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.
I. WHO WILL FOLLOW THIS NOTICE
This Notice of Privacy Practices (“Notice”) is effective as of May 16, 2016. This Notice describes the privacy practices of Dr. Kushwaha and:
All physicians, therapists, and other health care professionals authorized to enter information into your practice chart.
All Practice employees, staff, and other personnel.
All members of a volunteer group we allow to help you while you are in the Practice.
All departments and units of the Practice.
The Practice and all of the above individuals must follow the terms of this Notice. They may share medical information with each other for treatment, payment, health care operations, and/or other purposes, as described in this Notice. This Notice applies to services furnished to you at Dr. Kushwaha, 5420 West Loop South #2300, Bellaire, Texas 77401.
II. OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Practice. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records containing your protected health information (“PHI”) maintained by the Practice, whether made by practice personnel or your personal doctor. Your personal doctor may have different polices or notices regarding the doctor’s use and disclosure of your PHI created in the doctor’s office or clinic.
This Notice will tell you about the ways in which we may use and disclose your PHI. We also describe your rights and certain obligations we have regarding the use and disclosure of your PHI. We use computerized systems that may subject your PHI to electronic disclosure.
We are required by law to:
Maintain the privacy of your PHI;
Give you this Notice of our legal duties and privacy practices with respect to PHI about you;
Notify you if there is a breach of your unsecured PHI; and
Follow the terms of this Notice that are currently in effect.
III. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU WITHOUT YOUR WRITTEN AUTHORIZATION
In certain situations, which are described in Section IV below, your written authorization must be obtained in order for us to use or disclosure your PHI. The following categories describe different ways that we may use and disclose your PHI without any type of authorization from you. For each category of uses and disclosures, we provide an explanation and may include certain examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose your PHI without any authorization will fall within one of the categories.
For Treatment, Payment, and Health Care Operations
For Treatment We may use PHI about you to provide you with medical treatment or services. We may disclose PHI about you to doctors, nurses, technicians, medical students, or other practice personnel who are involved in taking care of you at the practice. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the practice also may share PHI about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose PHI about you to people outside the practice, such as family members, clergy, or others we use to provide services that are part of your care. Furthermore, we may use and disclose PHI to contact you as a reminder that you have an appointment for treatment or medical care at the practice.
For Payment We may use and disclose PHI about you so that the treatment and services you receive at the practice may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the practice so your health plan will pay us or reimburse you for the surgery. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations We may use and disclose PHI about you to facilitate practice operations. These uses and disclosures are necessary to run the practice and make sure that all of our patients receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We also may combine PHI about many practice patients to decide what additional services the practice should offer, what services are not needed, and whether certain new treatments are effective. We also may disclose PHI to doctors, nurses, technicians, medical students, and other practice personnel for conducting training programs. In addition, we may combine the PHI we have with medical information from other practices to compare how we are doing and see where we can make improvements for the care and services we offer. We may remove information that identifies you from this set of information so others may use it to study health care and health care delivery without learning the identity of any specific patients. In addition, we may use and disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you, as well as to tell you about health-related benefits or services that may be of interest to you.
Your PHI also may be disclosed to: (1) your health care providers when such PHI is required for them to treat you; (2) another covered entity or health care provider for the payment activities of the entity receiving the information; and (3) another covered entity for certain health care operations of the entity receiving your information, including quality assessment and improvement activities, review of the quality and competence of health care professionals, and health care fraud and abuse detection or compliance.
Practice Directory We may include certain limited information about you in the practice directory while you are a patient at the practice unless you object. This information may include your name, location in the practice, and religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name. The information, including your religious affiliation, also may be released to members of the clergy, such as priests or rabbis, even if they do not ask for you by name. This is so your family, friends, and clergy can visit you in the practice and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care and Notification We may release PHI about you to your family member, other relative, close personal friend, or any other person identified by you, who is involved in your medical care or payment related to your care. We also may release your PHI in order to notify, or assist in notifying, your family member or personal representative, or any other person responsible for your care, of your location and general condition or death.
If you are present for, or otherwise available prior to, any such use or disclosure for payment purposes, and have the capacity to make health care decisions, we will either obtain your agreement to the use or disclosure, provide you with an opportunity to object to the use or disclosure, or disclose if we reasonably infer from the circumstances that you do not object to disclosure. If you are present for, or otherwise available prior to, any such use or disclosure for medical care or notification purposes, and have the capacity to make health care decisions, we will obtain your consent to the use or disclosure. If you are unavailable, incapacitated, or facing an emergency medical situation and we reasonably determine that a limited disclosure is in your best interest, we may share your PHI without your approval. In certain instances, we may disclose your PHI to an entity assisting in a disaster relief effort so that your family may be notified about your location and condition.
After your death, we may disclose to your personal representative and, at times, certain other individuals (such as your family members), your PHI that is relevant to such person’s involvement with your care or payment for your care unless doing so is inconsistent with any prior expressed preference of you that is known to us.
Research We may release your PHI for certain research purposes when approved by a review board with established rules to ensure privacy.
To Avert a Serious Threat to Health or Safety We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat or to assist law enforcement authorities to identify or apprehend an individual.
Organ, Eye or Tissue Donation If you are an organ donor, we may release your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue, as necessary to facilitate organ, eye, or tissue donation and transplantation
Military and Veterans If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Employers We may release to your employer PHI about you when we have provided health care to you at the request of your employer and you have consented to the release of such information.
Workers’ Compensation We may release your PHI as authorized by laws relating to workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health Activities We may use or disclose PHI about you for public health activities. These activities generally include the following:
To report health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability;
To report births and deaths;
To report child abuse or neglect;
To report information about products and services under the jurisdiction of the United States Food and Drug Administration, such as reactions to medications, problems with products, and product recalls;
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 report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance; and
To report proof of immunization to your school or prospective school as required under laws addressing school immunization records.
Victims of Abuse, Neglect, or Domestic Violence If we reasonably believe you are a victim of abuse, neglect, or domestic violence, we may disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence. We may only make this disclosure if you agree or it is required or authorized by law.
Health Oversight Activities We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with regulatory standards and civil rights laws.
Lawsuits and Disputes We may disclose your PHI in response to a court or administrative order. In certain instances, we also may disclose your PHI in response to a subpoena, discovery request, or other lawful process, provided that efforts have been made to inform you of the request or to obtain a judicial order protecting the information requested from disclosure.
Law Enforcement We may release your PHI to a law enforcement official:
As required by law, including laws that require the reporting of certain types of wounds or other physical injuries;
In response to a court order, subpoena, warrant, summons, or similar process;
In response to the official’s request for such information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person;
In response to the official’s request for such information about you where you are, or are suspected to be, the victim of a crime, we are unable to obtain your agreement, and certain other conditions are met;
To alert the official about a death we believe may be the result of criminal conduct;
To alert the official about criminal conduct at the practice; and
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.
Coroners, Medical Examiners and Funeral Directors We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Upon obtaining the consent of your personal representative, we may also release PHI about patients of the practice to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others We may release your PHI to authorized Federal officials for the provision of protective services to the President, foreign heads of state, or other persons as authorized by law, as well as for the conduct of investigations as authorized by law.
Inmates If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official. This release may be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
As Required by Law We may use and disclose your PHI when required to do so by any other laws not already referenced above.
IV. USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION REQUIRING YOUR WRITTEN AUTHORIZATION
Uses and Disclosures Not Covered by this Notice Other uses and disclosures of your medical information not covered by this Notice will be made only with your written permission.
Marketing and Sale of Your PHI Your authorization must be obtained before using or disclosing your PHI for most marketing purposes, as well as for any disclosure of your PHI which constitutes a sale of PHI.
Uses and Disclosures of Your Highly Confidential Information Federal and Texas law require special privacy protections for certain highly confidential information about you, including the subset of your PHI that: (1) is maintained in psychotherapy notes; (2) is about mental health and developmental disability services; (3) is about alcohol and drug abuse diagnosis, treatment, and referral; (4) is about HIV/AIDS-related testing, diagnosis, or treatment; (5) is about sexual assault victims; and (6) is about genetic testing. Generally, we must obtain your written authorization to release this type of information. However, there are limited circumstances under the law when this information may be released without your consent.
Revocation of Your Authorization If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except: (i) to the extent that we have taken action in reliance on your authorization; or (ii) if you provided the authorization as a condition of obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy or the policy itself. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provide to you.
V. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding PHI we maintain about you:
Right to Inspect and Copy You have the right to inspect and copy PHI that may be used to make decisions about your care. Usually this includes medical and billing records, but does not include psychotherapy notes and certain other items protected by law.
You may request a copy of your PHI by contacting Medical Records at 713-208-6273.
We may charge a fee for the costs of copying, mailing, or other supplies associated with your request, as permitted by state law.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed. In certain instances, another licensed health care professional chosen by the practice will review the denial. The person conducting the review will not be the person who denied the request. We will comply with the outcome of the review.
Right to Amend If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice.
You may request an amendment on the form provided by the practice, which requires specific information about the 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:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the PHI kept by or for the practice;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
Right to an Accounting of Disclosures You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of your PHI.
You may request a list of the disclosures of your PHI that have been made to persons or entities, other than for health care treatment, payment, operations, or certain other purposes, in the past six (6) years. After the first request, there may be a charge for additional requests made within twelve (12) months of the first request.
Right to Request Restrictions You have the right to request a restriction or limitation on the use and disclosure of your PHI: (1) for treatment, payment, or health care operations; (2) to someone who is involved in your care or the payment for your care, such as a family member or friend; and/or (3) to notify or assist in the notification of your family member or friend regarding your location and general condition.
We generally are not required to agree to your request for a restriction or limitation on the use or disclosure of your PHI. We are, however, required to agree to a request to restrict disclosure of your PHI to a health plan if: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the PHI pertains solely to a health care item or service for which you, or someone other than the health plan on behalf of you, has paid us in full. If we do agree to a restriction or limitation on the use or disclosure of your PHI, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request on the consent form you sign when you become a patient. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use or disclosure or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse).
Right to Request Confidential Communications 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.
Your request must specify how or where you wish to be contacted, and you must provide this request in writing.
Right to a Paper Copy of This Notice You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
VI. CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice. We also reserve the right to make the revised or changed Notice effective for PHI we already have about you, as well as any information we receive in the future. If this Notice is revised or changed, the new notice will be posted in waiting areas around the practice and on the practice’s website at http://drkushwaha.wpengine.com. You also may obtain any new notice by contacting Medical Records at 713-208-6273.
In addition, each time you register at or are admitted to the practice for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.
VII. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the practice or with the Secretary of the U.S. Department of Health & Human Services at www.hhs.gov/ocr/hipaa.
VIII. PRACTICE PRIVACY CONTACT
For further information regarding this Notice and/or our privacy policies, please contact the Privacy Officer at 713-208-6273.