Health Information Privacy Practices
A-MED HEALTHCARE NOTICE OF PRACTICES FOR PROTECTED HEALTH INFORMATION
“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.”
Our Agency is required by law to maintain the privacy of protected health information
and to provide you adequate notice of your rights and our legal duties and privacy
practices with respect to the uses and disclosures of protected health information. [45
CFR §164.520]. We will use or disclose protected health information in a manner that is
consistent with this notice.
The agency maintains a record of information we receive and collect about you of the
care we provide to you. This record includes physicians’’ orders, assessments,
medications lists, clinical progress notes and billing information.
As required by law, the agency maintains policies and procedures about our work
practices, including how we provide and coordinate care provided to our patients. These
policies and procedures include how we create, maintain and protect medical records;
access to medical and information about our patients; how we maintain the
confidentiality of all information related to tour patients; security of the building and
electronic files; and how we educated staff on privacy of patient information.
How the Agency Uses or Discloses PHI
PHI may be used or disclosed by the Agency as necessary for the operation of the
Agency. Specifically, PHI may be used or disclosed for the following Agency purposes:
Treatment. Providing, coordinating or managing health care and related
services, consultation between health care providers relating to a patient or
referral of a patient for health care from one provider to another. For example
we meet on a regular basis to discuss how to coordinate care to patients and
Payment. Billing and collecting for services provided, determining plan
eligibility and coverage, utilization review (UR), precertification, medical
necessity review. For example, occasionally the insurance requests a copy of
the medical record be sent to them for review prior to paying the bill.
- Other health care operations. General agency administrative and business
functions, quality assurance/improvement activities; medical review; auditing
functions; developing clinical guidelines; determining the competence or
qualifications of health care professionals; evaluating agency performance;
conducting training programs with students or new employees; licensing,
survey, certification, accreditation and credentialing activities; internal
auditing and certain fundraising and marketing activities. For example, our
agency periodically holds clinical record review meetings where the
consulting professional of our record review committee will audit clinical
records for meeting professional standards and utilization review.
In addition to the typical Agency purposes described above, PHI also may be used or
disclosed as permitted or required under applicable law for the following purposes:
Use or disclosure required by law. To the extent that the Agency is legally
required to provide PHI to a government agency or anyone else, it will do so.
In such cases, the Agency will make reasonable efforts to avoid disclosing
more information that is required by applicable law.
Disclosure for public health activities. The Agency may disclose PHI to a
public health authority that is authorized to collect such information (or to a
foreign government agency, at the direction of a public health authority) for
purposes of preventing or controlling injury, disease or disability.
The Agency may also disclose PHI to a public health authority or other
government agency that is responsible for receiving reports of child abuse or
In addition, certain information may be provided to pharmaceutical companies
or other business that are regulated by the Food and Drug Administration
(FDA), as appropriate for purposes relating to the quality, safety and
effectiveness of FDA-regulated products. For example, disclosure might be
appropriate for purposes of reporting adverse reactions, assisting with recalls
and contacting patients who have received products that have been recalled.
Also, to the extent permitted by applicable law, the Agency may disclose PHI,
as part of a public health investigation or intervention, to an individual who
may have been exposed to a communicable disease or may otherwise be at
risk of contracting or spreading a disease or condition.
Disclosures about victims of abuse, neglect or domestic violence. (The
following does not apply to disclosures regarding child abuse or neglect,
which may be made only as provided under Disclosure for public health
If required by law, the Agency may disclose PHI relating to a victim of abuse,
neglect or domestic violence, to an appropriate government agency.
Disclosure will be limited to the relevant required information. The Agency
will inform the individual if any PHI is disclosed as provided in this paragraph
or the next one.
If disclosure is not required by law, the Agency may disclose relevant PHI
relating to a victim of abuse, neglect or domestic violence to an authorized
government agency, to the extent permitted by applicable law, if the Agency
determines that the disclosure is necessary to prevent serious harm to the
individual or to other potential victims. Also, to the extent permitted by law,
the Agency may release PHI relating to an individual to a law enforcement
official, if the individual is incapacitated and unable to agree to the disclosure
of PHI and the law enforcement official indicated that the information is
necessary for an immediate enforcement activity and is not intended to be
used against the individual.
Health oversight activities. The agency may disclose PHI to a health
oversight agency (this includes Federal, State or local agencies that are
responsible for overseeing the health care system or particular government
program for which health information is needed) for oversight activities
authorized by law. This type of disclosure applies to oversight relating to the
health care system and various government programs as well as civil rights
laws. This disclosure would not apply to any action by the government in
investigating a participant in the Agency, unless the investigation relates to the
receipt of health benefits by that individual.
Disclosures for judicial and administrative proceedings. The Agency may
disclose PHI in the course of any judicial or administrative proceeding in
response to an order from a court or an administrative tribunal. Also, if
certain restrictive conditions are met, the Agency may disclose PHI in
response to a subpoena, discovery request or other lawful process. In either
case, the Agency will not disclose PHI that has not been expressly requested
or authorized by the order or the process.
Disclosures for law enforcement purposes. The Agency may disclose PHI for
a law enforcement purpose to a law enforcement official if certain detailed
restrictive conditions are met.
Disclosures to medical examiners, coroners and funeral directors following
death. The Agency 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. The Agency also may disclose PHI to a
funeral director as needed to carry out the funeral director’s duties. PHI may
also be disclosed to a funeral director, if appropriate, in reasonable
anticipation of an individual’s death.
Disclosures to avert a serious threat to health or safety. The Agency may,
consistent with applicable law and standards of ethical conduct, use or
disclose PHI, (1) if it believes the use or disclosure is necessary to prevent or
lessen a serious and imminent threat to the health or safety of a person or the
public; and the disclosure is made to a person or persons reasonably able to
prevent or lessen the threat, including the target of the threat; or (2) if it
believes the disclosure is necessary for law enforcement authorities to identify
or apprehend an individual because of a statement by an individual admitting
participation in a violent crime that the Agency reasonably believes may have
caused serious physical harm to the victim or where it appears that the
individual has escaped from a correctional institution or from lawful custody.
Disclosures for specialized government functions. If certain conditions are
met, the Agency may use and disclose the PHI of individuals who are Armed
Forces personnel for activities deemed necessary by appropriate military
command authorities to assure the proper execution of the military mission.
Also, the Agency may use and disclose the PHI of individuals who are foreign
military personnel to their appropriate foreign military authority and similar
The Agency may also use or disclose PHI to authorized federal officials for
the conduct of lawful intelligence, counter-intelligence, and other national
security activities or for the provision of protective services to the President or
other persons as authorized by Federal law to those protective services.
Disclosures for workers’ compensation purposes. The Agency may disclose
PHI as authorized by and to the extent necessary to comply with laws relating
to workers’ compensation or other similar programs.
Uses and Disclosures Not Mentioned Above: Authorization Required
The Agency will not use or disclose PHI for any purpose that is not mentioned above,
except as specifically authorized by you. If the Agency needs to use or disclose PHI for a
reason not listed above, it will request your permission for that specific use and will not
use PHI for that purpose except according to the specific terms of your authorization.
You may complete an Authorization form if you want the Agency to use or disclose
health information to you, or to someone else at your request, for any reason.
Any authorization you provide will be limited to specified information, and the intended
use or disclosure as well as any person or organization that is permitted to use, disclose or
receive the information must be specified in the Authorization Form. Also, an
authorization is limited to a specific limited time period and it expires at the end of that
period. Finally, you always have the right to revoke a pervious authorization by making
a written request to the Agency. The Agency will honor your request to revoke an
authorization but the revocation will not apply to any action that the Agency took in
accord with the authorization before you informed the Agency that you were revoking the
Your Health Information rights
Under Federal law, you have the following rights:
You may request restrictions with regard to certain types of uses and
disclosures. This includes the uses and disclosures described above for
treatment, Payment and other health agency operations purposes. If the
Agency agrees to a restriction you request, it will abide by the terms of that
restriction. However, under the law, the Agency is not required to accept any
restrictions. If the Agency determines that a requested restriction will
interfere with the efficient administration of the Agency, it may decline the
If PHI is begin provided to you, you may request that the information be
provided to you in a confidential manner. This right applies only if you
inform the Agency in writing that the ordinary disclosure of part or all of the
information might endanger you. For example, an individual may not want
information about certain types of treatment to be sent to his or her home
address because someone else who lives there might have access to it. In such
a case, the individual could request that the information be sent to an alternate
address. The Agency will honor such request as long as they are reasonable,
but the Agency reserves the right to reject a request that would impose too
much of an administrative burden or financial risk on the Agency.
You may request access to certain medical records possessed by the Agency
and you may inspect or copy those records. This right applies to all
enrollments, claims processing, medical management and payment records
maintained by the Agency and also to any other information possessed by the
Agency that is used to make decisions about you or your health coverage.
However, there are certain limited exceptions. For example, the Agency may
deny access to psychotherapy notes and to information prepared in
anticipation of litigation.
You may request that PHI maintained by the Agency be amended. If you feel
that certain information maintained by the Agency is inaccurate or
incomplete, you may request that the information be amended. The Agency
may reject your request if it finds that the information is accurate and
complete. Also, if the information you are challenging was created by some
other person or organization, the Agency ordinarily would not be responsible
for amending that information unless you provide sufficient information to the
Agency to establish that the originator of the information is not in a position to
You have the right to receive details about certain non-routine disclosures of
health information made by the Agency. You may request an account of all
disclosures of health information, with certain exceptions. This accounting
would not include disclosures that are made for Treatment, Payment and other
health agency operations purposes, disclosures made pursuant to an individual
authorization from you, disclosures made to you and certain other types of
disclosures. Also, your request will not apply to any disclosures made before
April 16, 2003 or for any period earlier than 6 years from the date your
request is properly submitted to the Agency. You may receive an accounting
of disclosures once every 12 months at no charge. The Agency may charge a
reasonable fee for any additional request during a 12 month period.
You have the right to request and receive a paper copy of this Privacy Notice.
If the Agency provides this Notice to you in an electronic form, you may
request a paper copy and the Agency will provide one.
Health Information Complaint Procedures
If you believe your health information privacy rights have been violated, you may file a
complaint with the Agency. To file a complaint you should contact Cathy Harrison at
(409) 935-1234 extension 106. In addition to your right to file a complaint wit the
Agency, if you feel your privacy rights have been violated you may file a complaint with
the U.S. Department of Health and Human Services at 1-800-458-9858. You will never
be retaliated against in any way as a result of any complaint that you file.
We are required to abide by the terms of this notice currently in effect, but we reserve the
right to change these terms as necessary for all protected health information that we
maintain. If we change the terms of this notice (while you are receiving service), we will
promptly revise and distribute a revised notice to you as soon as practicable by mail, email
(if you have agreed to electronic notice) or hand delivery.
If you require further information about matters covered by this notice, please contact:
Cathy Harrison at 409-935-1234 extension 106 or write to 8901 EF Lowry Expressway,
Suite A, Texas City, TX 77591.