Joint Notice of Information Privacy Practices
This Joint Notice is being provided to you on behalf of The Austin Diagnostic Clinic and all its Staff with respect to services provided at The Austin Diagnostic Clinic’s facilities.
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.
Means of communication among the many health professionals who contribute to your care.
Legal document describing the care and treatment you received.
Means by which you or a third party payer can verify that services billed were actually provided.
A tool to educate health professionals.
A source of data for medical research.
A source of information for public health officials charged with improving the health of the nation.
A source of data for facility planning and marketing.
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:
Ensure its accuracy.
Better understand who, what, where, and why others may access your health information.
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:
If the information is psychotherapy notes.
If the information is identity of a person who provided information if it was obtained under a promise of confidentiality.
If the information is subject to the Clinical Laboratory Improvements Amendments of 1988.
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:
If the information wasn’t created by this practice or the physicians here in this practice.
If the information is not part of the Designated Record Set.
If the information is not available for inspection because of an appropriate denial.
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.
To request an accounting of disclosures you must submit your request in writing to The Austin Diagnostic Clinic Director of Health Information Management.
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.
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.
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.
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.
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.
We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
We may contact you as part of a fund-raising effort.
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.
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.
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:
- The information is released pursuant to a legal process, such as valid court order, subpoena, warrant, and summons;
- The information pertains to a victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- The information pertains to a person who has died under circumstances that may be related to criminal conduct;
- The information pertains to a victim of crime and you are incapacitated;
- The information is released because of a crime that has occurred on these premises; or
- 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