NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
The following notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please review this information carefully. We are required by law to maintain the privacy of your health information, to give you this notice, and your rights concerning your health information.
Our office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Example of use of your health information for treatment purposes:
A nurse obtains treatment information about you and records it in a health record.
Example of use of your health information for payment purposes:
We submit requests for payment to your health insurance company. The health insurance company or
business associate helping us obtain payment requests information from us regarding the medical care
given. Flow Vascular will provide information to them about you and the care given.
Your Health Information Rights
The health and billing records we maintain are the physical property of the doctor’s office. You have the following rights with respect to your Protected Health Information.
Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office – we are not required to grant the request but Flow Vascular will comply with any request granted;
Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.
Right to inspect and copy our health record and billing record – you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request; appeal a denial of access to your protected health information except in certain circumstances;
Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request. (The physician or other health care provider is not required to make such amendments); you may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
Right to receive an accounting of disclosures of your health information as required to be maintained by law delivering a written request to our office using the form we provide to you upon request. An account will not include internal uses of information for treatment, payment, or operation, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.
Right to confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we give you upon request; and;
If you want to exercise any of the above rights, please contact the Security Officer at 1724 Richmond Avenue, Houston, TX 77098 in person or in writing, during normal business hours Mon-Fri from 7:00 am- 5:30 pm. The office manager will provide you with assistance on the steps to take to exercise your rights.
The office is required to:
Maintain the privacy of your health information as required by law;
Provide you with a notice as to our duties and privacy as to the information we collect and maintain about you;
Abide by the terms of this Notice;
Notify you if we cannot accommodate a requested restriction or request;
Accommodate your reasonable request regarding methods to communicate health information with you;
Accommodate your request for an accounting of disclosures.
To Request Information or File a Compliant
If you have questions, want additional information, or want to report a problem regarding the handling of your information, you may contact the Security Officer at 1724 Richmond Avenue, Houston, TX 77098.
Following is a List of Other Uses and Disclosures Allowed by the Privacy Rule
We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.
Unless you object we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.
Controlling disease – As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Your protected health care information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
ACKNOWLEDGEMENT OF RECEIPT I acknowledge that I was provided a copy of the notice of privacy practices and that I have read (or had the opportunity to read if I so choose) and understood the notice. Please enter your name in the box below to acknowledge the receipt.