Your Rights Regarding Your PHI

You have the right to:

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Our Uses and Disclosures

We may use and share your information as we:

• Treat you.
  • We may use or disclose your health information to provide and coordinate the mental health treatment and services you receive.
• Run our organization.
  • We may use and disclose your health information for certain operational, administrative, and quality assurance activities, in connection with our healthcare operations. These uses and disclosures are necessary to run our practice and to make sure that our patients receive quality treatment and services.
• Bill for your services.
  • We may use and disclose your health information for various payment related functions, so that we can bill for and obtain payment for the treatment and services we provide for you.
• Help with public health and safety issues.
  • We may disclose your PHI to federal, state, or local authorities, or other entities charged with preventing or controlling disease, injury, or disability for public health activities.
• Do research.
  • Under certain circumstances, we may use or disclose your PHI for research purposes. However, before disclosing your PHI, the research project must be approved by an intuitional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
• Comply with laws that may be in place now or in the future.
  • We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for government monitoring of the health care system, government programs, and compliance with federal and applicable state laws.
• To avert a serious threat to safety.
  • We may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public. We may disclose your health information to appropriate authorities if we reasonably believe that you are the possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.
• As required by law.
  • We must disclose your PHI when required to do so by applicable federal or state law. We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, provision of protection to the President, other authorized persons or foreign heads of state, and other national security activities authorized by law.
• Appointment reminders.
  • We may use your PHI to provide you with appointment reminders. You have a right to request restrictions or limitations to the information we disclose.

Your Rights

When it comes to your health information, you have certain rights. This section 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 summary of your health information, usually with 15 days of your request. We may charge a reasonable, cost-based fee.

• You may not be able to obtain all your information in a few special cases. For example, if your treatment provider determines that the information may endanger you or someone else.

• In accordance with Texas law, you have the right to obtain a copy of your PHI in electronic form for records that we maintain using an Electronic Health Records (HER) system capable of fulfilling the request.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Requests must identify which information you seek to amend, what corrections you would like to make, and why in the information needs to be amended. We will respond to your request in writing within 60 days.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days. If denied, you have the right to file a statement of disagreement with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal.

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 purposes of payment or operations with your heath insurer. We will say “yes” unless the 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. We will notify you in advance of the cost involved, and you may choose to withdraw or modify your request at that time.

• We will respond in writing within 60 days of receipt of your request (with a possible 30-day extension).

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. A reasonable fee may be charged for the costs of copying, mailing, or other supplies associated with your request.

Choose someone to act for you

• If you have given someone medical 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.

Be notified in the event of a breach

• You have the right to be notified of an impermissible use or disclosure that compromises the security of your PHI. We will provide notice to you as soon as is reasonably possible and no later than sixty (60) calendar days after discovery of the breach and in accordance with federal and state law.

File a complaint if you feel your rights are violated

• You may also file a complaint directly with any or all the following federal and state agencies: the Secretary of the Department of Health and Human Services, the Office of the Attorney General of Texas, or the Texas Behavioral Health Counsel. We can provide you with the addresses to file your complaint upon request. You will not be penalized in any way for filing a complaint.

• If you feel that we have violated these rights, please feel free to contact us at [email protected] or by calling our offices at (512) 528-3131.

If you would like more information about our privacy practices or have questions or concerns, please contact us.

Privacy Officer: Melissa McHugh Dillon, Ph.D., BCBA.

Office: (512) 528-3131

Email:  [email protected]

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. 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:

• Share information with your family, close friends, or others involved in your care.
• 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.

We will not use or disclose psychotherapy notes without your written authorization, and only as permitted by law.

Marketing Health-Related Services

We will not use or disclose your protected health information for marketing communications without your written authorization, and only as permitted by law.

Sale of PHI.

We will not sell your protected health information. Ever.

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 must 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.

Help with public health and safety issues

We can share health information about you for certain situations such as:

• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

• We can use or share your information for health research.

Comply with the law

• We will 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 can use or share health information about you:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order

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. We are not required to agree to those restrictions. We cannot agree to restrictions on uses or disclosures that are legally required, or which are necessary to administer our business. We must agree to the request to restrict disclosure of PHI to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the PHI pertains solely to a health care item or service for which you, or another individual other than a health plan on behalf of you, has paid us in full.

 For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website, www.hillcountryanxiety.com.