Russell N. McDonald, D.O.
Christine LaComb, R.N., FNP-C
Medical Spa, Family Practice & Weight Control
6000 39th Street
Groves, Texas 77619
Notice of Privacy Practices
As required by the Privacy Regulations Created as a result of the Health Insurance Portability and Accountability Act of 1996
also known as HIPPA
THIS INFORMATION DESCRIBES HOW HEALTH INFORMATION ABOUT YOU AS A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
Please review this information carefully.
A. Our Commitment to Your Privacy:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with a notice of our legal duties and the privacy practices we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. The laws are complicated, but we must provide you with the following information:
-How we may use and disclose your PHI
-Your privacy rights in your PHI
-Our obligations concerning the use and disclosure of your PHI
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practice. Only a copy of the most current notice, including any amendments will be posted.
B. If you have any questions in reference to this notice, please contact our office at (409)962-8509.
C. We may use and disclose your individually identifiable health information in the following ways:
Our practice may use your PHI to treat you. Your information may be disclosed to pharmacies, doctors, or nurses, or anyone involved in your care in order to treat you or assist others in your treatment.
We may use your information to bill and collect payment for services you receive from us. We may use the information to verify eligibility and benefits, obtain payment from third parties, or to other healthcare providers to assist in collection efforts.
3. Health Care Options:
We may use your information to evaluate the quality of care you received from us, or to conduct cost management audits for our practice. However, your personal information, PHI, will never be disclosed to other practices for this reason without your consent.
4. Appointment Reminders:
We may use your information to contact you or notify you of an appointment.
5. Treatment Options:
We may use and disclose your Protected Health Information to inform you of potential treatment options or alternatives.
6. Health Related Benefits:
We may use and disclose your PHI to notify you of benefits or services that may be of interest to you.
7. Release of Information to Relatives or Friends:
We may use or release information to a family member or a friend, or someone that assists in your care.
8. Disclosures as Required by Law:
We will use and/or disclose your PHI when we are required to do so by local, state or federal law.
D. USE AND DISCLOSURE OF YOUR PHI IN SPECIAL CIRCUMSTANCES.
The following categories describe unique scenarios in which we may use your PHI:
1. Public Health Risk:
Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
-Maintaining statistical records
-Reporting child abuse or neglect
-Controlling or preventing disease, injury, or disability
-Notifying a person regarding potential exposure to a communicable disease.
-Reporting reactions to drugs
-Notifying individuals of a problem with a product or device they may be using; or notification of a recalled product.
-Notifying appropriate authorities of potential abuse or neglect.
-Information regarding adult abuse, including domestic violence. This information will only be disclosed if the patient agrees or we are authorized or required to do so by law.
-Notifying your employer under limited circumstances related primarily to work place injury or illness or medical surveillance.
2. Health Oversight Activities:
Our practice may use and disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include investigations, inspections, audits, surveys, or other activities necessary for the government to monitor government programs.
3. Lawsuits and other Proceedings:
We may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your information in response to a request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made the effort to inform you of the request or to obtain an order protecting the information that the party has requested.
4. Law Enforcement
We may release your health information if required to do so by law enforcement for the purpose of:
-Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
-Concerning a death we believe has resulted in criminal conduct.
-Regarding criminal conduct at our office.
-In response to a warrant, summons, court order, subpoena, or similar process.
-To identify or locate a suspect, material witness, fugitive or missing person.
-In an emergency, to report a crime, including the location or victims of the crime, or the description, identity, or location of the perpetrator.
5. Deceased Patients
We may release your personal health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their job.
6. Organ and Tissue Donation
We may release your personal information to organizations that handle transplant coordination if you are an organ donor.
We may use and disclose your health information for research purposes in limited circumstances. We will obtain your written authorization to use your information to use your information except when an Internal Board or Privacy Board has determined that the waiver of authorization satisfies the following:
-An adequate plan to protect the identifiers from improper use and disclosure
-An adequate plan to destroy the identifiers at the earliest opportunity available consistent with the research, unless there is a health or research justification for retaining the information or such retention is required by law.
- Adequate written assurances that the protected health information will not be released or disclosed to any other entities except as required by law for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted, or if the research could not be practicably be conducted without the waiver or without access to the PHI.
8. Serious Threats to Health and Safety
We may use your PHI if and when necessary to reduce or prevent a threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to assist in the prevention of the threat.
We may disclose your PHI if you are a member of U.S. or foreign military forces, including veterans, and if required by the proper authorities.
10. National Security
We may disclose your information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
We may disclose information to correctional institutions or law enforcement officials if you are an inmate or under custody of a law enforcement official. Disclosure for these purposes would be necessary for the institution to provide health care services to you, for the health and safety of the institution, and to protect the health and safety of other individuals.
12. Worker’s Compensation
We may release your PHI for worker’s compensation and similar programs if necessary.
E. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding your PHI and the information we maintain about you:
1. Confidential Communication
You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. You may ask that we contact you at home. Any requests for a particular type of confidential communication must be in writing specifying the requested method of contact. We will accommodate reasonable requests to the best of our ability.
2. Requesting Restrictions
You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or other health care options. Additionally, you have the right to request that we restrict disclosure of your PHI to certain individuals involved in your care such as family members and/or friends. We are not required to agree to your request. However, if we do agree, we are bound by our agreement except when required by law or in emergencies when the information is necessary to treat you. In order to request restriction of disclosure, you must submit in writing the information you wish restricted, whether you are restricting to limit our practice’s use and disclosure, or both, and to whom you want the limits to apply.
3. Inspection and Copies
You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical and billing records, but NOT including any psychotherapy notes. You must submit your request in writing in order to inspect and/or obtain a copy of your PHI. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and or copy in certain circumstances. However, you may request a review of your denial. Another licensed healthcare professional, chosen by us, will review conduct reviews.
You may ask us to amend your health information if you believe that it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by our practice. To request an amendment, your request must be in writing and submitted to our office. You must provide a reason that supports your request. We will deny your request if you fail to submit the request in writing. We may deny your request if you ask us to amend information that is, in our opinion, accurate and complete, not part of PHI kept by or for our practice, not part of the PHI that you would be permitted to inspect and copy, not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures
All of our patients have the right to request an accounting of disclosures. An accounting of disclosures is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment, or non-operations purposes. Use of your PHI as part of routine patient care is not required to be documented. In order to obtain an accounting of disclosures, please submit the request to our office in writing. The request must state a time period which may not be longer than six months from the date of disclosure and may not include dates before April 14, 2003. The first list you request is free of charge, but we may charge you for additional lists within the same 12 month period. We will notify you of any costs associated with the additional request, and you have the opportunity to withdraw the request before you incur any costs.
6. Right to a paper copy of this notice
You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. Please let us know if you want a copy.
7. Right to file a complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice, or with the Secretary of the Department of Health and Human Services. You must submit your complaint in writing. You will not be penalized for writing a complaint.
8. Right to Provide Authorization for Other Uses and Disclosures
We will obtain written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to use regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, however, that we are required to retain certain information and documents.
If you have any questions regarding this notice or our health information privacy policies, please contact us at (409)962-8509.