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Notice of Privacy Practices

Notice of Privacy Practices
First Issued April 14, 2003; New Effective Date:  July 12, 2010    
          
To Our Patients:

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice applies to all of the records of your care, called Protected Health Information, which are created by the CommUnityCare health centers and associated health care providers.  The policies to protect your Protected Health Information apply to all CommUnityCare staff, including medical, front desk, billing and administrative staff.  Our policies on protecting your health information also extend to all professional authorized health care providers and staff, including resident physicians and health care students who have a need to know about your health information in order to provide care to you.  It also applies to any entity or individual with whom we contract for health care services, such as medical providers we refer you to.

I. YOUR PROTECTED HEALTH INFORMATION

We are legally required to protect the privacy of your health information. We call the information “Protected Health Information” and it includes information that can be used to identify you and information we have created or received about your past, present, or future health conditions or services we provide you. 

We need this medical information to provide you with continuity of care and to comply with certain legal requirements.  We are required by law to:

II. HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION

A. Uses and Disclosures that DO NOT Require Your Consent

For Treatment.  We may use your Protected Health Information to provide you with current or future health care treatment or services and to coordinate or manage your treatment. We may, and most likely will, disclose your Protected Health Information to doctors, nurses, students and other health care personnel who are involved in your care, and to medical and nursing personnel who are assisting our health care providers. We may disclose your information for treatment to another physician(s) you have been referred to.

For Payment. We may use and disclose your Protected Health Information to bill and collect for services provided to you.  This use and disclosure may be to insurance companies or other third parties responsible for paying for health services provided to you.

For Health Care Operations. We may use and disclose your Protected Health Information for our business operations in order to operate CommUnityCare efficiently and make sure our patients receive quality care.

Disclosure at Your Request.  We may disclose Protected Health Information when you ask us to.  This disclosure may require a written authorization by you.

ADDITIONAL USES AND DISCLOSURES INCLUDE:

Appointment and Patient Recall Reminders.  We may use and disclose your Protected Health Information to contact you to remind you of appointments or for medical care you are to receive.

Sign In Sheet. We may use and disclose health information about you by having you sign in when you arrive at CommUnityCare for your appointment. We may also call out your name when you are ready to be seen.

Family, Friends or Other Individuals Involved in Your Care or Payment for Your Care.  We may disclose your Protected Health Information to notify or assist in notifying a family member, your personal representative, or another person involved in or responsible for your health care about your location at CommUnityCare, your general condition, or in the event of your death.  We may also disclose information to someone who helps arrange for payment for your care.  If you are able and available to agree or to object, we will give you the opportunity to agree or object prior to making these disclosures, although we may disclose this information in the case of a disaster even over your objection if we believe it is necessary to respond to the disaster or emergency situation.  If you are unable or unavailable to agree or object, we will use our best judgment in any communication with your family, personal representative, and other involved persons.

Business Associates. Some of our functions are accomplished through contracted services provided by “Business Associates”. A “Business Associate” may include any individual or entity that receives your health information from us in the course of performing services for CommUnityCare. Such services may include legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation or financial services. When these services are contracted, we may disclose your health information to our Business Associates so that they can perform the job we have asked them to do. To protect your health information, however, we require the Business Associate to appropriately protect your information.

External Entities.  In an emergency, we may disclose your Protected Health Information to an entity assisting in disaster relief so your family can be notified about your condition, status, and location.

Research. We may participate in research concerning the use of certain treatment protocols that have proper governmental and CommUnityCare approval. We may disclose your Protected Health Information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected Health Information.

Required by Law.  We will disclose your Protected Health Information when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety.  We may use and disclose your Protected Health Information to persons who need to know when necessary to prevent a serious threat to either your health or the health and safety of others.  For example, when there is an infectious disease outbreak.

Public Health Issues and Risks.  We may use and disclose your Protected Health Information for certain public health activities.  These activities may be for preventing or controlling certain health conditions, disease, to track disease and assess the risk of spreading disease, reports regarding births and deaths, to report abuse, neglect or domestic violence, reactions to medications or products, recalls of products, and notice of exposure to a condition.

Victims of Abuse, Neglect, or Domestic Violence.  We may disclose your Protected Health Information to law enforcement, social services, or other government agencies authorized to receive the report if we have reason to believe you are a victim of abuse, neglect, or domestic violence. In certain circumstances, we may disclose your Protected Health Information to report suspected child or elder abuse.

Investigations and Government Activities.  We may disclose your Protected Health Information to a local, state, or federal agency for the agency’s oversight activities authorized by law that may concern inspections, licensure, illegal conduct, or compliance with other laws and regulations, including civil rights laws.

Lawsuits and Disputes.   If you are involved in a judicial or administrative legal proceeding (lawsuit or a dispute), we may disclose Protected Health Information about you in response to a court or administrative order or when such disclosure is otherwise required or permitted by law.  For example, we may disclose psychiatric or mental health information to courts, attorneys and court employees in the course of conservatorship, and certain other judicial or administrative proceedings. In addition, we may disclose your Protected Health Information in response to a subpoena, a discovery request or other lawful process by someone else involved in the dispute but only if efforts have been made to obtain your authorization or a court order protecting the Protected Health Information requested.

Law Enforcement.  We may release your Protected Health Information if asked to do so by a law enforcement official in the following circumstances:  (1) In response to a court order, subpoena, warrant, summons or similar process; (2) To identify or locate a suspect fugitive, material witness, or missing person; (3) About the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) About a death we believe may be the result of criminal conduct; (5) About criminal conduct at CommUnityCare; and/or (6) In emergency situations to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors.  We may release your Protected Health Information to a coroner or medical examiner or funeral directors as necessary for them to carry out their duties.

Military and National Security.  If you currently serve in the military or are a veteran, we may disclose your Protected Health Information to the military upon proper request. We may also disclose your information to federal officials conducting national security and intelligence activities.

Workers’ Compensation.  We may disclose your information if required by workers’ compensation laws and other similar laws and regulations.

Organ and Tissue Procurement Organizations.  If you are an organ donor, we may disclose Protected Health Information to organizations that handle organ procurement or organ or tissue transplantation or to an organ donation bank, as needed to facilitate donation and transplantation.

Special Categories of Health Information. In some circumstances, your health information may be subject to additional restrictions that may limit or preclude some uses or disclosures described in this Notice of Privacy Practices. For example, there are special restrictions on the use and /or disclosure of certain categories of health information such as (1) AIDS treatment information and HIV test results; (2) treatment for mental health conditions and psychotherapy notes; (3) alcohol, drug abuse and chemical dependency treatment information; and (4) genetic information. In addition, government health benefit programs, such as Medicare or Medicaid, may also limit the disclosure of beneficiary information for purposes unrelated to the program.

Psychotherapy Notes.  Psychotherapy notes are notes recorded (in any format) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record.

Psychotherapy notes exclude:  (a) medication prescription and monitoring; (b) counseling session start and stop times; (c) the modalities and frequencies of treatment furnished; (d) results of clinical tests; and (e) any summary of the following items:  diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

We may use or disclose your psychotherapy notes, for treatment, payment or healthcare operations, or: 

  1. for use by the originator of the notes;
  2. in supervised mental health training programs for students, trainees, or practitioners;
  3. by the covered entity to defend a legal action or other proceeding brought by the individual;
  4. to prevent or lessen a serious and imminent threat to the health or safety of a person or the public;
  5. for the health oversight of the originator of the psychotherapy note;
  6. for use or disclosure to a coroner or medical examiner to report a patient’s death, and information related to the diagnosis and treatment of the patient’s physical condition;
  7. for use or disclosure necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public;
  8. for use or disclosure to the Secretary of the U.S. Department of Health and Human Services (“DHHS”) in the course of an investigation; and/or
  9. as required by law.

Other uses and disclosures of your psychiatric or mental health information not covered by this Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization. 

B. All Other Uses and Disclosures Require Your Prior Written Authorization.

Uses and disclosures of your Protected Health Information other than those described above require a written authorization signed by you that contains certain information.

If you choose to sign an authorization to disclose your Protected Health Information, you may later revoke that authorization in writing to stop any future uses and disclosures to the extent we have not taken action relating to the authorizations.  You may request a copy of the Revocation of Authorization to Disclose Protected Health Information and Authorization to Release Medical Information forms.

III. YOUR PRIVACY RIGHTS

You have the right to:

Inspect and copy your health information.  You may ask to review and receive a copy of your health information that CommUnityCare keeps for as long as CommUnityCare has it. Except in very limited circumstances, you have a right to receive a copy of your medical record within fifteen (15) days of the date you submit a valid request for release to CommUnityCare.  We may deny your request to inspect and copy your health information in limited circumstances. If you are denied access you may request that the denial be reviewed by another health care professional. CommUnityCare may charge a fee for any copies you request. Please make this request in writing to the department’s Privacy Representative.

Amend your health information, if you feel it is wrong or not complete.  You may request that we amend the health information CommUnityCare keeps.  CommUnityCare may deny your request for an amendment if we determine the information is accurate and complete.  CommUnityCare may also deny a request if it is not in writing, does not include a reason to support the request, was not created by CommUnityCare (unless the person or entity that created the information is no longer available to make the amendment), or is not part of the information you would be permitted to inspect and copy. If CommUnityCare accepts your request to amend your health information, the change will become a permanent document in your health care record. Please make this request in writing to the department’s Privacy Representative.

Request a limit to the health information we disclose.  You may ask CommUnityCare to limit or restrict the Protected Health Information we use or disclose about you for treatment, payment or health care operations.  We are not required to agree to your request but if we do agree, we will comply unless the Protected Health Information is needed to provide you emergency treatment.  Your request must describe the specific limits you are requesting. Please make this request in writing to the department’s Privacy Representative.

Request a list of disclosures we have made of your health information. You may request a list of disclosures CommUnityCare has made of your Protected Health Information. This list will not include any routine disclosures of your Protected Health Information for the treatment, payment, or business operation purposes described above. Please make this request in writing to the department’s Privacy Representative.

Request confidential communications from us. We will not disclose your health information except as described in this notice. However, you may ask us to contact you about medical matters by another means or at a different address or to limit the number or type of people who have access to your Protected Health Information. Please make this request in writing to the department’s Privacy Representative.

Receive a copy of this notice from us.  You have the right to get a copy of this notice by email.  Even if you agree to receive notice via e-mail, you also have the right to a paper copy. You may request a copy of this notice at any time.

IV. CHANGES TO THIS NOTICE

 We reserve the right to change this Notice at any time.  Except when required by law, a material change to this Notice will not be implemented before the effective date of the new Notice in which the material change is included.  CommUnityCare’s Chief Executive Officer and HIPAA Privacy Representative will approve in advance any material change to:

If any such change is approved, we will promptly revise and distribute the Notice.  We will post a copy of the current Notice in the health centers with the effective date on the first page.  You may request a copy of the current Notice each time you visit a CommUnityCare health center for services or you may call the health center to request the current Notice be sent to you in the mail.

V. YOUR RIGHT TO FILE A COMPLAINT

Complaints.  If you believe that your privacy rights have been violated, you may file a complaint with the CommUnityCare Privacy Representative or the Secretary of the Department of Health and Human Services (DHHS).  All complaints, which must be in writing, will be investigated.

CommUnityCare Compliance Officer
15 Waller Street, 5th floor
Austin, TX 78702
Tel: (512) 978-9917
Fax: (512) 275-2850

Secretary
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Building 200
Independence Avenue, S.W.
Room 509F HHH Building
Washington, D.C. 20201

You will not be penalized for filing a complaint.

VI. PRIVACY CONTACT INFORMATION

If you have any questions about this Notice or wish to submit a request, please contact CommUnityCare’s Privacy Representative at the address or phone number above.

VII. EFFECTIVE DATE

THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.

AMENDED

ADDITIONAL NOTICE TO PATIENTS OF COMMUNITYCARE AT RED RIVER

This notice also describes the practices of the CommUnityCare-Red River location and the physicians and other health professionals who will provide treatment for you at CommUnityCare-Red River regarding your Protected Health Information. CommUnityCare has entered into a contract with Emergency Service Physicians, P.L.L.C. (“ESP”) to provide medical services at the Red River location. Physicians and nurse practitioners/physician assistants (“mid-level providers”) contracted with ESP's affiliate, Central Austin Physicians, P.A. (“CAP”), will provide your care at the CommUnityCare-Red River. These physicians and mid-level providers, as well as CommUnityCare-Red River nurses who are not contracted with CAP, are authorized to have access to your medical chart and Protected Health Information and are subject to this Notice of privacy practices. In addition, Red River employees and the CAP physicians and mid-level providers will share Protected Health Information with each other for purposes of treatment, payment, or health care operations.

CommUnityCare at Red River is an Organized Healthcare Arrangement, as that term is defined in the regulations issued under the federal Health Insurance Portability and Accountability Act of 1996, and this arrangement includes ESP and its affiliate CAP. Physicians and mid-level providers contracted with CAP who provide care to you at the CommUnityCare-Red River are not employees or agents of the Travis County Healthcare District or Central Texas Community Health Centers d/b/a CommUnityCare but are agents of ESP’s affiliate CAP.


 

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