NOTICE OF PRIVACY PRACTICES

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.

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information. We may use and disclose your medical records only for treatment, payment or health care operations as follows:

• Treatment means providing, coordinating or managing health care and related services by one or more health care providers. Examples of this would be:
• Providing copies of test results or doctor’s notes to a surgeon we send you to for consultation
• Providing copies of doctor’s notes to a physician who referred you to us
• Payment means activities such as billing for services, collecting billed amounts, confirming coverage or obtaining approvals for services from an adjustor or insurance company. Examples of this would be:
• Sending a bill with doctor’s notes to your insurance company for payment
• Discussing the status of your care or recommended procedures with a workers’ compensation case manager
• Obtaining confirmation that a particular procedure is covered by your insurance plan
• Health Care Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example of this would be reviewing charts to confirm that all required documentation is present and complete.

For workers’ compensation cases, we must disclose information as required by the Texas Workers’ Compensation Commission, the employer, their insurer, or their coverage administrator, all of whom are exempt from the requirements of HIPAA. By law, we are required to make these disclosures without regard to patient consent.

We may also create and distribute de-identified health information by removing all references to individually identifiable information. We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent we have already taken actions relying on your authorization or are required by law to make the disclosure.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our Privacy Officer:

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are not required, however, to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to specify where and how you receive confidential communications of protected health information from us.
• The right to inspect, copy or request amendment of your protected health information
• The right to receive a history of non-routine disclosures of your protected health information
• The right to obtain a paper copy of this notice from us at your first service delivery date beginning April 14, 2003.
• The right to provide and we are obligated to receive a written acknowledgement that you have received a copy of our Notice of Privacy Practices.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. This notice is effective as of April 14, 2003. We reserve the right to change the terms of our Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of any revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with us at the address below or with the Department of Health and Human Services, Office of Civil Rights, about violation of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.