Our Responsibilities
We are required by applicable federal and state law to maintain the privacy of your protected health information. “Protected health information” (PHI) is information about you, including demographic information that may identify you and that relates to your past, present or future health condition, physical or mental and related health care services. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all PHI that we maintain, including PHI we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
Uses and Disclosures of Protected Health Information
We use and disclose PHI about you for treatment, payment, and health care operations. Following are examples of the types of uses and disclosures that we are permitted to make.
Treatment: We may use or disclose your PHI to treat you. Many of the people who work for our organization may use or disclose your identifiable health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children or parents.
Payment: We may use and disclose your PHI in order to bill and collect payment for the health care services provided to you and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. In addition, we may use your identifiable health information to bill you directly for services and items.
Health Care Operations: We may use and disclose your PHI in connection with our health care operations. Health care operations include the business functions conducted by a health insurer. These activities may include providing customer services, responding to complaints and appeals from your insurer. In certain instances, we may also in our health care operations disclose PHI to business associates1 with whom we have written agreements containing terms to protect the privacy of your PHI.
On Your Authorization: You may give us written authorization to use your PHI or to disclose it to another person and for the purpose, you designate. If you give us an authorization, you may withdraw it in writing at any time. Your withdrawal will not affect any use or disclosures permitted by your authorization while it is in effect. Unless you give us a written authorization, we cannot use or disclose your PHI for any reason except for those described in this notice.
Personal Representatives: We will disclose your PHI to your personal representative when the personal representative has been properly designated by you and the existence of your personal representative is documented to us in writing through a written authorization.
Disaster Relief: We may use or disclose your PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.
Health Related Services. We may use your PHI to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. We may disclose your PHI to a business associate to assist us in these activities.
We may use or disclose your PHI to encourage you to purchase or use a product or service by face-to-face communication or to provide you with promotional gifts.
Schedule Refills: Our organization may use and disclose your identifiable health information to contact you and remind you of deliveries.
Release of Information to Family/Friends. Our organization may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you.
Disclosures Required By Law. Our organization will use and disclose your identifiable health information when we are required to do so by federal, state or local law.
Use and Disclosure of your identifiable health information in certain special circumstance: The following is a list of scenarios in which we may use or disclose your identifiable health information.
1. Public Health Risks (ex. Vital records, reporting abuse, product recalls.)
2. Health Oversight Activities (ex. Investigations, audits, surveys, licensure and disciplinary actions.)
3. Lawsuits and Similar Proceedings (ex. Court orders, subpoena of records or other lawful process.)
4. Law Enforcement (ex. Criminal situations, response to subpoenas, warrants, summons.)
5. Serious threats to health or safety (ex. This would only be down to help prevent the threat.)
6. Military (ex. If you are a veteran)
Confidential Communications. You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Ray Davis, Dr. Bruce Tyler or Sonya LeBlanc, HIPAA Compliance Officers, 4500 Blalock Suite C, Houston, Texas 77041, 713-934-4500 specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.
Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records. You must submit your request in writing to Ray Davis, Dr. Bruce Tyler or Sonya LeBlanc, HIPAA Compliance Officers, 4500 Blalock Suite C, Houston, Texas 77041, 713-934-4500 in order to inspect and/or obtain a copy of your identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor and/or supplies associated with your request.
Accounting of Disclosures. All of our customers have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures our organization has made of your PHI. In order to obtain an accounting of disclosures, you must submit your request in writing to Ray Davis, Dr. Bruce Tyler or Sonya LeBlanc, HIPAA Compliance Officers, 4500 Blalock Suite C, Houston, Texas 77041, 713-934-4500. All requests for an “accounting of disclosures” must state a time, which may not be longer than six years and may not include dates before April 14, 2003. The first list your request within a 12-month period is free of charge, but our organization may charge you for additional lists within same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to Receive a Copy of the Notice: You must request a copy of our notice at any time by contacting the Privacy Office or by using our Web site, www.medwise.us. If you receive this notice on our Web site or by electronic mail (e-mail), you are also entitled to request a paper copy of the notice.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact, us using the information listed at the end of this notice.
If you are concerned that we may have violated your privacy rights, you may complain to us using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human Services; see information at its Website: www.hhs.gov. If you request, we will provide you with the address to file your complaint with the U.S. Department of Health and Human Services.
We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.