PURPOSE: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY UIWSOM HEALTH SERVICES AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The following categories describe different ways we may use and disclose your medical information either electronic, verbal, or written. The examples do not include every possible use or disclosure.
Use of Personal Health Information (PHI)
Treatment: We will use and disclose your medical information to provide, coordinate, or manage your health care and any related service. This includes but not limited to sharing your information with a counselor, primary care provider, or other specialists to whom we are coordinating care with. We would require your permission to disclose any health information to family or friends unless we were unable to obtain that consent due to your health condition. Example-Sharing health information to order a lab test, a prescription, or referring to outside provider.
Payment: We will use and disclose medical information about you so that the treatment and services received at UIWSOM Health Services may be billed and payment may be collected from you, an insurance company, or a third party. For example, we may disclose your medical information to an insurance company in order to receive payment.
Health Care Operations: We may use and disclose medical information about you for office operation to run UIWSOM Health Services in an efficient manner and so that all patients receive quality care. For example, your medical records and health information may be used in the evaluation of services, and the appropriateness and quality of health care treatment. Medical records are audited for timely documentation and correct billing.
As Required by Law: We will disclose medical information about you when required to do so by federal or Texas laws or regulations. Information can be verbal, written, or electronic format.
Public Health and Safety: We may disclose medical information about you to a public health authority for the purpose of preventing or controlling disease, injury, or disability. This may include reporting tuberculosis results, communicable disease, or medication reactions. Such disclosures will be made in accordance with the requirements of Texas and Federal laws and regulations.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These activities are necessary for the government to monitor the health care system, government programs, eligibility or compliance, and to enforce health-related civil rights and criminal laws.
Law Enforcement Purposes: We may release your medical information for law enforcement purposes, including in response to a subpoena or warrant. We may disclose your information if UIWSOM Health Services determines there is a danger of imminent physical, mental or emotional injury to you or another person. We may also disclose pertinent information to the appropriate authorities if we suspect abuse, neglect, or domestic abuse or to avert a serious threat to the safety or health of a person or the general public.
Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner when authorized by law. Example- Information needed to determine cause of death. We may also release information or for procurement of organ, eye, or tissue transplantations if you have documented your wish to be a donor.
Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
Workers’ Compensation: We may release medical information about you for workers’ compensation or similar programs.
Research: We may use and disclose medical information about you for research purposes, but only if you have given specific authorization prior to the release of information for research purposes.
Other Uses or Disclosures: Any other use or disclosure of PHI will be made only upon your individual authorization. You will receive a copy of the authorization and may revoke an authorization at any time, provided that it is in writing and we have not already relied on the authorization.
DISCLOSURES REQUIRING AUTHORIZATION
Marketing: Marketing generally includes a communication made to describe a health-related product or service that may encourage you to purchase or use the product or service. We will obtain your written authorization to use and disclose PHI for marketing purposes unless the communication is made face-to-face, involves a promotional gift of nominal value, or otherwise permitted by law. You have the right to revoke such authorization in writing.
Sale of your Medical Information: For any sale of protected health information UIWSOM Health services would require your written authorization. You have the right to revoke such authorization in writing.
YOUR RIGHTS CONCERNING YOUR HEALTH INFORMATION
Right to Inspect and Copy: You have the right to inspect and receive a copy of your medical information. We must receive a written request and a fee may apply as established by the Texas regulation. This can include cost of copying, mailing, or summarizing records.
UIWSOM Health services may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by UIWSOM Health Services will review your request and denial. The person conducting the review will not be the person who denied your request. UIWSOM Health Services will comply with the outcome of the review.
Right to Amend: If you feel that medical information maintained about you is incorrect or incomplete, you may ask UIWSOM Health Services to amend the information. You have the right to request an amendment for as long as the information is kept by UIWSOM
Health Services. Your request for an amendment must be made in writing with a reason that supports your request.
UIWSOM Health Services 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, UIWSOM Health Services may deny your request if you ask us to amend information that:
If your request is denied, UIWSOM Health Services will inform you in writing. You have the right to submit a rebuttal to add to your medical record and we have the right to submit a response to this rebuttal. You have to right to have us disclose the documents as part of any records request to be transmitted to other parties.
Right to an Accounting of Disclosures: This is a list of the disclosures made of your medical information for purposes other than treatment, payment, or health care operations. To request this list, submit your request in writing to UIWSOM Health Services. Your request must state a time period, which may not be longer than six (6) years and must indicate in what form you want the list (for example, on paper or electronically). There may be a cost for this request. You will be notified prior to it being completed.
Right to Request Restrictions: You also have the right to request a restriction or limitation on the medical information. UIWSOM Health Services uses or discloses about you for treatment, payment or health care operations, including the medical information UIWSOM Health Services discloses about you to someone who is involved in your care or the payment for your care.
UIWSOM Health Services is not required to agree to your request, unless the request pertains solely to a healthcare item or service for which UIWSOM Health Services has been paid out of pocket in full and: (i) the restriction pertains to payment or a healthcare operation and (ii) the disclosure is not otherwise required by law. Should UIWSOM Health Services agree to your request, UIWSOM Health Services will comply with your request unless the information is needed to provide you with emergency treatment.
To request restrictions, you must make your request in writing to UIWSOM Health Services. In your request, you may indicate: (1) what information you want to limit; (2) whether you want to limit UIWSOM Health Services use and/or disclosure; and (3) to whom you want the limits to apply.
If your request is denied, UIWSOM Health Services will inform you in writing.
Right to Request Confidential Communications: To request that UIWSOM Health Services communicate with you about medical matters in a certain way or at a certain location, you must make your request in writing. You do not have to give a reason for the request. UIWSOM Health Services will accommodate all reasonable requests. You must specify how or where you wish to be contacted. If additional costs are incurred, those costs will be passed on to you. If your request is denied, UIWSOM Health Services will inform you in writing.
Right to Revoke an Authorization: If you authorize a particular use or disclosure of your medical information, you may revoke such authorization in writing by contacting the UIWSOM Health Services at 4301 Broadway, CPO #30 San Antonio, TX 78209. We will honor your revocation, except to the extent that we have already taken action in reliance of the specific authorization.
Right to Receive a Copy of this Document: You have a right to obtain a paper or electronic copy of this document upon request.
CHANGES TO THIS NOTICE
We reserve the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our information practices change, we will post the amended Notice of Privacy Practices in our office and on our website. You may request that a copy be provided to you by contacting UIWSOM Health Services. See contact information below.
Breach of Information: You will be notified of any breaches of your unsecured PHI.
If you believe your privacy rights have been violated, you may file a complaint with UIWSOM Health Services or with the Office for Civil Rights, U.S. Department of Health and Human Services. To file a complaint with UIWSOM Health Services, contact the Dr. Jedynak-Bell our Privacy Officer at 210-283-6430 or firstname.lastname@example.org within 180 days of when you knew that the act occurred. The address for the Office of Civil Rights is:
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Customer Response Center: (800) 368-1019
Fax: (202) 619-3818
TDD: (800) 537-7697
All complaints should be submitted in writing. You will NOT be penalized for filing a complaint. If you have any questions about this Notice, please contact the Privacy Officer at the above contact information.