To our Patients:
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at the Center. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the Center, whether made by Center personnel or other healthcare providers. Your other healthcare providers may have different policies or Notices regarding their use and disclosure of your health information created at their location.
We are required by law to:
- Maintain the privacy of health information that identifies you (with certain exceptions);
- Give you this Notice of our legal duties and privacy practices with respect to health information we collect and maintain about you; and
- Follow the terms of this Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION
We use information previously compiled about you to provide you with current or future health care treatment and services. Therefore, we may, and most likely will, disclose your information to doctors, nurses and other health care personnel who are involved in your care.
We may use and disclose medical information about you concerning services and procedures so they may be billed and collected from you, your insurance company or third party reimbursement entity such as Workers Compensation.
We may use and disclose medical information about you in order to operate the Center efficiently and make sure our patients receive quality of care.
Appointment and Patient Recall Reminders
We may use and disclose your health information to contact you to remind you regarding appointments or for medical care that you are to receive.
In an emergency, we may disclose information about you to an entity assisting in disaster relief so that your family can be notified about your condition, status and location.
We may participate in research concerning the use of certain treatment protocols that have proper governmental and Center approval. In that case, we would secure your informed consent that will identify all aspects of your involvement, risks and benefits and possible disclosures.
Required by Law
We will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose your health information to persons who need to know when necessary to prevent a serious to either your health or the health and safety of others.
Organ and Tissue Donation
If you are an organ donor, we may disclose medical information to organizations that handle organ procurement and transplantation.
Public Health Issues and Risks
We may report your health information as required by law or by your authorization concerning certain health conditions to prevent or control disease, injury or disability, births and deaths, child or elder abuse or neglect, reactions to medications or products, recalls of products, and notice of exposure to a condition.
Victims of Abuse, Neglect or Domestic Violence
We may disclose your health information to a local, state or federal agency for oversight activities authorized by law that may concern inspections, licensure, illegal conduct, or compliance with other laws and regulations including civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or dispute, we may disclose your health information in response to a subpoena, court subpoena or court order, discovery request or other lawful process by someone else involved in the dispute.
We may release your health information to law enforcement officials in response to a court order, subpoena, warrant, summons or similar process, to identify or locate a suspect witness or missing person, concerning a victim of crime, about a death we believe may involve criminal actions, criminal conduct progress, crimes on the Center premises, or emergency situations to report a crime or details of a crime.
Coroners, Medical Examiners and Funeral Directors
We may release your health information to a coroner or medical examiner or funeral directors as necessary for them to carry out their duties.
Military and National Security
If you currently serve in the military or are a veteran, we may disclose your health information to the military upon proper request. We may also disclose your information to federal officials conducting national security and intelligence activities.
We may disclose your information if required by workers’ compensation laws and other similar laws and regulations.
YOUR PRIVACY RIGHTS
You have the right to:
Inspect and copy your health information. You may ask to review and get a copy of health information about you that the Center keeps for as long as the Center has it. If you request to review your health information, the Center will determine whether to allow you to review some or all of the health information you asked for. The Center may charge a fee for any copies that you ask for. Please make a request in writing to the Center’s Executive Director and/or Privacy Officer.
Amend your health information, if you feel it is wrong or not complete. You may request that we amend the health information the Center keeps. If the Center accepts your request to amend your health information, the change will become a permanent document in your health care record. Please make this request in writing to the Center’s Executive Director and/or Privacy Officer.
Request a limit to the health information we disclose. You may ask the Center not to use or disclose your health information. Your request must describe the specific limits you are requesting. The center may deny your request. Please make this request in writing to the Center’s Executive Director and/or Privacy Officer.
Request confidential communications from us. We will not disclose your health information except as described in this Notice. However, you may ask us to contact you by another means or at a different address or to limit the number or type of people who have access to your health information. Please make this request in writing to the Center’s Executive Director and/or Privacy Officer.
Receive a paper copy of this Notice from us. You may request a copy of this Notice at any time.
YOUR RIGHT TO COMPLAIN
Complaints. If you believe that your privacy rights have been violated, you may file a complaint with the Center or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing, and all complaints will be investigated.
CHANGES TO THIS NOTICE
Changes to this Notice. We reserve the right to change this Notice at any time. We will post a copy of the current notice in the Center with the effective date in the upper right hand corner of the first page. You may request a copy of the current notice each time that you visit the Center for services or by calling the Center and requesting that the current notice be sent to you in the mail.
PRIVACY CONTACT INFORMATION
If you have any questions about this Notice or wish to submit a request, please contact the Center’s Executive Director and/or Privacy Officer at:
|Elmo Lopez, Jr., CEO||1515 Pappas, Laredo, TX 78041|
|Tel (956) 795-8100 Fax: (956) 795- 8137||Email: firstname.lastname@example.org|