privacy notice

This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your "protected health information" means any written and oral 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 health care provider, and that relates to your past, present or future physical or mental health or condition.

Hemmo Bosscher, P.A., M.D., Pain Management is required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your health information. If you have any questions about any part of this notice or if you want more information about the privacy practices please contact our privacy officer at 806-785-5700.

I. Uses and Disclosures for Treatment, Payment, and Health Care Operations

We may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:

• “PHI” refers to information in your health record that could identify you.
• “Treatment, Payment and Health Care Operations”

– Treatment is when we provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your family physician. We will not do this without your written authorization.

– Payment is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage, or when we provide PHI to our billing department to submit claims, send statements to you, and obtain pre-certification and authorization for your sessions with us.

– Health Care Operations are activities that relate to the performance and operation of our clinic. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination. We may use and disclose your health information to remind you of appointments you have made by telephone at a number you provide us.

• “Use” applies only to activities within our clinic such as employing, applying, utilizing, examining, and analyzing information that identifies you.
• “Disclosure” applies to activities outside of our clinic such as releasing, transferring, or providing access to information about you to other parties.

II. Uses and Disclosures Requiring Authorization

We may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances when the clinic is asked for information for purposes outside of treatment, payment and health care operations, We will obtain an authorization from you before releasing this information.

You may revoke all such authorizations (of PHI) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) the clinic have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

III. Uses and Disclosures with Neither Consent nor Authorization

The clinic may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse: If the clinic has cause to believe that a child has been, or may be, abused, neglected, or sexually abused, we must make a report of such within 48 hours to the Texas Department of Protective and Regulatory Services, the Texas Youth Commission, or to any local or state law enforcement agency.

Adult and Domestic Abuse: If the clinic have cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, we must immediately report such to the Department of Protective and Regulatory Services.

Health Oversight: If a complaint is filed against the clinic with the State Board of Medical Examiners, they have the authority to subpoena confidential mental health information from us relevant to that complaint.

Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment and the records thereof, such information is privileged under state law, and the clinic will not release information, without written authorization from you or your personal or legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.

Serious Threat to Health or Safety: If the clinic determined that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate injury to you, we may disclose relevant confidential health information to medical or law enforcement personnel.

Worker’s Compensation: If you file a worker's compensation claim, the clinic may disclose records relating to your diagnosis and treatment to your employer’s insurance carrier.

IV. Patient's Rights and Clinic's Duties

Patient’s Rights:

• Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, the clinic is not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
• Right to Inspect and Copy – You have the right to inspect or obtain a copy in our health and billing records used to make decisions about you for as long as the PHI is maintained in the record. The clinic may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, the clinic will discuss with you the details of the request and denial process. We have the right to charge a reasonable fee for providing you with a copy of these records.
• Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
• Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, we will discuss with you the details of the accounting process.
• Right to a Paper Copy – You have the right to obtain a paper copy of the notice from the clinic upon request, even if you have agreed to receive the notice electronically.

V. Complaints

If you are concerned that the clinic has violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the clinic by telephone at (806) 797-4985, in person at our clinic, or in writing by certified mail at the address above.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. The address is:

The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257 or toll free at 1-877-696-6775

You will not be retaliated against for filing a complaint.

VI. Effective Date, Restrictions and Changes to Privacy Policy

Effective Date: April 14, 2003.

We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that the clinic maintains. We will provide you with a revised notice by providing you with a copy in person or by mail at your request.