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DALLAS NEPHROLOGY
ASSOCIATES
NOTICE OF PRIVACY PRACTICES
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.
I. 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 your 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 post a new notice in the waiting area. 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.dneph.com.
II. HOW
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We use and disclose health information for many different reasons. For some
of these uses or disclosures, we need your prior consent or specific
authorization. Below, we describe the different categories of our uses and
disclosures and give you some examples of each category.
A. Uses
and disclosures relating to treatment, payment, or health care operations
require your prior written consent. We may use and disclose your PHI
with your consent for the following reasons:
1. 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.
2. 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. We may also provide your PHI to our business associates, such as
billing companies, claims processing companies, and others that process our
health care claims.
3. For
health care operations. We may disclose your PHI in order to operate
our clinical facilities. 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 the health care 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. It may be necessary to provide PHI
for purposes of obtaining malpractice insurance.
4.
Exceptions to consent requirement for treatment, payment, and health care
operations. Although your consent is required for numbers 1-3 of this
section, above, we may disclose your PHI to others without your consent in
certain situations. For example, your consent isn’t required if you need
emergency treatment, as long as we try to get your consent after treatment
or we try to get your consent but you are unable to communicate with us (for
example, if you are unconscious or in severe pain) and we think you would
consent if you were able to do so.
B. Certain
uses and disclosures do not require your consent. We may use and
disclose your PHI without your consent or authorization for the following
reasons:
1. 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.
2. 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 provide coroners, medical examiners, and
funeral directors necessary information relating to an individual’s death.
3. For
health oversight activities. For example, we will provide information
to assist the government when it conducts an investigation or inspection of
a health care provider or organization.
4. For
purposes of organ donation. We may notify organ procurement
organizations to assist them in organ, eye, or tissue donation and
transplants.
5. For
research purposes. In certain circumstances, we may provide PHI in
order to conduct medical research.
6. 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.
7. For
specific government functions. We may disclose PHI of military
personnel and veterans 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.
8. For
workers’ compensation purposes. We may provide PHI in order to comply
with workers’ compensation laws.
9. 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.
10.
Fundraising activities. We may use PHI to raise funds for our
organization. The money raised through these activities is used to expand
and support the health care services and educational programs we provide to
the community. If you do not wish to be contacted as part of our
fundraising efforts, please contact the person listed in section VI below.
C. All
other uses and disclosures require your prior written authorization. In
any other situation not described in sections III A and B 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).
III.
WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect
to your PHI:
A. 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.
B. 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). We
must agree to your request so long as we can easily provide it in the format
you requested.
C. 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 your PHI but we know who does, we
will tell you how to get it. We will respond to you within 30 days after
receiving your written request. In certain situations, we may deny your
request. If we do, we will tell you, in writing, our reason for the denial
and explain your right to have the denial reviewed.
A
physician may charge “a reasonable fee” for copying medical records, and the
Texas State Board of Medical examiners has clarified the interpretation of
“reasonable” to be a charge of no more than $25 for the first twenty (20)
pages and $.15 per page thereafter. DNA usually provides medical records to
patients when requested for no charge on an annual basis, and if requested
more frequently than annually, a charge will be submitted.
D. 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 consented 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, or before April 1, 2003.
We will
respond within 60 days of receiving your request. The list will include the
date of the disclosure, to whom PHI was disclosed (including their address,
if known), a description of the information disclosed, and the reason for
the disclosure. We will provide the list to you at no charge, but if you
make more than one request in the same year, we will charge you according to
our fee schedule for each additional request.
E. 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 or add
the missing 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.
F. 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.
IV.
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 following person/persons. We will take no retaliatory action
against you if you file a complaint about our privacy practices.
DNA Privacy
Officer: John Schwartz, M.D.
3601 Swiss Avenue
Dallas, TX 75201
(214) 358-2300
schwartzj@dneph.com
Office for Civil Rights: Ralph Rouse,
Regional Manager
1301 Young Street, Suite 1169
Dallas, TX 75202
(214) 767-4056
V. PERSON
TO CONTACT FOR INFORMATION ABOUT THIS NOTICE
If you have any questions about this notice
or would like to know how to file a complaint, please contact:
DNA Privacy Officer: John
Schwartz, M.D.
VI.
EFFECTIVE DATE OF THIS NOTICE
This
notice went into effect on April 1, 2003.
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