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.
“Protected health information” (PHI) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care.
You have the right to:
We may use and share your information as we:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or summary of your health information, usually with 15 days of your request. We may charge a reasonable, cost-based fee.
You may not be able to obtain all your information in a few special cases. For example, if your treatment provider determines that the information may endanger you or someone else.
In accordance with Texas law, you have the right to obtain a copy of your PHI in electronic form for records that we maintain using an Electronic Health Records (HER) system capable of fulfilling the request.
You can ask us to correct health information about you that you think is incorrect or incomplete. Requests must identify which information you seek to amend, what corrections you would like to make, and why in the information needs to be amended. We will respond to your request in writing within 60 days.
We may say “no” to your request, but we’ll tell you why in writing within 60 days. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal.
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purposes of payment or operations with your heath insurer. We will say “yes” unless the law requires us to share that information.
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. We will notify you in advance of the cost involved, and you may choose to withdraw or modify your request at that time.
We will respond in writing within 60 days of receipt of your request (with a possible 30-day extension).
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
You have the right to be notified of an impermissible use or disclosure that compromises the security of your PHI. We will provide notice to you as soon as is reasonably possible and no later than sixty (60) calendar days after discovery of the breach and in accordance with federal and state law.
You may also file a complaint directly with any or all the following federal and state agencies: the Secretary of the Department of Health and Human Services, the Office of the Attorney General of Texas, or the Texas Behavioral Health Counsel. We can provide you with the addresses to file your complaint upon request. You will not be penalized in any way for filing a complaint.
If you feel that we have violated these rights, please feel free to contact us at [email protected] or by calling our offices at (512) 528-3131.
If you would like more information about our privacy practices or have questions or concerns, please contact us.
Privacy Officer: Melissa McHugh Dillon, Ph.D., BCBA.
Office: (512) 528-3131
Email: [email protected]
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
We will not use or disclose psychotherapy notes without your written authorization, and only as permitted by law.
We will not use or disclose your protected health information for marketing communications without your written authorization, and only as permitted by law.
We will not sell your protected health information. Ever.
We are allowed or required to share your information in other ways- usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
We can share health information about you for certain situations such as:
We can use or share your information for health research.
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
We can use or share health information about you:
For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
We can share health information about you in response to a court or administrative order
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website, www.hillcountryanxiety.com.