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Notice of Privacy Practices
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.
Texas Back Institute has adopted the following privacy policies.
Uses and Disclosures
Treatment. Your health information may be used by staff members
or disclosed to other health care
professionals for the purpose of evaluating your health, diagnosing medical
providing treatment. For example, results of laboratory tests and procedure
will be available in
your medical record to all health professionals who may provide treatment
or who may be consulted
by staff members.
Payment. Your health information may be used to seek payment from
your health plan, from other
sources of coverage such as an automobile insurer, or from credit card
companies that you may use
to pay for services. For example, your health plan may request and receive
information on dates of
service, the services provided, and the medical condition being treated.
If you have paid
out-of-pocket and in full for services, you have the right to request
the restriction of certain
disclosures to a health plan.
Health care operations. Your health information may be used as
necessary to support the day- to-day
activities and management of Texas Back Institute. For example, information
on the services you
received may be used to support budgeting and financial reporting, and
activities to evaluate and
Law enforcement. Your health information may be disclosed to law
enforcement agencies, without your
permission, to support government audits and inspections, to facilitate
investigations, and to comply with government mandated reporting.
Public health reporting. Your health information may be disclosed
to public health agencies as
required by law. For example, we are required to report certain communicable
diseases to the
state’s public health department.
Other uses and disclosures require your authorization. Disclosure
of your health information or its
use for any purpose other that those listed above requires your specific
written authorization. If
you change your mind after authorizing a use or disclosure of your information
you may submit a
written revocation of the authorization. However, your decision to revoke
the authorization will
not affect or undo any use or disclosure of information that occurred
before you notified us of
Deceased Patient. Our practice may release PHI to a medical examiner
or coroner to identify a
deceased individual or to identify the cause of death. If necessary, we
also may release
information in order for funeral directors to perform their jobs. Any
PHI related to an individual
who has been deceased 50 years or more, is no longer protected.
Research. Our practice may use and disclose your PHI for research
purposes in certain limited
circumstances. We will obtain your written authorization to use your PHI
for research purposes
except, when an Internal Review Board or Privacy Board has approved the
research project and its
Psychotherapy Notes. Most uses and disclosures of psychotherapy
notes, uses and disclosures of
protected health information for marketing purposes, and disclosures that
constitute a sale of
protected health information require authorization, as well as a statement
that other uses and
disclosures not described in the NPP will be made only with authorization
from the individual.
Fundraising. Should you receive fundraising or marketing information,
you have the right to "opt
out" of receiving any further communications.
Prohibition Against Sale. Our practice is prohibited from the sale
of Protected Health Information
without the express written authorization of the individual.
Additional Uses of Information
Appointment reminders. Your health information will be used by our
staff to send you appointment
reminders by mail or to contact you by phone regarding appointment reminders.
Information about treatments. Your health information may be used
to send you information on the
treatment and management of your medical condition that you may find to
be of interest. We may also
send you information describing other health-related goods and services
that we believe may
You have certain rights under the federal privacy standards. These include:
- The right to request restrictions on the use and disclosure of your Protected Health
- The right to receive confidential communications concerning your medical condition and
- The right to inspect and copy your Protected Health Information;
- The right to amend or submit corrections to your protected health information;
- Should an unsecured breach of your Protected Health Information occur, all affected individuals
have the right to be notified.
- Our practice maintains its records in electronic format. Therefore, if you request copies of
your records they can be released to you in electronic format if they
are requested by you.
- The right to receive an accounting of how and to whom your protected health information
has been disclosed; and
- The right to receive a printed copy of this notice.
Texas Back Institute’s Duties
We are required by law to maintain the privacy of your protected health
information and to provide
you with this notice of privacy practices. We also are required to abide
by the privacy policies
and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy
policies and practices.
These changes in our policies and practices may be required by changes
in federal and state laws
and regulations. Whatever the reason for these revisions, we will provide
you with a revised notice
on your next office visit. The revised policies and practices will be
applied to all protected
health information that we maintain.
Requests to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect
or copy Protected Health
Information be submitted in writing. You may obtain a form to request
access to your records by
contacting: Cheryl Zapata, Privacy Officer, 6020 W. Parker Road, Suite
200, Plano, Texas 75093.
If you would like to submit a comment or complaint about our privacy practices,
you can do so by
sending a letter outlining your concerns to: Cheryl Zapata, Privacy Officer,
Texas Back Institute,
6020 W. Parker Rd., Ste. 200, Plano, TX 75093
If you believe that your privacy rights have been violated, you should
call the matter to our
attention by sending a letter describing the cause of your concern to
the same address. You will
not be penalized or otherwise retaliated against for filing a complaint.
The name and address of the person you can contact for further information
privacy practices is: Cheryl Zapata, Texas Back Institute, 6020 W. Parker
Rd., Ste. 200, Plano, TX
This Notice is effective on or after September 15, 2013.