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.
Pathway Healthcare, LLC and its affiliates and subsidiaries are required by law to maintain the privacy of your medical information, to give you this Notice of Privacy Practices (“Notice”) describing its legal duties and privacy practices with respect to your medical information, to notify you of any breaches of your unsecured medical information, and to abide by the terms in this Notice. This Notice applies to records of your care created and maintained by Pathway Healthcare, LLC and its affiliates and subsidiaries, including subsidiary physician practices and offices, and further including Impact Behavioral Counseling, LLC (the “Practices”). The Practices are required to abide by the terms of the privacy notice currently in effect. The Practices reserve the right to change the terms of this Notice for all records and will inform you by posting the revised notice on its website or by providing it to you in the same manner this Notice was provided to you.
This Notice is effective March 3, 2017.
HOW THE PRACTICES MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The Practices may use your medical information only as permitted by HIPAA and other applicable federal laws, including those related to the confidentiality of records maintained by drug and alcohol treatment programs.
DISCLOSURES MADE WITHOUT YOUR AUTHORIZATION –The following is a list of ways that the Practices are allowed to use your medical information without your consent or authorization.
1. For Treatment. The Practices are permitted to use and disclose your medical information for treatment purposes. For example, the nurse at the Practice might discuss your medical information with a lab technician or physician at the same Practice. The Practices will not disclose your medical information to practitioners who are not working at the Practices without your consent.
2. For Health Care Operations. The Practices are permitted to use and disclose your medical information for healthcare care operations of the Practices. For example, the Practice may disclose your medical information to review treatment and services to evaluate the performance of its staff and for other management and administrative purposes.
3. Appointment Reminders and Services. The Practice may also use and disclose your medical information incident to a permitted use or disclosure. For example, it may use your medical information to remind you of services scheduled to be received, to inform you about possible treatment alternatives, or health-related benefits and services that may be of interest to you.
4. Business Associates/Qualified Service Organizations. The Practices will also disclose your medical information with third party “Business Associates” who are “Qualified Service Organizations” that perform various activities on behalf of the Practices (for example, billing, legal, and network and software services) and agree to maintain the confidentiality of your medical information.
5. In Medical Emergencies. The Practices may use and disclose your medical information to medical personnel who have a need for such information for purposes of treating a condition that poses an immediate threat to an individual’s health and safety and which requires immediate medical intervention. The Practices must limit the disclosures to only that medical information which is necessary to treat the emergency condition.
6. To Report Suspected Child Abuse or Neglect. As required by law, the Practices will use and disclose your medical information when the law requires it to report suspected child abuse or neglect, but it will limit its use or disclosure to the relevant requirements of the law and only for initial reporting purposes.
7. To Report a Crime on the Premises. The Practices may disclose your medical information to law enforcement officers as necessary to report crimes and threats to commit crimes on the Practices’ premises or again Practices’ personnel. However, any such disclosures must be limited to the circumstances of the incident and your patient status, name, address, and last known whereabouts.
8. Judicial and Administrative Proceedings. The Practices may, and at many times are required by law, to disclose your medical information in response to a special court order and accompanying subpoena. Federal regulations require the court order to be made only after certain procedures are strictly followed.
9. Research. The Practices may use and disclose your medical information to researchers if the Practices’ program director(s) makes the determination to disclose your medical information in accordance with federal law, which includes that an institutional review board has approved such use and disclosure and whose approval ensures adequate safeguards have been taken to protect your medical information.
10. To Auditors and Evaluators. The Practices may disclose your medical information to qualified persons who are conducting an audit or evaluation of the Practices, provided certain safeguards are met. Additionally, the Practices will only disclose the amount of your medical information that is necessary for the purpose of the audit or evaluation.
11. Vital Statistics. The Practices may disclose your medical information relating to causes of death if required by law to provide such information be reported to registries of vital statistics or as legally permitting inquiries into causes of death.
DISCLOSURES MADE ONLY WITH YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice. These uses and disclosures include most uses and disclosures of psychotherapy notes (where applicable), uses and disclosures for marketing purposes, and disclosures that constitute a sale of your medical information. You may revoke the authorization at any time, except to the extent that (i) the Practice has taken action in reliance thereon, or (ii) the authorization was obtained as a condition of obtaining treatment.
YOUR INDIVIDUAL RIGHTS
The following are statements of your rights about medical information:
1. Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your medical information, by sending a written request specifying what information you want to limit and what limitations on the Practices’ use or disclosure of that information you wish to have imposed. The Practices reserve the right to accept or reject your request and will notify you of its decision. However, the Practices will honor your request if your request restricts disclosure to your insurance company for payment or health care operations provided that you agree to fully pay and be solely responsible for such payment for the service or treatment that is the basis for your request for restriction.
2. Right to Inspect and Copy. You have the right to inspect and copy your records, with limited exceptions. In certain circumstances, the Practices may deny your request. The Practices will respond, in most cases, within thirty (30) days of your request. It may charge a reasonable fee to accommodate your request.
3. Request Amendment. If you believe the Practices’ records are incomplete or inaccurate, you may request that the Practices change your medical information by submitting a written request and explaining the reason in support of the requested revision. The Practices reserve the right to deny your request in certain circumstances, including if the information you asked to amend was not created by the Practices.
4. Request an Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your medical information that the Practices have made. If you would like to have an accounting of disclosures that the Practices have made regarding your medical information, please contact the office listed at the bottom of this Notice.
5. Request a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. In addition, you may obtain a copy of this Notice at the Practices’ website at www.pathwayhealthcare.com.
6. Request Confidential Communications. You have the right to request that you receive your medical information in a specific way or at a specific location. For example, you may ask that the Practices send information to a particular e-mail or to your work address. The Practices will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these notifications, but the Practices will verify the authenticity of such request. You do not need to provide an explanation as to the basis for your request.
COMPLAINTS AND CONTACT INFORMATION
If you believe your privacy rights have been violated, you may make a written complaint to the Practices or to the Secretary of HHS. To file a complaint with the Practices, please submit your complaint to email@example.com.
You will not be retaliated against if you file a complaint.
You may also request additional information regarding how the Practices use your medical information by written request to:
Pathway Healthcare, LLC
ATTN: Privacy Officer
2911 Turtle Creek Blvd., Suite 1240
Dallas, TX 75219