HIPAA Notice of Medical Records Privacy Practices

As medical professionals, we realize that your health information is very sensitive and personal. This is especially true of information regarding your mental health. Our practice is dedicated to maintaining the privacy of your health information. In conducting our business, in order to serve you, we will create records regarding you and the treatment and services we provide to you. We sometimes also need to share information with other parties.

This notice describes the privacy practices at our office, how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact our office at (512) 212-4670.

We are required by law to:

• Maintain the privacy of protected health information.
• Give you this notice of our legal duties and privacy practices regarding your health information.
• Follow the terms of the notice currently in effect.

Described as follows are the ways we may use and disclose your health information. Except for the following purposes, we will use and disclose your health information only with your written permission. You may revoke such permission at any time by submitting a written request to: 

CARMAhealth PLLC
630 W 34th St, Ste 301
Austin TX 78705

 

Treatment 
We may use and disclose your health information for your treatment and to provide you with treatment-related health care services. For example, we may disclose your health information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

Payment
We may use and disclose your health information so that others or we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may give information to your health plan so that they will pay for your treatment.

Health Care Operations
We may use and disclose your health information to evaluate and improve our medical care and to operate and manage our office. For example, we may use and disclose information to a peer review organization or a health plan that is evaluating our care.

We may also share information with others that have a relationship with you for their health care operation activities.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services
We may use and disclose your health information to contact you and remind you of your appointment, to tell you about treatment alternatives, or health-related benefits and services you could use.

Individuals Involved in Your Care or Payment for Your Care
When appropriate, we may share your health information with a person involved in, or paying for, your care (such as your family to a close friend). We may notify your family about your location or condition or disclose such information to an entity assisting in disaster relief.

Research
We may use and disclose your health information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another for the same condition. Before we do so, the project needs to go through a special approval process. Even without special approval, we may permit researchers to look at records to help identify patients who may be included in their research, as long as they do not remove or copy any of your health information.

As Required by Law
We will disclose your health information when required to do so by international, federal, state, or local law.

To Avert a Serious Threat to Health or Safety
We may use and disclose your health information when necessary to prevent a serious threat to the health and safety of you, another person, or the public. Disclosures will be made only to someone who can prevent the threat.

Business Associates
We may disclose your health information to our business associates that perform functions on our behalf or provide us with services if necessary. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose the information for any other purpose than appears in their contract with us.

Military and Veterans
If you are a member of the armed forces, we may release your health information as required by military command authorities. If you are a member of a foreign military we may release your health information to the foreign military command authority.

Worker’s Compensation
We may release your health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illness.

Public Health Risks
We may disclose your health information for public health activities to prevent or control disease, injury, or disability. We may use your health information in reporting births or deaths, suspected child abuse or neglect, medication reactions or product malfunctions or injuries, and product recall notifications. We may use your health information to notify someone who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. If we are concerned that a patient may have been a victim of abuse, neglect, or domestic violence we may ask your permission to make a disclosure to an appropriate government authority. We will make that disclosure only when you agree or when required or authorized to do so by law.

Health Oversight Activities
We may disclose your health information to a health oversight agency for activities authorized by law. These may include 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.

Lawsuits and Disputes
If you are involved in a lawsuit or dispute, we may disclose your health information in response to a court or administrative order. We may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement
We may release your health information request by law enforcement official if (1) there is a court order, subpoena, warrant, summons or similar process; (2) if the request is limited to information needed to identify or locate a suspect, fugitive, material witness, or missing person; (3) the information is about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain your agreement; (4) the information is about a death that may be the result of criminal conduct; (5) the information is relevant to criminal conduct on our premises; and (6) it is needed in an emergency to report a crime, the location of a crime or victims, or the identity, description, or location of the person who may have committed the crime.

Coroners, Medical Examiners, and Funeral Directors
We may release your health information to a coroner, medical examiner, or funeral director to identify a deceased person or cause of death, or other similar circumstance.

National Security and Intelligence Activities
We may disclose your health information to authorized federal officials for intelligence and other national security activities authorized by law.

Inmates or Individuals in Custody
If you are an inmate of a correctional institution or in custody, we may disclose your information (1) for the institution to provide you with health care; (2) to protect your health and safety or that of others; and (3) for the safety and security of the institution.

Right to Inspect and Copy
You have the right to inspect and copy your medical and billing records by written request to CARMAhealth PLLC. In some cases, disclosure of the requested information may be clinically counterproductive or harmful to you and disclosure may be restricted.

Right to Amend
You have the right to request an amendment to your records by written request to CARMAhealth, PLLC.

Right to an Accounting of Disclosures
You have a right to an accounting of certain disclosures by written request to CARMAhealth, PLLC.

Right to Request Restrictions
You have the right to request restriction or limitation on your health information used for treatment, payment, or health care operations. You may request us to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request to CARMAhealth, PLLC. We are not required to agree with your request, but we will try to comply.

Right to Request Confidential Communication
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that we contact you only by mail or at work. Your written request must specify how or where you wish to be contacted and be addressed to CARMAhealth, PLLC. We will accommodate reasonable requests.

Right to file a written complaint without fear of retaliation
If you believe we have violated your privacy rights, you may forward us a written complaint to our contact address given above. You may also file a complaint with the Secretary of the United States Department of Health and Human Services. If you do file a complaint we are legally prohibited from retaliating against you.

 

CHANGES TO THIS NOTICE
We may change this notice and make it effective for medical information we already have about you as well as new information. The current notice will be posted and available at all times. You have a right to request a paper copy of the current notice at any visit or by written request to:

CARMAhealth PLLC 
630 W 34th St, Ste 301
Austin, TX 78705

 

For a representative of the patient: