NORTH TEXAS INFECTIOUS DISEASES CONSULTANTS, P.A.
NOTICE OF PRIVACY PRACTICES
THIS notice describes how a patient’s personal healthcare information may be used and disclosed. It also states how you can get access to your healthcare information.
Please Read Carefully
North Texas Infectious Diseases Consultants (NTIDC) uses a patient’s personal health information for treatment, to obtain payment for treatment, for health care operations and also to evaluate the quality of care that the patient receives. The patient’s health information is contained in a medical record that is the physical property of NTIDC.
NTIDC MAY USE OR DISCLOSE PATIENT INFORMATION AS FOLLOWS:
For Treatment. NTIDC may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment. NTIDC may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations. NTIDC may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
Evaluate the performance of NTIDC’s staff;
Assess the quality of care and outcomes in your case and similar cases;
Continually improve the quality and effectiveness of the health care NTIDC provides.
Appointments. NTIDC may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Required By Law. NTIDC may use and disclose information about you as required by law. For example, NTIDC may disclose information for the following purposes:
For judicial and administrative proceedings pursuant to legal authority;
To report information related to victims of abuse, neglect or domestic violence;
To assist law enforcement officials in their law enforcement duties;
To Worker’s Compensation programs when your health condition arises out of a work-related illness or injury;
May disclose your health information in response to a request received from a law enforcement official to report criminal activity or to respond to a subpoena, court order, warrant, summons, or similar process;
May disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death;
To avert a serious threat to health or safety to you or other individuals;
As required by military command authorities if you are in the armed forces;
For national security activities as authorized by law;
For drug research studies under limited circumstances.
Except for the generalized listing above, NTIDC will use all reasonable efforts not to disclose your health information for any other purpose unless we have your specific written authorization.
You have the right to revoke a written authorization at any time as long as you do so in writing. If you revoke your authorization, NTIDC will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization.
PATIENTS RIGHTS REGARDING HEALTH INFORMATION
You have the following rights regarding your health information. You may exercise each of these rights, in writing, by providing NTIDC with a completed form obtained from NTIDC’s front desk personnel. In some instances, NTIDC may charge you for the cost associated with providing you with the requested information. Additional information regarding how to exercise your rights, and the associated cost, can be obtained at the front desk.
Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. We may deny your request to inspect and copy your health information in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.
Right to Amend. You have the right to request an amendment of your health information that is maintained by or for our practice and is used to make health care decisions about you. We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information sought to be amended: (a) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (b) is not part of the information that is kept by or for our
practice; (c) is not part of the information which you are permitted to inspect and copy; or (d) is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures of your health information made by us. NTIDC will record and chart when and to whom these disclosures were given.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received. We are not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.
Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care 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 a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
QUESTIONS OR COMPLAINTS
If you have any additional questions regarding this Notice or wish to receive additional information about our privacy practices, please contact our Privacy Officer at (214) 823-2533.
If you believe your privacy rights have been violated, you may file a written complaint to the following address:
RegionVI, Office for Civil Rights,
Dept. of Health and Human Services,
1301 Young Street Suite 1169
Dallas, Texas Zip Code 75202
To file a written complaint with NTIDC, you may do so by mailing the complaint to the attention of the Privacy Officer at 3409 Worth Street, suite 710, Dallas, Texas 75246.
