Our Promise to You
We are required by law and regulation to
protect the privacy of your medical information, to provide
you with this notice of our privacy practices with respect
to protected health information, and to abide by the terms
of the notice of privacy practices in effect.
ADC and all its staff will share protected
health information with one another as necessary for
treatment, payment and healthcare operations relating to the
services rendered at ADC’s facilities.
The terms of this Notice may change with time and
ADC will post the current Notice at its facilities, on its
website and have copies available for distribution.
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.
This practice uses and discloses health
information about you for treatment, to obtain payment for
treatment, for administrative purposes, and to evaluate the
quality of care that you receive. This notice describes our
privacy practices. We may change our policies and this
notice at any time and have those revised policies apply to
all the protected health information we maintain. If or
when we change our notice, we will post the new notice in
the office where it can be seen. You can request a paper
copy of this notice, or any revised notice, at any time
(even if you have allowed us to communicate with you
electronically). You may obtain a copy of this notice on our
website
www.adclinic.com.
For more information about this notice or our
privacy practices and policies, please contact the person
listed below.
Understanding Your Health Record
Each
time you visit a hospital, clinic, physician or other health
care provider, a record of your visit is created. Typically
this record contains your symptoms, examination and test
results, diagnoses, treatment, and plan for future care or
treatment. This information, often referred to as your
health or medical record, serves as a:
Basis for planning your care and treatment.
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Means of communication among the many health
professionals who contribute to your care. |
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Legal document describing the care and treatment you
received. |
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Means by which you or a third party payer can verify
that services billed were actually provided. |
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A
tool to educate health professionals. |
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A
source of data for medical research. |
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A
source of information for public health officials
charged with improving the health of the nation. |
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A
source of data for facility planning and marketing. |
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A
tool with which we can assess and continually work
to improve the care we render and the outcomes we
achieve. |
Understanding your medical record and how your health
information is used helps you to:
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Ensure its accuracy. |
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Better understand who, what, where, and why others
may access your health information. |
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Make more informed decisions when authorizing
disclosures to others. |
Your
Rights Regarding Health Information About You
Although
your health record is the physical property of The Austin
Diagnostic Clinic, the information contained in your health
record belongs to you. You have the right to:
Request a Restriction on Certain Uses and Disclosures
To
request restrictions you must make your request in writing
to The Austin Diagnostic Clinic Director of Health
Information. In your request you must state what information
you want to limit, whether you want to limit our use,
disclosure or both, and to whom you want the limits to apply
to; for example, disclosures to your spouse. We are not
required to agree to your request.
We will notify you if we are unable to agree
to a requested restriction
Receiving Confidential
Communications by Alternative Means
You may
request that we send communications of protected health
information by alternative means, or to an alternative
location. This request must be made in writing to the
person listed below. We are required to accommodate only
reasonable requests. Please specify in your
correspondence exactly how you want us to communicate with
you; and if you are directing us to send it to a particular
place, the contact/address information.
Inspection and Copies of Protected Health Information
You may
inspect and/or copy health information that is within the
designated record set, which is information that is used to
make decisions about your care. Texas law requires that
requests for copies be made in writing and we ask that
requests for inspection of your health information also be
made in writing. Please send your request to the person
listed below.
We may
ask that a narrative of that information be provided rather
than copies. However, if you do not agree to our request,
we will provide copies.
We can
refuse to provide some of the information you ask to inspect
or ask to be copied.
We can
refuse to provide access to, or copies of some of the
information for the following reasons:
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If the information is psychotherapy notes. |
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If the information is identity of a person who
provided information if it was obtained under a
promise of confidentiality. |
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If the information is subject to the Clinical
Laboratory Improvements Amendments of 1988. |
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If the information has been compiled in anticipation
of litigation. |
We can
refuse to provide access to, or copies of some information
for other reasons, provided we provide a review of our
decision on your request. Any such review will be made by
another licensed health care provider who was not involved
in the prior decision to deny access.
Texas
law requires that we are ready to provide copies or a
narrative within 15 days of your request. We will inform
you when the records are ready, or if we believe access
should be limited. If we deny access, we will inform you in
writing.
HIPAA
permits us to charge a reasonable cost-based fee.
Amendment of Medical Information
You may
request an amendment of your medical information in the
designated record set. Any such request must be made in
writing to the person listed below. We will respond within
60 days of your request. We may refuse to allow an
amendment for the following reasons:
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If
the information wasn’t created by this practice or the
physicians here in this practice. |
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If
the information is not part of the Designated Record
Set. |
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If
the information is not available for inspection because
of an appropriate denial. |
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If
the information is accurate and complete. |
Even if we
refuse to allow an amendment you are permitted to include a
patient statement about the information at issue in your medical
record. If we refuse to allow an amendment we will inform you
in writing.
If we
approve the amendment, we will inform you in writing, allow the
amendment to be made and tell others that we know have the
incorrect information.
Obtain an
Accounting of Disclosures
Accounting
of Disclosures is a list of certain disclosure we made of
medical information about you. For instance, it does not include
disclosures that are made for treatment, payment, or health care
operations.
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To
request an accounting of disclosures you must submit
your request in writing to The Austin Diagnostic Clinic
Director of Health Information Management. |
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Your
request must state a time period that may not be longer
than six years and may not include dates before April
14, 2003. The first list you request within a
twelve-month period will be free. For additional lists,
we may charge you for the costs of providing the list.
We will notify you of the cost involved and you may
choose to withdraw or modify your request at that time,
before any costs are incurred. |
Examples of
Disclosures for Treatment, Payment, and Health Operations:
For each category of use and disclosure we
provide examples of what we mean. Not every use of disclosure
will be listed. However, all of the ways we are permitted to use
and disclose information will fall within one of the categories.
We will use
your health information for treatment:
For
example: Information obtained by a nurse, physician,
technicians, medical students or other member of your health
care team, will be recorded in your record and used to determine
the course of treatment that should work best for you. Your
physician will document in your record his or her expectations
of the members of your health care team. Members of your health
care team will then record the actions they took and their
observations. In that way, the physician will know how you are
responding to treatment.
We will
also provide your physician or a subsequent health care provider
with copies of various reports that should assist him or her
treating you once you leave this office.
We will use
your health information for payment:
For example:
A bill may be sent to you or a third party payer. The
information on or accompanying the bill may include information
that identifies you, as well as your diagnosis, procedures and
supplies used. We may also 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.
We will use your health
information for regular health operations:
For
example: Members of the medical staff, the risk or quality
improvement manager, or members of the quality improvement team
may use information in your health record to assess the care and
outcomes in your case and others like it. This information will
then be used in an effort to continually improve the quality and
effectiveness of the healthcare service we provide.
Business Associates:
There are
some services provided in our organization through contracts
with business associates. Examples include physician services in
radiology, certain laboratory tests,
transcription services and medical record copying services.
When these services are contracted, we may disclose your health
information to our business associate so that they can perform
the job we’ve asked them to do and bill you or your third party
payer for services rendered. To protect your health information,
however, we require the business associate to appropriately
safeguard your information.
Telemedicine and Email:
We may contact you using our secure messaging
email system. We will not do so without first obtaining your
permission and not all providers participate. All information
concerning you will be kept confidential and stored in your
medical record. Further information and guidelines for usage can
be obtained from ………. On occasion we may transmit radiology
images to a third party for interpretation. The providers are
our business associate are required to appropriately safeguard
your information.
Health-Related Benefits and Services:
We may use
and disclose medical information to tell you about health
related benefits or services that may be of interest to you.
Appointment
Reminders:
For example:
Members of the staff may contact you as a reminder that you have
an appointment for treatment or medical care. We may leave a
message on your answering machine regarding appointment
reminders.
Notification:
Communication with Family: Health professionals, using their
best judgment, may disclose to a family member, or other
relative, close personal friend or any other person you
identify, health information relevant to that person’s
involvement in your care or payment related to your care.
Research:
All research
projects are subject to government mandated approval process.
Under certain circumstances, we may use minimally necessary
medical information about you for research purposes. Before we
release medical information for research, you must sign a
research authorization form.
Marketing:
We may contact you with information about
treatment alternatives or other health-related benefits and
services that may be of interest to you.
Fundraising:
We may contact you as part of a fund-raising effort.
Treatment Alternatives:
We may use
and disclose medical information to tell you about, or recommend
possible treatment options or alternatives that may be of
interest to you.
Food and Drug Administration:
We may disclose to the FDA health information
relative to adverse events with respect to food, supplements,
product and product defects, or post-marketing surveillance
information to enable product recalls, repairs, or replacement.
Workers Compensation:
We may disclose health information about you for
workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness. State
and/or federal law control the release of the information.
Public
Health, Abuse or Neglect, and Health Oversight:
As required by
law, we may disclose your health information to public health
activities. Public health activities are mandated by federal,
state or local government for the collection of information
about disease, vital statistics (like births and death), or
injury by a public health authority. We may disclose medical
information, if authorized by law, to a person who may have been
exposed to disease or may be at risk for contracting or
spreading a disease or condition. We may disclose our medical
information to report reactions to medications, problems with
products, or to notify people of recalls of products they may be
using.
We may also
disclose medical information to a public agency authorized to
receive reports of child abuse or neglect. Texas law requires
physicians to report child abuse or neglect. The HIPAA privacy
regulations also permit the disclosure of information to report
abuse or neglect of elders or the disabled. Texas law requires
a person having cause to believe an elderly or disabled person
is in a state of abuse, neglect, or exploitation to report the
information to the state.
We may disclose
your medical information to a health oversight agency for those
activities authorized by law. Examples of these activities are
audits, investigations, licensure applications and inspections
which are all government activities undertaken to monitor the
health care delivery system and compliance with other laws, such
as civil rights laws.
Organ and
Tissue Donation:
If you are an organ donor, we may release medical
information to organizations that handle organ procurement or
organ, eye or tissue transplantation, or to an organ donation
bank as necessary to facilitate organ or tissue donation and
transplantation.
Coroner, Medical Examiners and
Funeral Directors:
We may
release medical information to a coroner or medical examiners.
This may be necessary for example to identify a deceased person
or determine the cause of death. We may also release medical
information about patients to funeral directors as necessary to
carry out their duties.
Correctional Institutions:
If
you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may disclose to the
institution or law enforcement official thereof, health
information necessary for your health and the health and safety
of other individuals.
Legal Proceedings and Law Enforcement:
We may
disclose your medical information in the course of judicial or
administrative proceedings in response to an order of the court
(or the administrative decision-maker) or other appropriate
legal process. Certain requirements must be met before the
information is disclosed.
If asked by a law enforcement official, we may
disclose your medical information under limited circumstances
provided:
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The
information is released pursuant to a legal process,
such as valid court order, subpoena, warrant, and
summons; |
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The
information pertains to a victim of a crime if, under
certain limited circumstances, we are unable to obtain
the person’s agreement; |
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The
information pertains to a person who has died under
circumstances that may be related to criminal conduct; |
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The
information pertains to a victim of crime and you are
incapacitated; |
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The
information is released because of a crime that has
occurred on these premises; or
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The
information is released to locate a fugitive, missing
person, or suspect. |
We may also release information if we believe the
disclosure is necessary to prevent or lessen an imminent threat
to the health or safety of you, a person, or the public. Any
disclosure however, would only be to someone able to help
prevent the threat.
Military, National Security and Intelligence Activities,
Protection of the President:
We may disclose your medical information for
specialized governmental functions such as separation or
discharge from military service, requires as necessary by
appropriate military command officers (if you are in the
military), authorized national security and intelligence
activities, as well as authorized activities for the provision
of protective services for the President.
As Required by Law:
We may
release your medical information where the disclosure is
required by law.
Disclosures That Can Be Made Without a Written Authorization or
an Opportunity to Object
There are situations in which we are permitted to
disclose or use your medical information without your written
authorization or an opportunity to object. In other situations
we will ask for your written authorization before using or
disclosing any identifiable health information about you. If
you choose to sign an authorization to disclose information, you
can later revoke that authorization, in writing, to stop future
uses and disclosures. However, any revocation will not apply to
disclosures or uses already made or taken in reliance on that
authorization.
Individual Rights Under the Privacy Regulations of the Health
Insurance Portability and Accountability Act
The United
States Department of Health and Human Services created
regulations intended to protect patient privacy as required by
the Health Insurance Portability and Accountability Act (HIPAA).
Those regulations create several privileges that patients may
exercise. We will not retaliate against a patient that
exercises their HIPAA rights.
For
More Information or to Report a Problem
If you have questions and would like additional
information, you may contact the Director of Health Information
Management at 512-901-1111 or if you are making a request,
please write to this person at this address: The Austin
Diagnostic Clinic 12221 North Mopac Expressway, Austin, Texas
78758. If you believe your privacy rights have been violated,
you can file a complaint with the Director of Health Information
Management or with the Secretary of Health and Human Services.
All complaints must be in writing. There will be no retaliation
for filing a complaint.
Effective Date: April 14, 2003
Revised: September 23, 2003
Revised: January 5, 2005
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