Privacy Policy
Your Information. Your Rights. Our Responsibilities.
When it comes to your health information, our Providers take your privacy and security seriously. This policy explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee when appropriate. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney (not a durable power of attorney or a general power of attorney) or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
File a complaint
You can complain if you feel we have violated your if you feel your rights by contacting us as follows: Office of General Counsel, 1901 John McCain, Colleyville, Texas 76034 ATTN: Privacy Enforcement. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting Health & Human Services. We will not retaliate against you for filing a complaint.
Your choices
You can tell us your choices about what we share for certain health information. Talk to us if you have a clear preference for how we share your information in the situations described below. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to: (i) Share information with your family, close friends, or others involved in your care, (ii) Share information in a disaster relief situation, (iii) Share information through communication instructions that you provide to us (text, email, etc.) If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
When We Need Your Permission
We never sell your information, however when you give us written permission, we may use your information for marketing purposes.
How do we typically use or share your health information?
We can use and share your health information with other professionals who are treating you, to run our practice, improve your care, and contact you when necessary. We can also use and share your health information to bill you for services or to bill and get payment from health plans or other entities.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. We can also share health information about you for certain situations such as: (i) Preventing disease, (ii) Helping with product recalls, (iii) Reporting adverse reactions to medications, (iv) Reporting suspected abuse, neglect, or domestic violence, (v) reventing or reducing a serious threat to anyone’s health or safety, or (vi) doing research. We may use your personal information to contact you or remind you of appointments when you have requested that we do so.
Required Disclosures
Will also share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. We may share your information to respond to requests from a medical examiner, coroner, or funeral director. We may share your information in response to a proper request, for instance, we can use or share health information about you: (i) For workers’ compensation claims, (ii) For law enforcement purposes or with a law enforcement official, (iii) With health oversight agencies for activities authorized by law, (iv) For special government functions such as military, national security, and presidential protective services, (v) To respond to lawsuits and legal actions, (v) In response to a subpoena, or a court or administrative order.
Other Important Information
We will provide you with copies of your medical records at your request within fifteen days of your request, subject to the conditions and charges allowed by your state’s laws. We will not attempt to re-identify deidentified protected health information without your permission. If you test positive for HIV, we will not release or cause to become known the positive result of such test without your permission. We may use deidentified statistical or numerical data for purposes of medical research (deidentified means that your identifying information has been removed). We will not use non-deidentified data for research without your permission and consent.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see the US Government’s Health & Human Services. You may obtain forms for submitting written requests, or obtain additional information, by addressing such requests to:
Privacy Officer
c/o Crystal Nowell
1901 John McCain Road Colleyville,
Texas 76034
Fax: 817-576-5699