Privacy Notice
\
South Texas Chiropractic
225 E. Sonterra Blvd. Ste. 113
San Antonio, TX 78258
(210)493-9119
Notice of Patient
Privacy Policy
|
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.
If you have any questions about this Notice please
contact our Privacy Officer or any staff member in our office.
Our Privacy Officer is Velma
Kling
This Notice of Privacy Practices describes how we
may use and disclose your protected health information to carry out your
treatment, collect payment for your care and manage the operations of this
clinic. It also describes our policies
concerning the use and disclosure of this information for other purposes that
are permitted or required by law. It
describes your rights to access and control your protected health information. "Protected Health Information"
(PHI) is information about you, including demographic information that may
identify you, that relates to your past, present, or future physical or mental
health or condition and related health care services.
We are required by federal law to abide by the terms
of this Notice of Privacy Practices. We
may change the terms of our notice at any time. The new notice will be effective for all
protected health information that we maintain at that time. You may obtain revisions to our Notice of
Privacy Practices by accessing our website www.stxchiro.com,
calling the office and requesting that a revised copy be sent to you in the
mail or asking for one at the time of your next appointment.
A.Uses
and Disclosures of Protected Health Information
By applying to be treated in our office, you are
implying consent to the use and disclosure of your protected health information
by your doctor, our office staff and others outside of our office that are
involved in your care and treatment for the purpose of providing health care
services to you. Your protected health
information may also be used and disclosed to bill for your health care and to
support the operation of the practice.
Uses and Disclosures of
Protected Health Information Based Upon Your Implied Consent
Following are examples of the types of uses and
disclosures of your protected health care information we will make, based on this
implied consent. These examples are not
meant to be exhaustive but to describe the types of uses and disclosures that
may be made by our office.
Treatment:We
will use and disclose your protected health information to provide, coordinate,
or manage your health care and any related services. This includes the coordination or management
of your health care with a third party that has already obtained your
permission to have access to your protected health information. For example, we would disclose your protected
health information, as necessary, to another physician who may be treating you.
Your protected health information may be
provided to a physician to whom you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
In addition, we may disclose
your protected health information from time-to-time to another physician or
health care provider (e.g., a specialist or laboratory) who, at the request of
your doctor, becomes involved in your care by providing assistance with your
health care diagnosis or treatment.
Payment:Your
protected health information will be used, as needed, to obtain payment for
your health care services. This may
include certain activities that your health insurance plan may undertake before
it approves or pays for the health care services we recommend for you such as
making a determination of eligibility or coverage for insurance benefits,
reviewing services provided to you for medical necessity, and undertaking
utilization review activities. For
example, obtaining approval for chiropractic spinal adjustments may require
that your relevant protected health information be disclosed to the health plan
to obtain approval for those services.
Healthcare Operations:We may use or disclose, as needed, your protected health information in
order to support the business activities of this office. These activities may include, but are not
limited to, quality assessment activities, employee review activities and
training of chiropractic students.
For example, we may disclose
your protected health information to chiropractic interns or precepts that see
patients at our office. In addition, we
may use a sign-in sheet at the registration desk where you will be asked to
sign your name and indicate your doctor. We may call you by name in the
reception area when your doctor is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you to remind you of your appointment. We
do have open therapy/adjusting areas.
We will share your protected
health information with third party "business associates" that
perform various activities (e.g., billing, transcription services for the
practice). Whenever an arrangement
between our office and a business associate involves the use or disclosure of
your protected health information, we will have a written contract with that
business associate that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your
protected health information, as necessary, to provide you with information
about treatment alternatives or other health-related benefits and services that
may be of interest to you. We may also
use and disclose your protected health information for other internal marketing
activities. For example, your name and
address may be used to send you a newsletter about our practice and the
services we offer. We may also send you information about products or services
that we believe may be beneficial to you. You may contact our Privacy Officer to request
that these materials not be sent to you.
Uses and Disclosures of
Protected Health Information That May Be Made Only With Your Written
Authorization
Other uses and disclosures of your protected health
information will be made only with your written authorization, unless otherwise
permitted or required by law as described below.
·Disclosures that constitute
a sale of Protected Health Information;
·Other uses and disclosures
not described in the Notice of Privacy Practices will be made only with
authorization from the individual.
You may revoke any of these authorizations, at any
time, in writing, except to the extent that your doctor or the practice has
taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and
Required Uses and Disclosures That May Be Made With Your Authorization or
Opportunity to Object
In the following instance where we may use and
disclose your protected health information, you have the opportunity to agree
or object to the use or disclosure of all or part of your protected health
information. If you are not present or
able to agree or object to the use or disclosure of the protected health
information, then your doctor may, using professional judgment, determine whether
the disclosure is in your best interest. In this case, only the protected health
information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare:Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your protected
health information that directly relates to that person's involvement in your
health care. If you are unable to agree
or object to such a disclosure, we may disclose such information as necessary
if we determine that it is in your best interest based on our professional
judgment. We may use or disclose
protected health information to notify or assist in notifying a family member,
personal representative or any other person that is responsible for your care
of your location or general condition. Finally, we may use or disclose your protected
health information to an authorized public or private entity to assist in
disaster relief efforts and to coordinate uses and disclosures to family or
other individuals involved in your health care.
Other Permitted and
Required Uses and, Disclosures That May Be Made Without Your Consent,
Authorization or Opportunity to Object
We may use or disclose your protected health
information in the following situations without your consent or authorization. These situations include:
Required By Law:We may use or disclose your protected health information to the extent
that the law requires the use or disclosure. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of
any such uses or disclosures.
Public Health:We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted by law
to collect or receive the information. The
disclosure will be made for the purpose of controlling disease, injury or
disability. We may also disclose your
protected health information, if directed by the public health authority, to a
foreign government agency that is collaborating with the public health
authority.
Communicable Diseases:We may disclose your protected health information, if authorized by law,
to a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight:We may disclose protected health information to a health oversight agency
for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking
this information include government agencies that oversee the health care
system, government benefit programs, other government regulatory programs and
civil rights laws.
Abuse or Neglect:We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose
your protected health information if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency authorized to
receive such information. In this case,
the disclosure will be made consistent with the requirements of applicable
federal and state laws.
Legal Proceedings:We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly
authorized), in certain conditions in response to a subpoena, discovery request
or other lawful process.
Law Enforcement:We may also disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes. These law enforcement purposes include (I)
legal process and otherwise required by law, (2) limited information requests
for identification and location purposes, (3) pertaining to victims of a crime,
(4) suspicion that death has occurred as a result of criminal conduct, (5) in
the event that a crime occurs on the premises of the Practice, and (6) medical
emergency (not on the Practice's premises) and it is likely that a crime has
occurred.
Workers' Compensation:We may disclose your protected health information, as authorized, to
comply with workers' compensation laws and other similar legally-established
programs.
Required Uses and Disclosures:Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500 et. seq.
B.Your
Rights
Following is a statement of your rights with respect
to your protected health information and a brief description of how you may
exercise these rights.
You have the right to inspect and copy your protected
health information.This means you may inspect
and obtain a copy of protected health information about you that is contained
in a designated record set for as long as we maintain the protected health
information. A "designated record
set" contains medical and billing records and any other records that your
doctor and the Practice uses for making decisions about you.
Under federal law, however,
you may not inspect or copy the following records; information complied in
reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and protected health information that is subject to law
that prohibits access to protected health information. Depending on the circumstances, a decision to
deny access may be reviewed. In some
circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer, if you
have questions about access to your medical record.
You have the right to request a restriction of your
protected health information.This means you may ask us
not to use or disclose any part of your protected health information for the
purposes of treatment, payment or healthcare operations. You have
the right to restrict certain disclosures of Protected Health Information to a
health plan when you pay out of pocket in full for the healthcare delivered by
our office.You may also request
that any part of your protected health information not be disclosed to family
members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request must be in writing and state the
specific restriction requested and to whom you want the restriction to apply.You may
opt out of fundraising communications in which our office participates.
Your provider is not
required to agree to a restriction that you may request. If the doctor believes it is in your best
interest to permit use and disclosure of your protected health information,
your protected health information will not be restricted. If your doctor does agree to the requested
restriction, we may not use or disclose your protected health information in
violation of that restriction unless it is needed to provide emergency
treatment. With this in mind, please
discuss any restriction you wish to request with your doctor.
You may request a
restriction by presenting your request, in writing to the staff member
identified as "Privacy Officer" at the top of this form. The Privacy Officer will provide you with
"Restriction of Consent" form. Complete the form, sign it, and ask that the
staff provide you with a photocopy of your request initialed by them. This copy will serve as your receipt.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative location. We will accommodate
reasonable requests. We may also
condition this accommodation by asking you for information as to how payment
will be handled or specification of an alternative address or other method of
contact. We will not request an
explanation from you as to the basis for the request. Please make this request in writing.
You may have the right to have your doctor amend your
protected health information. This means you may request an amendment of protected
health information about you in a designated record set for as long as we
maintain this information. In certain
cases, we may deny your request for an amendment. If we deny your request for amendment, you
have the right to file a statement of disagreement with us and we may prepare a
rebuttal to your statement and will provide you with a copy of any such
rebuttal. Please contact our Privacy
Officer if you have questions about amending your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information. This right applies to
disclosures for purposes other than treatment, payment or healthcare operations
as described in this Notice of Privacy practices. It excludes disclosures we may have made to
you, to family members or friends involved in your care, pursuant to a duly
executed authorization or for notification purposes. You have the right to receive specific
information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is
subject to certain exceptions, restrictions and limits.
You have
the right to be notified by our office of any breech of privacy of your
Protected Health Information.
Certain treatments may be performed
in a common therapy area and/ or you may find yourself within public areas
within the clinic times, but please note private rooms are always available,
upon request, for discussing your private health information.
You have the right to obtain a paper copy of this
notice from us, upon request, even if you have agreed to accept this notice
electronically.
C.Complaints
You may
complain to us, or the Secretary of Health and Human Services, if you believe
your privacy rights have been violated by us. To file a complaint you may go to:http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf
Or our office can provide you with a written
form in which to file your complaint.You may
also file a complaint with us by notifying our Privacy Officer of your
complaint. We will not retaliate against
you for filing a complaint.
Our Privacy Officer is Velma
Kling you may contact our Privacy Officer, or any staff member, including
at the following phone number (210)493-9119or our website stxchiro.com for further information
about the complaint process.
This notice was published and becomes effective on May
13, 2016