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.
This Privacy Notice is being provided to you as required by the Health Insurance Portability and Accountability Act (“HIPAA”). This Privacy Notice describes how America’s ER (“AER”) may use and disclose your protected healthcare information (“PHI”) to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your right to access and control your PHI.
What constitutes Protected Healthcare Information?
Your “PHI” means any written or oral information about you, including demographic data that can be used to identify you, that was created or received by your healthcare provider and which relates to your past, present, or future physical or mental health condition.
Uses and Disclosures of PHI for Treatment, Payment, and Health Care Operations
America’s ER (“AER”) may use your PHI for the purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your PHI may be used or disclosed only for these purposes unless AER has obtained your authorization or the use or disclosure is permitted or required by HIPAA regulations or other law. Disclosures of your PHI for the purposes described in this Privacy Notices may be made in writing, orally, or by electronic means.
- Treatment: AER will use and disclose your protected healthcare information to provide, coordinate, or manage your health care and related services, including coordination and management with third parties for treatment purposes. For example, if you are being treated for a joint injury, AER may disclose your PHI to the physical rehabilitation department or your primary care physician in order to coordinate your care.
- Payment: AER will use your PHI to obtain payment for the services AER provides you. AER may disclose your PHI to another provider involved in your care for their payment activities. For example, AER may provide portions of your PHI to our billing company and your health plan to get paid for the healthcare services AER provided to you. AER may also provide your PHI to our business associates, such as claims processing companies, and others that process our healthcare claims.
- Health Care Operations: AER may use and disclose your PHI to facilitate our own healthcare operations so as to ensure the provision of quality care to all our patients. Healthcare operations include such activities as: quality assessment and improvement, employee review activities, conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse detection and compliance reviews, business planning and development, and business management and general administrative activities. In certain situations, AER may also disclose your PHI to another provider or health plan for their healthcare operations. Here are some examples of how AER may use or disclose your PHI for healthcare operations:
- Use medical records to review our treatment and services as well as to evaluate the performance of our staff, agents and independent contractors in caring for you;
- Combine medical records about many of our patients to decide what additional services AER should offer, what services are not needed, and to study the safety and effectiveness of treatments
- Disclose information to doctors, nurses, and other AER personnel for training purposes;
- Remove information that identifies you from a set of medical records so that others may use it to study healthcare and healthcare delivery without learning who the specific patients are; or
- Use and disclose medical records to contact you by telephone or in writing as a reminder that you have an appointment for a test or procedure, or to see your doctor.
- Client/Patient Satisfaction Surveys. AER may conduct client/patient satisfaction surveys to understand how we can improve our services to patients and their families or friends. For example: A client or patient may receive a survey from a patient satisfaction research organization, asking for comments on the services provided.
- Business Associates. There are some services at AER that may be provided through contracts with business associates. Examples include, but are not limited to certain laboratory tests and a copy service that we may use to make copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.
- Fundraising Activities. AER may solicit contributions to support the expansion and improvement of services and programs we provide to the community. In connection with our fundraising efforts, we may disclose to our employees or business associates, demographic information about you (e.g., your name, address and phone number), dates on which we provided healthcare to you, health insurance status, department of service, treating physician and general outcome information. If you do not wish to receive any fundraising requests in the future, you may respond via one of the methods identified in the fundraising correspondence that you may receive in the future.
- Other Uses and Disclosures: As part of the functions above, AER may use or disclose PHI to inform you of treatment alternatives, or to provide you with information about other health-related benefits and services which may be of interest to you.
Uses and Disclosures of PHI Permitted without Authorization or Opportunity for the Individual to Object
The federal privacy rules allow us to use or disclose your PHI without your authorization and without you having the opportunity to object to such use or disclosure in certain circumstances, including:
- When Required by Law: AER will disclose your PHI when AER is required to do so by federal, state, or local law.
- For Public Health Reasons: AER may disclose your PHI as permitted or required by law for the following public health reasons:
- To prevent or control disease, injury, or disability, to report vital statistics such as births and deaths, and for public health surveillance or interventions;
- To report births and deaths;
- To report abuse or neglect of children, elders, and dependent adults;
- To the Federal Drug Administration (FDA), to report reactions to medications or problems with products, to track products, to enable product recalls, or to conduct post-market surveillance as required by the FDA;
- To notify people of recalls of products they may be using; and
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- To Report Abuse, Neglect, or Domestic Violence: AER may notify government authorities if AER believes a patient is a victim of abuse, neglect, or domestic violence. AER will make this disclosure only when specifically authorized or required by law, or when the patient agrees to the disclosure.
- For Health Oversight Activities: AER may disclose your PHI for health oversight activities authorized by law including: audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.
- For Judicial or Administrative Proceedings: AER may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order. AER may disclose your PHI in response to a subpoena, discovery request, or other lawful process that is not accompanied by an order of a court or administrative tribunal if AER has received satisfactory assurances that you have been notified of the request or that an effort has been made to secure a protective order.
- For Law Enforcement Purposes: AER may disclose your PHI to a law enforcement official for law enforcement purposes, including:
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death AER believes may be the result of criminal conduct;
- About criminal conduct at AER; and
- In emergency circumstances to report a crime; the location of the crime or victims, or the identity, description or location of the person who committed the crime.
- To Coroners, Medical Examiners, and Funeral Directors: AER may disclose PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law. AER may disclose PHI to funeral directors, consistent with applicable law, as necessary to carry out our duties with respect to the decedent. In some cases, such disclosures may occur prior to, and in reasonable anticipation of, the individual’s death.
- For Organ or Tissue Donation: AER may use or disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating donation and transplant.
- For Research Purposes: AER may use or disclose your PHI for research purposes when an institutional review board that has reviewed the research proposal and protocols to safeguard the privacy of your PHI, has approved such use or disclosure.
- To Avert a Serious Threat to Health or Safety: AER may, consistent with applicable law and standards of ethical conduct, use or disclose your PHI if AER believes, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health and safety or that of the public.
- For Specialized Government Function: AER may use or disclose your PHI, as authorized or required by law, to facilitate specified government functions related to military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions and other law enforcement custodial situations.
- For Worker’s Compensation: AER may use or disclose your PHI, as necessary to comply with worker’s compensation laws or similar programs.
Uses and Disclosures of PHI Permitted without Authorization but with an Opportunity for the Individual to Object
AER may use your PHI to maintain a directory of patients in our facility. The information included in the directory will be limited to your name, your location in our facility, and your condition described in general terms.
AER may disclose your PHI to a friend or family member who is involved in your medical care or payment for care. In addition, if applicable, AER may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
You may object to these disclosures. If you do not object to these disclosures, or AER determines in the exercise of our professional judgment that it is in your best interest for us to disclose information that is directly relevant to the person’s involvement with your care, AER may disclose your PHI.
Uses and Disclosures of PHI Which You Authorize
Other than the uses and disclosures described above, AER will not use or disclose your PHI without your written authorization. Authorizations are for specific uses of your PHI, and once you give us authorization, any disclosures AER makes will be limited to those consistent with the terms of the authorization. You may revoke your authorization by submitting a revocation in writing, at any time, except to the extent that AER has already taken action in reliance upon your authorization.
Your Rights Regarding Your PHI
You have the following rights regarding your PHI:
- The Right to Request Restriction of Uses and Disclosures: You have the right to request that AER not use or disclose certain parts of your PHI for the purposes of treatment, payment, or healthcare operations. You also have the right to request that AER not disclose your PHI to friends or family members who may be involved in your care, or for notification purposes as described earlier in this notice. Your request must be made in writing and must state the specific restriction requested and the individuals to whom the restrictions apply.AER is not required to agree to a restriction you may request. AER will notify you if AER does not agree to your restriction request. If AER does agree to the restriction request, AER will not use or disclose your PHI in violation of the agreed upon restriction, unless necessary for the provision of emergency treatment.AER may terminate our agreement to a restriction if you agree to the termination in writing, if you agree to the termination orally and the oral agreement is documented, or if AER notifies you of termination of the agreement and the termination applies only to PHI created or received by us after you receive the notice of termination of the restriction.Requests for restriction must be made in writing to AER’s Privacy Officer.
- The Right to Request Confidential Communications: You have the right to request that you receive communications of PHI from us by alternative means or at alternative locations. AER must accommodate any reasonable request of this nature. AER may condition the provision or accommodation by requesting information from you describing how payment will be handled, or by requesting specification of an alternate address or alternate form of contact.Requests for confidential communications must be made in writing to the Privacy Officer.
- The Right to Inspect and Copy PHI: You have the right to inspect and obtain a copy of your PHI that is maintained in a designated record set for as long as AER maintains the PHI. The designated record set is a collection of records maintained by us, which contains medical and billing information used in the course of your care, and any other information used to make decisions about you.By law, you do not have the right to access psychotherapy notes, information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative proceeding, and PHI which is subject to a law which prohibits access to PHI. Depending on the circumstance of your request, you may have the right to have a decision to deny access reviewed.AER may deny your request to inspect or copy your PHI if, in our professional judgment, AER determines that the access requested is likely to endanger you or another person, or is likely to cause substantial harm to another person referenced within the PHI. You have the right to request a review of a denial of access.Requests for access to your PHI must be made in writing to the Privacy Officer.
- The Right to Amend PHI: You have the right to request that AER amend your PHI in a designated record set for as long as AER maintains that information. In certain cases, AER may deny your request. If AER denies your request, you will be notified in writing, and you will have the right to file a statement of disagreement. If AER does so, AER will provide a copy of our rebuttal to you.Requests for amendment of PHI must be made in writing to the Privacy Officer and must include a reason to support the requested amendments.
- The Right to Receive an Accounting of Disclosures of PHI: You have the right to request an account of disclosures of your PHI made by us. This right applies to disclosures made by us except for disclosures to carry out treatment, payment, or health care operations as described in this Notice or incidental to such use; to you or your personal representatives; pursuant to your authorization; for our directory, or other notification purposes, or to persons involved in your care; for certain other disclosures AER is permitted to make without your authorization.Requests for accounting of disclosures must specify a time period sought for the accounting, with the maximum time period being six years prior to the date of the request. AER is not required to provide accounting disclosures made before April 14, 2003. AER will provide the first disclosure accounting you request during any 12-month period without charge.
- The Right to Obtain a Paper Copy of this Notice: Upon request, AER will provide a paper copy of this Notice.
Your Rights Regarding Your PHI:
AER is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice of our legal duties and privacy practices with respect to PHI. AER is required to abide by the terms of the Notice currently in effect. AER reserve the right to change the terms of this Notice and to make any new provisions effective for all PHI that AER maintains. If AER changes the Notice, AER will provide a copy of the revised Notice through in-person contact.
You have the right to express complaints to us and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated.
If you wish to complain to us, please do so in writing to the Privacy Officer.
You will not be penalized for filing a complaint.
For further information about this Notice, or if you have privacy issues, or if you believe that your privacy rights have been violated, please contact:
Attn: Privacy Officer
Pearland, Texas 77584
The Privacy Contact and Privacy Officer can be contacted either via email at firstname.lastname@example.org or by telephone at: (832) 895-6625