Notice of Privacy Practices for Protected Health Information

Privacy & Compliance Office: 866-687-5250

Effective Date: 11/15/2023

Your information. Your rights. Our responsibilities.

This notice outlines how your medical information may be used and disclosed, as well as how you can access and manage this information. Please review it carefully.

Your Rights

You have the right to:

• Obtain a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Obtain a list of those with whom we’ve shared your information
• Receive a copy of this privacy notice
• Designate someone to act on your behalf
• File a complaint if your privacy rights are violated

Your Choices

You can make choices regarding the use and sharing of your information. You may choose to:

• Share information with family, friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

Our Uses and Disclosures

• We may use and share your information for various purposes, including:
• Treatment
• Running our organization
• Billing for your services
• Public health and safety issues
• Research
• Compliance with the law
• Organ and tissue donation requests
• Working with medical examiners or funeral directors
• Addressing workers’ compensation, law enforcement, and government requests
• Responding to lawsuits and legal actions

Your Rights (Details)

• When it comes to your health information, you have certain rights:
• Obtain a copy of your medical record
• Correct your medical record
• Request confidential communications
• Ask us to limit information use or sharing
• Obtain a list of information disclosures
• Receive a copy of this privacy notice
• Designate someone to act for you
• File a complaint if your rights are violated

Reporting a Problem

If you believe your rights have been violated, contact our Corporate Compliance office at 866-687-5250.

Complaints

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

• By mail: 200 Independence Avenue S.W., Washington, D.C. 20201
• By phone: 1-877-696-6775
• Online: http://hhs.gov/ocr/privacy/hipaa/complaints
• We will not retaliate against you for filing a complaint.

Your Choices (Details)

You can specify your preferences for information sharing in certain situations. You have the right to:

• Share information with family, friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

Our Uses and Disclosures (Details)

We typically use or share your health information for treatment, running our organization, and billing for your services. Other uses and disclosures include public health and safety, research, compliance with the law, organ, and tissue donation, working with medical examiners or funeral directors, and addressing workers’ compensation, law enforcement, and government requests.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will promptly inform you of any breaches compromising your information’s privacy or security.
• We must adhere to the duties and privacy practices described in this notice.
• We will not use or share your information except as described here, unless you provide written consent.

For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms

We may change the terms of this notice, and such changes will apply to all your information. The updated notice will be available upon request, in our office, and on our website.

Other Important Information

• Effective Date: 11/15/2023
• Contact Corporate Compliance Office at 866-687-5250 for issues/concerns or send a letter to ****.
• We do not market or sell your information.
• We do not participate in research.
• We do not create or manage a hospital directory.
• We do not create or maintain psychotherapy notes.
• Some services are provided through Business Associates, who maintain confidentiality per our standards.
• Federal and Texas law allows your health information to be released to health oversight agencies to ensure compliance.