This notice
describes how information about you may be used and disclosed and
how you can get access to this information. Please review it carefully.
As a patient
of Stephen A. Landers, M.D. you are entitled to
have notice of our privacy practices which indicates how we may
use and disclose your protected health information under different
circumstances. This Notice explains how we use and disclose your
personal information and the choices and rights you have about how
your personal health information may be used and disclosed.
Stephen A. Landers, M.D. is required to maintain the privacy of
your Protected Health Information (“personal health information”)
and to provide you with a notice about our legal duties and privacy
practices with respect to your personal health information. Any
time we use or disclose your personal health information, we are
required to follow the terms of this Notice.
We reserve
the right to change our privacy practices and to alter this Notice
according to those changes. In the event that our Notice changes,
we will provide you with the revised Notice upon your request.
How We Use
and Disclose Your Protected Health Information:
§ Uses and Disclosures with Consent. As a condition
of receiving treatment, you will be asked to sign a written consent
form for use of your personal health information for treatment,
payment and health care operations. Upon obtaining consent, we
will use and disclose your personal health information in the following
ways:
(1) For Treatment. We will use and disclose your personal health information to plan,
provide and coordinate your health care services. For example,
we may provide your personal health information to a physician we
have referred you to in order to ensure the physician has the necessary
information to provide your health care.
(2) For Payment. We will use and disclose your personal health information to obtain
payment for health care services we have provided you. For example,
we may use and disclose your personal health information to obtain
payment from your insurance carrier.
(3) For Health Care Operations. We may use or disclose your protected health information for our
health care operations. For example, we may use or disclose your
personal health information for quality assessment and improvement
activities.
§ Uses and Disclosures with Authorization. For
uses and disclosures or your personal health information not involving
treatment, payment and health care operations, we will receive your
written authorization prior to using or disclosing any personal
health information (unless we are required or permitted by law to
use or disclose your information as set forth below). You have
the right to revoke any authorization previously granted. If you
have any questions about written authorizations, please contact
our Privacy Officer.
§ Uses and Disclosures without Consent or Authorization.
(1) Disclosures without
Consent or Authorization. We may use or disclose your personal
health information for treatment, payment and health care operations
without consent or authorization in order to administer emergency
treatment, to treat you when we are required by law but your consent
cannot obtained, and to treat you when we are unable to obtain your
consent due to communication barriers.
(2) Notification of Family
or Close Friends. We may use or disclose your personal health
information to notify a family member, personal representative or
another person responsible for your care, provided you have the
opportunity to agree or object to the disclosure. If you are unable
to agree or object, we may disclose this information as necessary
if we determine that it is in your best interests based upon our
professional judgment.
(3) Public Health Activities. We may use or disclose your personal health information for public
health activities and purposes in compliance with applicable laws
for the purpose of controlling disease, injury or disability; reporting
child abuse and neglect; reporting information about products and
services under the jurisdiction of the United States Food and Drug
Administration; alerting authorities of persons who may have been
exposed to a communicable disease; and reporting information to
your employer as required under Workers’ Compensation laws.
(4) Health Oversight
Activities. We may make disclosures of your personal health
information to a health oversight agency charged with overseeing
the health care industry.
(5) Marketing. We
may contact you to remind you of appointments or to provide you
with information about treatment alternatives or other health-related
products or services.
(6) Legal Proceedings. We may disclose your personal health information in nay judicial
or administrative proceeding in response to orders, subpoenas and
other valid legal processes.
(7) Law Enforcement. We may disclose your personal health information to law enforcement
officials in compliance with applicable law.
(8) Abuse or Neglect. We may disclose your personal health information to public authorities
authorized by law to receive reports of child abuse, neglect or
domestic violence.
(9) Limited Government
Functions. We may disclose your personal health information
to certain government agencies charged with special government functions
(e.g., the U.S. Military).
(10) Funeral Directors. We may disclose your personal health information to funeral directors
in accordance with applicable law.
(11) Organ Procurement. As allowed by law, we may disclose your personal health information
to organ procurement organizations for organ, eye or tissue donation
purposes.
(12) Coroners. We
may disclose you personal health information to a coroner or medical
examiner in accordance with applicable laws.
(13) Health and Safety. We may disclose your personal health information to prevent or lessen
a serious threat to a person’s or the public’s health and safety.
(14) Workers’ Compensation. We may disclose your personal health information in accordance with
workers’ compensation laws.
Your Rights. You have the right to do the following:
- Right
to Receive a Copy of this Notice. Upon request, you have the
right to receive a paper copy of this Notice.
- Right
to Receive Further Information. You have the right to contact
our Privacy Officer if you want additional information about our
privacy practices, your privacy rights, or disagree about a decision
we made about your personal health information, or if you believe
that your privacy rights have been violated. If desired, you
may make a formal complaint addressed to our Privacy Officer.
- Right
to Inspect and Copy Your Health Information. Upon request,
you have the right to access and obtain a copy of your health
information maintained by us.
- Right
to Amend Your Health Information. You have the right to request
that we amend your health information maintained in your medical
record. We will comply with your request in the event that we
determine the information that would be amended is false, inaccurate
or misleading.
- Right
to Request Additional Restrictions on Uses and Disclosures of
Your Health Information. You have the right to request that
we place additional restrictions on how we use or disclose your
personal health information. While we will consider any request
for additional restrictions, we are not required to agree to your
request.
- Right
to Request an Accounting of Disclosures. You have a right
to request an accounting of the disclosures made by us of your
personal health information. For each disclosure, the accounting
will include the date the information was disclosed, to whom,
the address of the person or entity that received the disclosure
(if known), and a brief statement of the reason for the disclosure.
- Right
to Request Confidentiality in Certain Communications. You
have the right to request and receive your health information
by alternative means of communication or at alternative locations.
We will accommodate any such reasonable written request made on
your behalf.
- Right
to File a Complaint. If you believe you privacy rights have
been violated, you also have the right to file a written complaint
with the Office of Civil Rights of the United States Department
of Health and Human Services. Upon request, the Privacy Officer
will provide the address to file your complaint. Under no circumstances
will we retaliate against you for filing a complaint.
Privacy
Officer. To contact the Privacy Officer, please address all
requests to Stephen A. Landers, M.D., Attention: Privacy
Officer, 7515 Greenville
Avenue, Suite 806, Dallas, TX 75231. The Privacy
Officer can also be contacted by calling 214-345-6868 or 800-375-4327
or via the internet at www.drlanders.com.
Effective
Date of this Notice. This Notice is effective as of September
1, 2002.
|
