law (the Health Insurance Portability and Accountability Act [HIPAA]) requires that healthcare providers inform patients of their rights regarding how the provider may use and disclose your protected health information (“PHI”) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. Your protected health information is any written and/or health information about you, including demographic data that can be used to identify you. This is health information that is created or received by your healthcare provider and relates to your past, present, or future physical or mental health or condition.
Uses and Disclosures
Uses and disclosures of your PHI may be permitted, required, or authorized. Examples are provided below under various categories to give you a sense of how we may use and/or disclose your PHI.
Treatment, Payment, and Operations
We will use and/or disclose your PHI as follows:
- To ensure that we appropriately provide for your care and Treatment
- To obtain Payment for our services
- As necessary to conduct our Healthcare Operations
Our staff, including doctors, nurses, and other clinicians, will use your PHI to order tests, procedures, and medications, and to otherwise provide for your care. We may disclose your PHI to pharmacies and other healthcare providers as needed. For example, we may disclose your PHI when we refer you to another healthcare provider.
Your PHI will be used to check for eligibility for insurance coverage and prepare claims for your insurance company where appropriate. We may also use your PHI to invoice you directly or to invoice a government agency on your behalf. For example, to prepare invoices, we will disclose information regarding your treatment, the conditions you were treated for, and when you were treated.
We may use and disclose your PHI to conduct our healthcare business and to perform functions associated with our business activities. For example, your PHI may be disclosed when we train staff, conduct quality improvement activities, and develop business plans. Your PHI may be shared with business associates who perform certain business functions on our behalf, such as billing, transcription, and electronic PHI transmissions with other healthcare providers.
Appointments and Reminders
We may use your PHI to contact you regarding appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care
We may use or disclose your PHI to a friend or family member who is involved in your medical care. We may also give information to someone assisting you in the payment for your care. We may also tell your family or friends that you are in the facility at the time of your care. If you want any of this information restricted, you must communicate that to us using the appropriate procedure.
There are a number of uses and disclosures that we are required or permitted to make for public policy reasons. The following is a representative list of uses and disclosures that fall under this category.
Required by Law
We may use or disclose your PHI to the extent that such use or disclosure is required by law. In such cases, the use or disclosure will be limited to uses and disclosures pertaining to the relevant requirements of such law.
Public Health Activities
We may disclose your PHI to governmental authorities for public health activities and for purposes described as follows:
- Preventing or controlling disease, injury, or disability, including but not limited to the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions;
- Reporting child abuse or neglect;
- Activities related to the quality, safety, or effectiveness of a Food and Drug Administration-regulated product or process;
- To persons who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if we are authorized by law to notify such persons as necessary in the conduct of a public health intervention or investigation; or
- To an employer, about an individual who is a member of the workforce of the employer, under a limited set of conditions.
We may disclose your PHI for law enforcement purposes to a law enforcement official. For example, we may disclose your PHI to law enforcement for purposes of identification and purposes related to a crime.
Threats to Health or Safety
We may, consistent with applicable law and standards of ethical conduct, use or disclose your PHI if we have a good-faith belief that the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is required by law enforcement authorities to identify or apprehend an individual.
We may disclose your PHI as necessary to comply with the laws relating to workers’ compensation or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information in it belongs to you. You have the following rights regarding your health information.
Right to Inspect and Copy Your PHI
You may inspect and obtain a copy of your PHI as long as we maintain the PHI. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to PHI. Depending on the circumstances, you may have the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your PHI if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety of that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.
To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is at the end of this Privacy Notice. If you request a copy of your PHI, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request.
Right to Request Restrictions
You have a right to request restrictions on how we use and disclose your PHI for treatment, payment, and operations, as well as regarding those instances where you have an opportunity to agree or object. We are not required to agree to restrictions for treatment, payment, and operations except in limited circumstances. If we do agree to a restriction of any kind, then we will honor it going forward, unless you take affirmative steps to revoke it or we believe, in our professional judgment, that an emergency warrants circumventing the restriction to provide the appropriate care. In rare circumstances, we reserve the right to terminate a restriction that we have previously agreed to, but only after providing you notice of termination.
You have a right to restrict certain disclosures of PHI to a health plan where you have paid out of pocket in full for the healthcare item or service. You are required to notify all downstream healthcare providers (e.g. a pharmacist) and business associates, including Health Information Exchanges of the restriction. We are required by law to honor this restriction and will do so unless affirmatively terminated by you in writing.
Right to Amend PHI
You have a right to request that we amend your PHI for as long as it is maintained by us. The request must be made in writing, and you must provide a reason to support the requested amendment. Under certain conditions we may deny your request to amend, including but not limited to when the PHI 1) was not created by us, 2) is excluded from access and inspection under applicable law, or 3) is accurate and complete. If we accept the amendment, we will work with you to identify other healthcare stakeholders that require notification and provide the notification. If we deny the amendment, we will provide the rationale for denial to you in writing and offer you the opportunity to submit a statement of disagreement.
Right to Confidential Communications
You have a right to request alternative communication methods with respect to your health matters and related PHI. We ask that you make such communication requests in writing. We will honor all reasonable requests consistent with our duty to ensure that your PHI is appropriately protected.
Right to an Accounting of PHI Disclosures
You have the right to receive an accounting of your PHI disclosures made by us during a time period specified by law prior to the date on which the accounting is requested. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Policy. We are not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in your care or certain other disclosures we are permitted to make without your authorization. You must make a request in writing. We will provide the first accounting during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable fee.
Our facility is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice of our duties and privacy practices. We are required to:
1. Keep your PHI private and only disclose it when required to do so by law
2. Explain our legal duties and privacy practices in connection with your health records
3. Obey the rules found in this notice
4. Inform you when we are unable to agree to a requested restriction that you have given us
5. Accommodate your reasonable request for an alternative means of delivery or destination when sending your PHI
We reserve the right to change our privacy practices and the terms of this Notice consistent with applicable law and our current business processes. Should we make revisions to this Notice, we will provide you notification as follows:
- Upon request
- Electrically via our website or via other electronic communications
- As posted in our place of business
Any modifications to our Notice will apply retroactively to your entire PHI, as maintained by us.
In addition to the above, we have an affirmative duty to respond to your requests in a timely and appropriate manner. We support and value your right to privacy and are committed to maintaining reasonable and appropriate safeguards for your PHI. We will not retaliate in any way, shape, or form should you decide to file a complaint with us or with the Department of Health and Human Services.
Questions and Requests for Information
Questions, requests for information, and other inquiries under this Notice should be directed to us as follows:
Southern Surgical Arts
Attn: Privacy Officer
2550 Elkton Trail
Tyler, TX 75703
If you believe your rights have been violated, then you may submit a formal written complaint to us using the contact information provided above.
You may also send a complaint directly to the Department of Health and Human Services in the following ways:
Texas Department of State Health Services
1100 W 49th St
Austin, TX 78756