Sleep Medicine Cosultants
Privacy of Policy Practices
Our Pledge Regarding Protected Health Information (“PHI”)
Our Legal Duty
Law requires us to:
Keep your PHI private and confidential.
We have the right to:
Make changes and or modifications to our privacy practices and to the new terms of our notice effective for all PHI that we keep, including information previously created or received before such changes and or modifications.
Notice of Change to Privacy Practices:
From time to time, we may change our privacy practices and this policy will be changed accordingly. Please [check our website frequently or request a copy of this policy] to see any recent changes to our privacy practices.
Use and Disclosure of Your PHI
The following Section describes different ways that we are permitted to use and disclose your PHI. We will not use or disclose your PHI for any purpose other than those listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by submitting such revocation in writing to us.
We may use your PHI to provide you with medical treatment or services. We may disclose your PHI to other doctors, nurses, medical assistants, technicians, or other people who are taking care of you within our practice. We may also share your PHI with your other health care providers to assist them in treating you.
We may use and disclose your PHI for payment purposes. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include your PHI.
For Health Care Operations:
We may use and disclose your PHI for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.
Additional Uses and Disclosures:
Notification: With your written permission we may disclose PHI to a family member, your personal representative or another person responsible for your care. In case of emergency, and if you are not able to give or refuse permission, we will only share the health information that is directly necessary for your health care, according to our professional judgment.
Research: With your verbal permission we may share your contact information with FutureSearch Trials (FST) with whom we participate in clinical research. If you agree to participate in a clinical trial, FST will obtain your written permission to view your PHI that we have in our records.
Coroner, Medical Examiner: We may share the PHI of a person who has died with a coroner or medical examiner to help them carry out their duties.
Specialized Government Functions: Subject to certain requirements, we may disclose personal health information for medical suitability determinations for Departments of State or Federal agencies, law enforcement custodial situations and for government programs providing public benefits.
6. Court Orders and Judicial and Administrative Proceedings: As required by law, we may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
7. Public Health Activities: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your PHI to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems.
8. Marketing: With your written permission, we may use your contact information to send marketing and promotional communications, as well as share your contact information with affiliates but not with third party advertisers.
Your Individual Rights
You Have a Right to:
1. Look at or get copies of certain parts of your PHI. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must submit a written request for medical records (a “HIPAA Authorization Form”) to request copies of your PHI. You may ask the receptionist for such HIPAA Authorization Form. There may be charges for copying and for postage if you want the copies mailed to you. Ask the receptionist about our fee structure.
2. Request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
3. Request that we communicate with you about your PHI by different means such as using qualified interpreters for deaf communication.
4. Request that we change certain parts of your PHI. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
Questions and Complaints
You may also submit a written complaint to:
The U.S. Department of Health and Human Services
Office for Civil Rights, DHHS
1301 Young Street, Suite 1169
Dallas, TX 75202
TDD # (214)767.8940
We will not retaliate in any way if you choose to file a complaint to the U.S Department of Health and Human Services.
This Notice of Privacy Practices is currently in effect and will remain in effect until further notice.
Privacy Officer for
Sleep Medicine Consultants:
Tavara Greene, Office Manager
(512)697.9896 ext. 225