Page ContentKelsey-Seybold Clinic 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.This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time, which will be effective for all protected health information that we maintain at that time. We will provide you with any revised Notice of Privacy Practices by updating our website (www.kelsey-seybold.com), or you may call the office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. 1. Uses and Disclosures of Protected Health Information Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care OperationsFollowing are examples of the types of uses and disclosures of your protected health care information that Kelsey-Seybold is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. Treatment We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third-party provider. For example, we would disclose protected health information to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care. Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include providing health information for making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of Kelsey-Seybold. These activities include, but are not limited to, quality assessment activities, training of medical students, licensing, and auditing activities.For example, we may use your protected health information to assess the quality of care at Kelsey-Seybold. We may use or disclose your protected health information, as necessary, for appointment reminders or to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. You may contact our Privacy Office to request that these materials not be sent to you.Kelsey-Seybold will strive to limit the use of health information to the minimum necessary to perform the activity, and physicians or employees whose job functions require review of health information will be required to sign a confidentiality statement. In addition, third party “business associates” that perform various activities (e.g., billing, transcription services) may need to have access to certain health information. Kelsey-Seybold will have a written contract with its business associates that contains terms that will protect the privacy of your protected health information. Kelsey-Seybold will collect your health information only in a lawful manner, and will not intimidate or deceive you into providing such information. Uses and Disclosures of Protected Health Information Based upon Your Written AuthorizationOther uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. Uses and Disclosures That May Be Made Unless You Object Unless you object, we may disclose protected health information to a person present with you during your visit (such as a member of your family, a relative, a close friend or any other person you identify), or to your emergency contact if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. Other Permitted and Required Uses and Disclosures That May Be Made Without Authorization We may use or disclose your protected health information in the following situations without your authorization. These situations include: Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures. Public Health: We may disclose your protected health information to the CDC, the Texas Department of Health, and other public health authorities for public health activities as permitted by law. The disclosure will be made for the purpose of controlling disease, injury or disability. Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. Health Oversight: We may disclose protected health information to the Texas Medical Board, US Department of Health and Human Services, or other health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Abuse or Neglect: We may disclose your protected health information to Child Protective Services, Adult Protective Services, or other governmental body that is authorized by law to receive reports of abuse or neglect. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required. Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process. Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to witnesses, defendants, or victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred. JPs, Coroners: We may disclose protected health information to a justice of the peace, coroner or medical examiner for identification purposes, determining cause of death or for the JP, coroner or medical examiner to perform other duties authorized by law. Research: 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. Safety: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized. Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs. Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of federal law. 2. Your RightsFollowing is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. A physician may deny access to health information if he determines that release of information could be harmful to the physical, mental, or emotional health of a patient or could endanger a patient. You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Please note that your treatment or any third-party payment may be impacted if you restrict the use of your protected health information.We are not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If Kelsey-Seybold does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician or our Privacy Office. You may request a restriction by signing our restriction form available from our Privacy Office. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Office. You may have the right to request an amendment of your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Office to determine if you have questions about amending your medical record. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically. You have the right to receive notice from us, in the event that your protected health information is used or disclosed in a manner not authorized or permitted by federal or state law. 3. ComplaintsYou may complain to us or to 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.You may contact our Privacy Office at (713) 442-5700 for further information about the complaint process. This notice was published and becomes effective on September 10, 2021. If you have any questions about this Notice, please contact our Privacy Office at (713) 442-5700.