Health Insurance Portability & Accountability Act of 1996
This Notice of Privacy Practices (the “Notice”) tells you about the ways we may use and disclose your protected health information (PHI or “medical information”) and your rights and our obligations regarding the use and disclosure of your medical information. This Notice applies to Legacy Developmental Pediatrics PLLC, including its providers and employees (the “Practice”).
PLEASE REVIEW IT CAREFULLY
Our Pledge Regarding Medical Information. We understand medical information about you and your healthcare is personal. We are committed to protecting medical information about you. A record is created from the care and services you receive at this office. This record is needed to provide the necessary care and to comply with legal requirements. This notice applies to all of the records of your care generated by this office.
This notice will tell about the ways in which this office may use and disclose medical information about you. Also described are your rights and certain obligations we have regarding the use and disclosure of medical information.
The law requires this office to:
Make sure medical information that identifies you is kept private to the extent required by state and federal law;
Provide copy of this Notice to inform you of our legal duties and privacy practices with respect to medical information about you;
Notify affected individuals following a breach of unsecured medical information under federal law; and
Follow the terms of the notice that is currently in effect.
I. Permitted Uses and Disclosures of PHI
The following categories describe different ways our office can use and disclose your medical information. Not every possible use or disclosure will be listed. However, all the different ways the office is permitted to use and disclose information will fall within one of these categories.
Treatment. Your medical information may be used to provide you with medical treatment or services. This medical information may be disclosed to physicians, physician extenders, nurses, or other agents of this office who are involved in your care. other health care providers and personnel who are providing or involved in providing health care to you (both within and outside of the Practice). Your medical information may also be disclosed to healthcare students, interns and residents.
For example: We may disclose medical information to doctors, nurses, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
Payment. Your medical information may be used and disclosed so that the treatment and services received at the office may be billed and payment may be collected from you, the insurance company and/or a third party.
Information may be given to someone who helps pay for your care.
Your health plan or insurance company may need information about a treatment you are going to receive to obtain prior approval (authorization) or to determine whether they will cover the treatment. If, however, you pay for an item or service in full, out of pocket and request that we not disclose to your health plan the medical information solely relating to that item or service we will follow that restriction on disclosure unless otherwise required by law.
Health Care Operations. Your medical information may be used and disclosed for purposes of furthering day-to-day operations. This is necessary to run the office and to monitor the quality of care our patients receive.
For example: Your medical information may be:
Reviewed to evaluate the treatment and services performed by our staff in caring for you.
Disclose to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers.
Combined with that of other patients to decide what other services we should offer, or what services are not needed.
Disclosed to doctors, nurses, technicians, healthcare students, interns, residents, and other office personnel for learning purposes.
Quality Assurance. We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients.
Utilization Review. We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
Credentialing and Peer Review. We may need to use or disclose your medical information in order for us to review the credentials, qualifications and actions of our health care providers.
Notification and communication with family. The Practice may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others. In addition, we 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.
Appointment Reminders, Check-In and Results. Your medical information may be used to contact you as a reminder of a scheduled appointment. We may use and disclose medical information to contact you (including, for example, contacting you by phone and leaving a message on an answering device) to provide appointment reminders and other information. The Practice may use a sign-in sheet at the registration desk and call you by name in the waiting room when your provider is ready to see you. The Practice may also use your PHI to contact you about test results. The Practice may leave a message reminding you of an appointment or the results of certain tests but will leave the minimum amount of information necessary to communicate this information.
Minors. For divorced or separated parents: each parent has equal access to health information about their unemancipated child(ren), unless there is a court order to the contrary that is known to us or unless it is a type of treatment or service where parental rights are restricted.
Treatment Alternatives. Your medical information may be used to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care. Your medical information may be released to a family member, guardian or other individuals involved in your care at the time care is being provided, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law (with an opportunity for you to agree or object when required under the law), or in accordance with your prior authorization. They may also be told about your condition unless you have requested additional restrictions. In addition, your medical information may be disclosed to an entity assisting in a disaster relief effort so your family can be notified about your condition, status, and location.
II. SPECIAL SITUATIONS
As Required by Law. Your medical information will be disclosed when required to do so by federal, state, or local authorities, laws, rules and/or regulations.
Minors. If you are a minor (generally an individual under 18 years old), we may disclose your PHI to your parent or guardian unless otherwise prohibited by law.
Business Associates. There are some services (such as billing or legal services) that may be provided to or on behalf of our Practice through contracts with business associates. When these services are contracted, we may disclose your medical information to our business associate so that they can perform the job we have asked them to do. To protect your medical information, however, we require the business associate to appropriately safeguard your information.
Electronic Disclosures of Medical Information. Under Texas law, we are required to provide notice to you if your medical information is subject to electronic disclosure. This Notice serves as general notice that we may disclose your medical information electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, your medical information will be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process by someone else involved in the dispute when we are legally required to respond. In addition to lawsuits, there may be other legal proceedings for which we may be required or authorized to use or disclose your medical information, such as investigations of health care providers, competency hearings on individuals, or claims over the payment of fees for medical services.
Law Enforcement. Your medical information will be released if requested by a law enforcement official:
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;
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 prevent or decrease a serious and imminent threat of injury to your physical, mental or emotional health or safety or the physical safety of another person.
About a death we believe may be the result of criminal conduct
National Security and Intelligence Activities. Your medical information will be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. Your medical information may be disclosed to authorize federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
To Avert a Serious Threat of Injury to Health or Safety. Your medical information may be used and disclosed when necessary to prevent or decrease a serious and imminent threat of injury to your physical, mental or emotional health or safety or the physical safety of another person. Such disclosure would only be to medical or law enforcement personnel.
Organ and Tissue Donation. If you are an organ or tissue donor, your medical information may be released to organizations that handle organ procurement or organ, eye, and tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, your medical information may be released as required by military authorities. If you are a member of the foreign military, your medical information may be released to the appropriate foreign military authority.
Workers Compensation. If you seek treatment for a work-related illness or injury, we must provide full information in accordance with state laws regarding workers’ compensation claims. Once state requirements are met and an appropriate written request is received, only the records pertaining to the work-related illness or injury may be disclosed.
Public Health Risk. Your medical information may be used and disclosed for public health activities. These activities generally include the following:
To prevent or control disease, injury or disability;
To report births and deaths;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
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 notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Coroners, Medical Examiners, and Funeral Directors. Your medical information may be released to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release your medical information to funeral directors as necessary to carry out their duties.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the following reasons:
For the institution to provide you with health care;
To protect the health and safety of you and others;
For the safety and security of the correctional institution.
Health Oversight Activities. Your medical information may be disclosed to agencies for activities authorized by law. These oversight activities include; audits, investigations, inspections, licensure and disciplinary actions, and other activities necessary for the government to monitor the health care system, certain governmental benefit programs, certain entities subject to government regulations which relate to health information, and compliance with civil rights laws.
Marketing of Related Health Services. We may use or disclose your medical information to send you treatment or healthcare operations communications concerning treatment alternatives or other health-related products or services. We may provide such communications to you in instances where we receive financial remuneration from a third party in exchange for making the communication only with your specific authorization unless the communication:
is made face-to-face by the Practice to you,
consists of a promotional gift of nominal value provided by the Practice, or
is otherwise permitted by law.
If the marketing communication involves financial remuneration and an authorization is required, the authorization must state that such remuneration is involved. Additionally, if we use or disclose information to send a written marketing communication (as defined by Texas law) through the mail, the communication must be sent in an envelope showing only the name and addresses of sender and recipient and must:
state the name and toll-free number of the entity sending the market communication; and
explain the recipient’s right to have the recipient’s name removed from the sender’s mailing list.
Fundraising. We will inform you of our intentions to raise funds and your right to opt out of receiving such communications.
III. DISCLOSURES REQUIRING YOUR AUTHORIZATION
Research. We may use or disclose your medical information for research purposes if your authorization has been obtained when required by law, or if the information we provide to researchers is “de-identified.”
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.
IV. YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
Other Uses of Your Medical Information. All other uses and disclosures of your medical information not covered by this notice or other state and federal laws will only be made with your written permission. This includes the following:
Uses and disclosures of Protected Health Information for marketing purposes; and
Disclosures that constitute a sale of your Protected Health Information under HIPAA require your authorization
Right to Revoke Authorization. If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
V. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding Health Information we have about you:
Right to Inspect and COPY. You have the right to inspect and copy your medical information that may be used to make decisions about your care. Usually, this information includes medical and billing records, but does not include psychotherapy notes. We have a minimum of 30 days to act on your request.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Practice. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. If you request to inspect your medical information, an appointment must be made and a fee will be charged.
If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the Practice that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the Practice and you.
In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
Right to Amend. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend this information. You have the right to request an amendment for as long as the information is kept by the Practice. We have a minimum of 60 days to act on your request.
To request an amendment, your request must be made in writing and submitted to the Practice. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
The medical information was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment);
The medical information is not part of the medical information kept by our office;
The medical information is not part of the information you would be permitted to inspect and copy; or
The medical information is accurate and complete.
For other reasons provided by State Law.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we have made of your medical information for purposes other than treatment, payment, and health care operations. We have a minimum of 60 days to act on your request.
If we make disclosures through an electronic health records (EHR) system, you may have an additional right to an accounting of disclosures for Treatment, Payment, and Health Care Operations. Please send a written letter to the Practice at the address set forth in Section VIII below for more information regarding whether we have implemented an EHR and the effective date, if any, of any additional right to an accounting of disclosures made through an EHR for the purposes of Treatment, Payment, or Health Care Operations.
To request a list of accounting, you must submit your request in writing to the Practice at the address set forth in Section VIII below.
Your request must state a time period, which may not be longer than six years (or longer than three years for Treatment, Payment, and Health Care Operations disclosures made through an EHR, if applicable) and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
For example: You can ask that we only contact you at work or by mail.
Right to Request Restrictions of Uses And Disclosures. To maintain a high level of patient care, we will not grant any requests from individuals to restrict the disclosure of their medical information as permitted by HIPPA for the treatment, payment, or health care operations.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information.
To request restrictions, you must submit your request in writing to the Practice at the address set forth in Section VIII below. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply.
As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed. However, if you pay or another person (other than a health plan) pays on your behalf for an item or service in full, out of pocket, and you request that we not disclose the medical information relating solely to that item or service to a health plan for the purposes of payment or health care operations, then we will be obligated to abide by that request for restriction unless the disclosure is otherwise required by law.
You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact your health plan’s decision to pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).
Right to a Paper COPY of This Notice. You have the right to a copy of this notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information as defined in and/or required by HIPAA and applicable state law.
Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
VI. ADDITIONAL INFORMATION
Patient Portal and Other Patient Electronic Correspondence. We may use and disclose your PHI through various secure patient portals that allow you to view, download and transmit certain medical and billing information and communicate with certain health care providers in a secure manner through the MyTeamCare patient portal.
Your Contact Information: Home and Email Addresses/Phone Numbers. If you provide us with a home or email address, home/work/cell telephone number, or other contact information during any registration or administrative process we will assume that the information you provided us is accurate and that you consent to our use of this information to communicate with you about your treatment, payment for service and health care operations. You are responsible for notifying us of any change of this information. We reserve the right to utilize third parties to update this information for our records as needed.
Email or Downloading PHI. If you email us medical or billing information from a private email address (such as a Yahoo, Gmail, etc. account), your information may not be secure in transmission. We therefore recommend you use your MyTeamCare patient portal to communicate with us regarding your care and/or billing issues. If you request that we email your PHI to a private email address, we will send it in an encrypted manner unless you request otherwise. Legacy Developmental Pediatrics is not responsible for the privacy or security of your PHI if you request that we send it to you in an unsecured manner or download, or post it on a dropbox, unencrypted USB drive, CD or other unsecure medium. In addition, Legacy Developmental Pediatrics is not responsible if your PHI is redisclosed, damaged, altered or otherwise misused by an authorized recipient. In addition, if you share an email account with another person (for example, your spouse/partner/roommate) or you choose to store, print, email, or post your PHI, it may not be private or secure.
Sensitive Health Information. Federal and state laws provide special protection for certain types of health information, including psychotherapy notes, information about substance use disorders and treatment, mental health and AIDS/HIV or other communicable diseases, and may limit whether and how we may disclose information about you to others.
Incidental Disclosures. Despite our efforts to protect your privacy, your PHI may be overheard or seen by people not involved in your care. For example, other individuals at your provider’s office could overhear a conversation about you or see you getting treatment. Such incidental disclosures are not a violation of HIPAA.
VII. USING TECHNOLOGY TO IMPROVE HEALTHCARE
Health Information Exchange (HIE) enables your healthcare providers to quickly and securely share your health information electronically among a network of healthcare providers, including physicians, hospitals, laboratories and pharmacies. Your health information is transmitted securely and only authorized healthcare providers with a valid reason may access your information.
How does HIE Help You? Improved access to information will enable us to provide better care for our patients.
Improved Care. Access to information about your health history and medical care gives your healthcare provider a more complete picture of your overall health. This can help your provider make better decisions about your care. The information may also prevent you from having repeat tests, saving you time, money and worry.
Emergency Treatment. In an emergency, your providers may immediately check to see if you have allergies, health problems, test results, medications or previous concerns that may help them provide you with emergency care.
Helps to Protect Privacy and Information Security. By sharing information electronically through a secure system, the risk that your paper or faxed records will be misused or misplaced is reduced.
How does HIE help protect your medical information and keep it secure? Legacy Developmental Pediatrics is committed to protecting the privacy and security of your health information, including the sharing and accessing of your information through HIE.
Every HIE and its participants must protect your private medical information under HIPAA law, as well as applicable state laws and regulations.
Information shared via HIE is encrypted, meaning it can be accessed only by authorized users. This prevents hackers from accessing your information.
Every individual who can access your information must have their own username and password and must receive training before they can access your information.
You have choices about participating in HIEs. Legacy Developmental Pediatrics recognizes you have certain rights related to how we share your information. You have the following choices:
Choice 1: You AGREE to participate in HIE. No further action needed. You agree to have your medical information shared through HIE and you have current Authorization and Consent to Treat form on file, you do not need to do anything. By agreeing, you have granted us permission to share your health information to HIE.
Choice 2: You choose NOT to participate in HIE. Follow the Instructions on the HIE OPT-IN/OUT Form. We recognize your right to choose not to participate in HIE, also referred to as opting-out. If you decide to opt-out of HIE, healthcare providers will not be able to access your health information through HIE. You should understand that providers may still request and receive your medical information from other providers using other methods permitted by law, such as fax, mail or other electronic communication. Also, , your opt-out does not affect health information that was disclosed through HIE prior to the time that you opted out. You can change your mind at any time.
If you have any questions about HIE or to Opt-out of HIE, you can contact the Practice at the address set forth in Section VIII.
NO WAIVER. Under no circumstances will Legacy Developmental Pediatrics require an individual to waive his or her rights under the HIPAA Privacy Rule or the HIPAA Breach Notification Rule as a condition for receiving treatment.
VIII. CHANGES TO THIS NOTICE, CONTACT/COMPLAINTS
Changes To This Notice. We reserve the right to change this notice and make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. A current copy of this notice will be displayed in the waiting room.
Contact/Complaints. Please contact the office if you have any questions about this Notice or if you wish to file a privacy complaint. You may file a complaint with the Practice at the following address or phone number.
Legacy Developmental Pediatrics, PLLC
2505 79th St Suite B
Lubbock, TX 79423
You can also send a letter to file a complaint to either department:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W
Washington, D.C. 20201
Or by calling: 1-877-696-6775
Or online at: www.hhs.gov/ocr/privacy/hipaa/complaints/
For a provider licensed in Texas:
Texas Department of State Health Services Investigations:
P.O. Box 141369
Austin, Texas 78714-1369.
More information is at:
We may not retaliate against you for filing a complaint.