I. 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.
II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH
INFORMATION (PHI)
We are legally required to protect the privacy of your health information.
We call this information “protected health information,” or “PHI”
for short, and it includes information that can be used to identify you that
we’ve created or received about you past, present, or future health or
condition, the provision of health care to you, or the payment of this health
care. We must provide you with this notice about our privacy practices that
explains how, when, and why we use and disclose your PHI. With some exceptions,
we may not use or disclose any more of your PHI than is necessary to accomplish
the purpose of the use or disclosure. We are legally required to follow the
privacy practices that are described in this notice.
However, we reserve the right to change the terms of this notice and our privacy
policies at any time. Any changes will apply to the PHI we already have. Before
we make an important change to our policies, we will promptly change this notice
and a new notice in all of Sadler Clinic’s main registration areas. You
can also request a copy of this notice from the contact person listed in Section
VI below at any time and can view a copy of the notice on our Web site at www.sadler.com.
III. HOW MAY WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION.
We use and disclose health information for many different reasons. Below, we
describe the different categories of our uses and disclosures and give you some
examples of each category.
- Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.
We may use and disclose your PHI without your consent for the following reasons:
- For treatment. We may disclose your PHI to physicians, nurses, medical
students, and other health care personnel who provide you with health
care services or are involved in your care. For example, if you’re
being treated for a knee injury, we may disclose your PHI to the physical
rehabilitation department in order to coordinate your care.
- To obtain payment for treatment. We may use and disclose your PHI in
order to bill and collect payment for the treatment and services provided
to you. For example, we may provide portions of your PHI to our billing
department and your health plan to get paid for the health care services
we provided to you.
- For health care operations. We may disclose your PHI in order to operate
this clinic. For example, we may use your PHI in order to evaluate the
quality of health care services that you received or to evaluate the performance
of health professionals who provided health care services to you. We may
also provide your PHI to our accountants, attorneys, consultants, and
others in order to make sure we’re complying with the laws that
affect us.
- Certain Uses and Disclosures Do Not Require Your Authorization.
We may use and disclose your PHI without your authorization for the following
reason:
- When a disclosure is required by federal, state or local law, judicial
or administrative proceedings, or law enforcement.
For example, we make disclosures when a law requires that we report information
to government agencies and law enforcement personnel about victims of
abuse, neglect, or domestic violence; when dealing with gunshot and other
wounds; or when ordered in a judicial or administrative proceeding.
- For public health activities. For example, we report information about
births, deaths, and various diseases, to government officials in charge
of collecting that information, and we proved coroners, medical examiners,
and funeral directors necessary information relating to an individual’s
death.
- For health oversight activities. For example, we will provide information
for them to assist the government when it conducts an investigation or
inspection of a health care provider or organization.
- For research purpose. In certain circumstances, we may provide PHI in
order to conduct medical research.
- To avoid harm. In order to avoid a serious threat to the health or safety
of a person or the public, we may provide PHI to law enforcement personnel
or persons able to prevent or lessen such harm.
- For specific government functions. We may disclose PHI of military personnel
and veteran in certain situations. And we may disclose PHI for national
security purposes, such as protecting the president of the United States
or conducting intelligence operations.
- For worker’s compensation purposes. We may provide PHI in order
to comply with worker’s compensation laws.
- Appointment reminders and health-related benefits or services. We may
use PHI to provide appointment reminders or give you information about
treatment alternatives, or other health care services or benefits we offer.
- Use and Disclosure Where You to Have the Opportunity to Object.
Disclosure to family, friends, others. We may provide your PHI to a family
member, friend, or other person that you indicate is involved in your care
or the payment for your health care, unless you object in whole or in part.
The opportunity to consent may be obtained retroactively in emergency situations.
- All other Uses and disclosures Require Your Prior Written Authorization.
In any other situation not described in sections IIIA, B, and C above, we
will ask for your written authorization before using or disclosing any of
your PHI. If you choose to sign an authorization to disclose your PHI, you
can later revoke that authorization in writing to stop any future uses and
disclosures (to the extent that we haven’t taken any action relying
on the authorization).
IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect to your PHI:
- The Right to Request Limits on Uses and Disclosures of Your PHI. You have
the right to ask that we limit how we use and disclose your PHI. We will consider
your request but are not legally required to accept it. If we accept your
request, we will put any limits in writing and abide by them except in emergency
situations. You may not limit the uses and disclosures that we are legally
required or allowed to make.
- The Right to Choose How We Send PHI to You. You have the right to ask that
we send information to you to an alternate address (for example, sending information
to your work address rather than your home address) or by alternate means
(for example, e-mail instead of regular mail). We must agree to your request
so long as we can easily provide it in the format you requested.
- The Right to See and Get Copies of Your PHI. In most cases you have the
right to look at or get copies of your PHI that we have, but you must make
the request in writing. If we don’t have the PHI, but we know who does,
we will tell you how to get it. In certain situations, we may deny your request.
If we do, we will tell you, in writing our reasons for the denial and explain
your right to have the denial reviewed.
If you request copies of your PHI, we may charge you a fee for the costs of
copying, mailing or other costs incurred by us in complying with your request.
Instead of providing the PHI you requested, we may provide you with a summary
or explanation of the PHI as long as you agree to that and to the cost in
advance.
- The Right to Get a List of the Disclosures We Have Made. You have the right
to get a list of instances in which we have disclosed your PHI. The list will
not include uses or disclosures that you have already consent to, such as
those made for treatment, payment, or health care operations, directly to
you, or to your family. The list also won’t include uses and disclosures
made for national security purposes, to corrections or law enforcement personnel,
on or before April 14, 2003.
The list we will give you will include disclosures made in the last six years
(beginning no sooner that April 14, 2003) unless you request a shorter time.
The list will include the date the date of the disclosure, to whom PHI was
disclosed (including their address if known), a description of the information
disclose, and the reason for the disclosure. We will provide the list to you
at no charge.
- The Right to Correct or Update Your PHI. If you believe that there is a
mistake in your PHI or that a piece of important information is missing, you
have the right to request that we correct the existing information. You must
provide the request and your reason for the request in writing. We will respond
within 60 days of receiving your request. We may deny your request in writing
if the PHI is (i) correct and complete, (ii) not created by us, (iii) not
allowed to be disclosed, or (iv) not part of our records. Our written denial
will state the reasons for the denial and explain your right to file a written
statement of disagreement with the denial. If you don’t file one, you
have the right to request that your request and our denial be attached to
all future disclosures of your PHI. If we approve your request, we will make
the change to your PHI, tell you that we have done it, and tell others that
need to know about the change to your PHI.
- The Right to Get This Notice by E-Mail. You have the right to get a copy
of this notice by e-mail. Even if you have agreed to receive notice via e-mail,
you also have the right to request a paper copy of this notice.
V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think that we may have violated your privacy rights, or you disagree
with a decision we made about access to your PHI, you may file a complaint with
the person listed in Section VI below. You also may send a written complaint
to the Secretary of The U.S. Department of Health and Human Services, 200 Independence
Avenue, S.W., Washington, D.C., 20201. We will take no retaliatory action against
you if you file a complaint about our prvacy practices.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR
TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice or any complaints about our privacy
practices, or would like to know how to file a complaint with the Secretary
of the Department of Health and Human Services, please send your correspondence
either by mail to the Privacy Officer of Sadler Clinic at 9201 Pinecroft Drive,
The Woodlands, TX, 77380; or by fax at (281) 297-6481.
VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on April 14, 2003.