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EAST TEXAS PROSTHETIC-ORTHOTIC CARE

Notice of Privacy Practices
Effective Date:  May 16, 2016

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.

This Notice of Privacy Practices (“Notice”) describes:

  • How East Texas Prosthetic-Orthotic Care (ETPOC) may use and disclose your protected health information (“PHI”)
  • Your rights to access and amend your PHI

We are required by law to:

  • Maintain the privacy of your PHI
  • Provide you with notice of our legal duties and privacy practices with respect to PHI
  • Abide by the terms of the Notice currently in effect for ETPOC

PERMITTED USES AND DISCLOSURES OF YOUR PHI
We may use and disclose your PHI for the following purposes.

  • Treatment: We may use and disclose your PHI to healthcare professionals or other third parties to provide, coordinate and manage the delivery of healthcare. For example, your physical therapist or other health care provider may disclose PHI about you to your doctor in order to coordinate the prescribing and delivery of your services. We also may provide you with treatment reminders and information about the device received during treatment by ETPOC.
  • Payment: We may use and disclose PHI about you to receive payment for our services, manage your account, fulfill our responsibilities under your benefit plan, and process your claims for services you have received. For example, we may give PHI to your health plan (or its designee) so we can confirm your eligibility for prosthetic and/or orthotic benefits, or we may submit claims to your health plan, employer or other third party for payment.
  • Healthcare Operations: We may use and disclose your PHI to carry on our own business planning and administrative operations. We need to do this so we can provide you with high-quality services. For example, we may use and disclose PHI about you to assess the use or effectiveness of certain prosthetic and/or orthotic devices and related components, monitor rehabilitation progress, and to provide information regarding helpful health-management services.
  • Information That May Be of Interest to You: We may use or disclose your PHI to contact you about treatment options or alternatives that may be of interest to you. For example, we may call you to remind you of missed appointments, suggest routine office visits, or to inform you of other products that may benefit your rehabilitation.
  • Individuals Involved in Your Care or Payment for Your Care: We may disclose PHI about you to someone who assists in or pays for your care. Unless you write to us and specifically tell us otherwise, we may disclose your PHI to someone who has your permission to act on your behalf. We will require this person to provide adequate proof that he or she has your permission.
  • Parents or Legal Guardians: If you are a minor or under a legal guardianship, we may release your PHI to your parents or legal guardians when we are permitted or required to do so under federal and applicable state law.
  • Business Associates: We routinely purchase materials, custom devices, and components through vendors or business associates which may require the release of PHI. We may disclose your PHI to business associates during procurement of materials, components, or devices to be utilized in treatment by ETPOC. If any PHI is disclosed, we will protect your information from unauthorized use and disclosure using confidentiality agreements.
  • Abuse, Neglect or Domestic Violence: We may disclose your PHI to a social service, protective agency or other government authority if we believe you are a victim of abuse, neglect or domestic violence. We will inform you of our disclosure unless informing you would place you at risk of serious harm.
  • Health Oversight: We may disclose PHI to a health oversight agency performing activities authorized by law, such as investigations and audits. These agencies include governmental agencies that oversee the healthcare system, government benefit programs, and organizations subject to government regulation and civil rights laws.
  • Creation of De-Identified Health Information: We may use your PHI to create data that cannot be linked to you by removing certain elements from your PHI, such as your name, address, telephone number, and health insurance member identification number. We may use this de-identified information to conduct certain business activities; for example, to create summary reports and to analyze and monitor quality assurance.
  • To Avert Serious Threat to Health or Safety: We may disclose your PHI to prevent or lessen an imminent threat to the health or safety of another person or the public. Such disclosure will only be made to someone in a position to prevent or lessen the threat.
  • Judicial Proceedings: We may disclose your PHI in the course of any judicial proceeding in response to a court order, subpoena or other lawful process, but only after we have been assured that efforts have been made to notify you of the request.
  • Law Enforcement: We may disclose your PHI, as required by law, in response to a subpoena, warrant, summons, or, in some circumstances, to report a crime.
  • Coroners and Medical Examiners: We may disclose your PHI to a coroner or a medical examiner for the purpose of duties authorized by law.
  • Organ, Eye and Tissue Donation: We may disclose your PHI to organizations involved in organ transplantation to facilitate donation and transplantation.
  • Workers’ Compensation: We may disclose your PHI to comply with workers’ compensation laws and other similar programs.
  • Specialized Government Functions, Military and Veterans: We may disclose your PHI to authorized federal officials to perform intelligence, counterintelligence, medical suitability determinations, Presidential protection activities, and other national security activities authorized by law. If you are a member of the U.S. armed forces or of a foreign military, we may disclose your PHI as required by military command authorities or law. If you are an inmate in a correctional institution or under the custody of a law enforcement official, we may disclose your PHI to those parties if disclosure is necessary for: 1. the provision of your healthcare; 2. maintaining the health or safety of yourself or other inmates; or 3. ensuring the safety and security of the correctional institution or its agents.
  • As Otherwise Required By Law: We will disclose PHI about you when required to do so by law. If federal, state or local law within your jurisdiction offers you additional protections against improper use or disclosure of PHI, we will follow such laws to the extent they apply.
  • Other Uses and Disclosures: Any other uses and disclosures of your PHI not listed in this Notice will be made only with your authorization unless we are permitted by applicable law to make such other use and disclosure in which case we shall comply with applicable law. You may revoke your authorization, in writing, at any time unless we have taken action in reliance upon it. Written revocation of authorization must be sent to the address listed below. 

    YOUR RIGHTS WITH RESPECT TO YOUR PHI
    You have the following rights regarding PHI we maintain about you:

    • Right to Amend: If you believe PHI about you is incorrect or incomplete, you may ask us to amend the information. You must provide a reason supporting your request to amend.
    • Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures of your PHI. This accounting identifies the disclosures we have made of your PHI other than for treatment, payment or healthcare operations. The provision of an accounting of disclosures is subject to certain restrictions.
    • Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use and disclose about you for treatment, payment or healthcare operations. You may also request your PHI not be disclosed to family members or friends who may be involved in your care or paying for your care. Your request must: 1. be in writing; 2. state the restrictions you are requesting; and 3. state to whom the restriction applies. We are not required to agree to your request.
    • Confidential Communications: You may ask that we communicate with you in an alternate way or at an alternate location to protect the confidentiality of your PHI. Your request must state an alternate method or location you would like us to use to communicate your PHI to you.
    • Right to be Notified: You have the right to be notified following a breach of unsecured PHI if your PHI is affected.
    • Right to a Paper Copy of This Notice: You have the right to request a paper copy of this Notice at any time. For pre-recorded information about how to obtain a copy of this Notice and answers to frequently asked questions, please call 903-236-4488. Even if we have agreed to provide this Notice electronically, you are still entitled to a paper copy. You may obtain a copy of this Notice from our website at etpoc.com
    • Right to File a Complaint: If you believe we have violated your privacy rights, you may file a written complaint to ETPOC at the address listed below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not face retaliation for filing a complaint.

     

    Written complaints, written revocation of authorization to use or disclose PHI, written requests for a copy of your PHI, amendment to your PHI, an accounting of disclosures, restrictions on your PHI or confidential communications may be mailed to:

    ETPOC
    Attn: Privacy Officer
    812 N. 4th Street
    Longview, Texas 75601
    E-mail: staff@etpoc.com

    Please include your name, address, and patient insurance ID number.

    We reserve the right to revise this Notice. A revised Notice will be effective for PHI we already have about you, as well as any PHI we may receive in the future. We will communicate revisions to this Notice through our website.