Hemmo A. Bosscher, MD, PA 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:
– 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.
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 has 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
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) 785-5700, 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
You will not be retaliated against for filing a complaint.
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.