Please read this notice carefully. It concerns your individual, private healthcare information and how this information may be used and disclosed by this office.
We have a legal, ethical and moral obligation to protect your confidentiality. Any information about you and/or your family will be held strictly confidential by all employees. No discussion about you outside of the patient care framework will be allowed and any conversation between staff members that pertains to delivering you quality care will be held in a confidential and professional manner.
In order to provide quality care to you, as well as operate this office in an efficient manner, we will need to access your private health-care information for purposes of treatment, payment and operations (such as quality assurance). In using this information this office will comply with all state and federal laws pertaining to your privacy rights, including the Privacy and Security protections provided to you by the Health Insurance Portability and Accountability Act (“HIPAA”) and the Texas Medical Privacy Act.
Specifically, we will need to disclose your private information under the following circumstances:
Sharing Information for purposes of treatment: We will share information with all members of your treatment team, both within this office and with other providers (personal and institutional) in order to provide you with quality care and the education/wellness programs specified in your insurance plan;
Sharing of Information for Purposes of Payment: We will share all necessary information with your insurer(s), payor(s), governmental entities (such as Medicare, Medicaid, Tricare, etc.) and their representatives (including, but not limited to benefits determination and utilization review) as well as our representatives involved in the billing process (including, but not limited to claims representatives, and electronic claims clearinghouses)
Sharing of Information For Purposes of Operations: We will share all information necessary for ongoing operations of this office. Including, (but not limited to) credentialing processes, peer review, accreditation and compliance with all federal and state laws.for treatment or medical care. This applies to any person you have listed on your authorization page.
Appointment Reminders: We may disclose medical information to contact you as a reminder that you have an appointment
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that me be of interest to you.
Individuals Involved in Your or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you have been seen in our office. In addition, we may disclose medical information about you to a friend or family member should an emergent situation arise while you are at our office.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. All personal identifiable information, with the exception of race, sex and age, will be removed from your medical information.
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public for another person. Any disclosure, however, would only be to someone able to help prevent the threat.
As Required by Law: WoundCentrics, LLC. will not release any information other than those incidents described above, unless disclosure is required by law, a court, a legal process, lawsuits or government agencies.
Special Situations: We may release medical information about you for Organ and Tissue Donation, Military or Veterans, Workers’ Compensation, Coroners, Medical Examiners, Funeral Directors, National Security and Intelligence Activities, Protective Services for the President and others, Health Oversight Activities (these oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Public Health Activities: We may disclose medical information about you for public health activities. The activities generally include the following:
To prevent or control disease, injury or disability
To report births and deaths
To report child abuse or neglect
To report reactions to medications or problems with products
To notify people of recalls of products they may be using
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Marketing: WoundCentrics, LLC. will be required to obtain written permission to use any patient information in any scope of marketing. No use of patient information will be allowed without this written authorization and the patient’s full understanding of how the information will be used.
Your consent for use and disclosure of information as described may be revoked in writing at any time. Please notify the office Privacy Officer if you ever decide to revoke your consent.
Your specific authorization will be required for the release of any information not included above or specifically given in your general consent form located in your patient medical record. Your authorization will need to be in writing and it will be specific to the disclosure requested. Incidences which may require your authorization under the HIPAA regulations/Texas Medical Privacy
Act include (but are not limited to ) some marketing purposes (e.g., notice of new procedures available in our office). Your private health care or personal information will not be given to anyone for the purpose of marketing outside of this office.
WoundCentrics, LLC., will not release any information other than those incidents described above, unless disclosure is required by law, a court, a legal process or governmental agencies.
WoundCentrics, LLC. will not re-identify any anonymized information that has been de-identified, (i.e., social security numbers, or credit card numbers that only show the last four digits will remain that way and we will never show your entire number on any payment receipt.
When the HIPAA privacy rule becomes effective or updates to the privacy rules go in effect our office will update any current notifications and then you will have the right to inspect and copy your protected information, amend your record (on a separate form), have reasonable requests for confidential communications accommodated and may obtain an accounting of disclosures. Your request for an accounting of disclosures must be submitted in writing to the Office Manager. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request will be free for any additional requests within a 12 month period. We will notify you at the time of the request what the current fee is and you will have the right to proceed or withdraw your request at that time. All other rights afforded to you by state and federal law will be honored as they are created. This office will attempt to comply with any of your requests before the HIPAA compliance date if feasible. Please contact the Privacy Officer if you have any questions about your rights or any other privacy questions you may have.
You have the right to request restrictions or limitations on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request restrictions, you must make your request in writing to the Privacy in writing to the Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
You have the right to request Confidential Communication with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must tell us how or where you wish to be contacted. If you do not tell us how or where you wish to be contacted, we do not have to follow your request.
You have the right to restrict release of information for certain services for which you have paid in full at the time of service. This information can be released only upon your written authorization. For example, you may request that we do not file a claim with your medical insurance. (This is not feasible at all times. For example, when a surgery is performed and you want your insurance to pay for some things but not others.)
You have the right to Breach Notification. We will notify you of any breach of your unsecured health information.
WoundCentrics, LLC. has policies and procedures in place to facilitate compliance with the law as well as assure that this office consistently treats you with respect for you, your privacy and confidentiality. These policies and procedures are available for you to review. If you would like to read them please notify the Privacy Officer.
The Privacy Officer is the person in the office responsible for your privacy and the security of your information. Any complaints you or your family may have in this area should be directed to the HIPAA Privacy Officer: Stuart Oertli (210) 701-9090 or email@example.com. You may also contact the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. We are also required to abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Office in person or by phone at our main phone number (210) 701-0909.