HIPAA is the common, short-hand way to refer to patient privacy issues. Patient privacy involves much more than the HIPAA law, but there are certain things that are specifically required by
law. And, regardless of the terms used, there are some important things you should know about how we handle your health information.
Simple Traditions Family Health PLLC
Notice of Privacy Practices for Protected Health Information
Effective Date: October 24, 2013
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
This office is permitted by federal privacy laws to
make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information (PHI) is the information we create and obtain in
providing our services to you. Such information may include documenting your symptoms, examination, and test results, diagnoses, treatment, and applying for future care or
Examples of Use of Your Health Information for
Treatment Purposes are:
- Obtaining medical information (PHI) from you and recording it in your health
record—either on paper or electronically.
- Referrals to specialists or other health care providers involved in your
treatment. Your protected health information may be released to them so they have the necessary information to manage your care.
- Orders for lab or imaging tests for you which include information about your
Example of Use of Your Health Information for
We do not participate with any third-party payer
(health insurance), so we will not normally submit any of your protected health information for billing purposes.
However, if you have health insurance, and your
insurer requires information about your protected health information, we may release it to them.
Example of Use of Your Health Information for
Health Care Operations:
- Training of medical students
- Documentation, as required, for licensing or
- Quality assessment activities
Your Health Information Rights
The health records we maintain are the
physical property of our office. The information in them, however, belongs to you. You have a right to:
- Request a restriction on certain uses and disclosures of your health information
by delivering the request to our office -- we are not required to grant the request, but we will comply with any request granted;
- Request a restriction on disclosures of medical information to a health plan for
purposes of carrying out payment or health care operations and is not for purposes of carrying out treatment; and the protected health information pertains solely to a health care service for which
the provider has been paid out of pocket in full—we must comply with this request;
- Obtain a paper or electronic copy of the current Notice of Privacy Practices for
Protected Health Information ("Notice") by making a request at our office;
- Request that you be allowed to inspect and copy your health record – you may
exercise this right by delivering the request to our office;
- Appeal a denial of access to your protected health information, except in certain
- Request that your health care record be amended to correct incomplete or incorrect
information by delivering a request to our office. We may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is
no longer available to make the amendment;
- Is not part of the health information kept by or for the
- Is not part of the information that you would be permitted to inspect and copy;
- Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial
and will have an opportunity to submit a statement of disagreement to be maintained with your records;
- Request that communication of your health information be made by alternative means
or at an alternative location by delivering the request in writing to our office;
- Obtain an accounting of disclosures of your health information as required to be
maintained by law by delivering a request to our office. An accounting will not include uses and disclosures of information for treatment, payment, or operations; disclosures for disaster relief,
national security, or intelligence purposes; disclosures to correctional institutions or law enforcement officials for certain purposes regarding inmates or individuals in lawful custody; disclosures
or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to family members or friends
relevant to that person's involvement in your care or in payment for such care; uses or disclosures to notify family or others responsible for your care of your location, condition, or your death; or
disclosures otherwise permitted or required.
- Revoke authorizations that you made previously to use or disclose information by
delivering a written revocation to our office, except to the extent information or action has already been taken.
- Elect to opt out of receiving further fundraising or marketing communications from
- Right to notice of breach. In certain instances we may be obligated to notify you
(and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by HIPAA and applicable
If you want to exercise any of the above rights,
please contact Dr. Paul Dibble at: 281-259-7400 or via mail at 18423 FM 1488 #C, Magnolia, TX 77354, in person or in writing, during regular, business hours. He will inform you of the steps that need
to be taken to exercise your rights.
Our office is required
- Maintain the privacy of your health information as required by
- Provide you with a notice as to our duties and privacy practices as to the
information we collect and maintain about you;
- Abide by the terms of this Notice;
- Notify you if we cannot accommodate a requested restriction or request;
- Accommodate your reasonable requests regarding methods to communicate health
information with you.
We reserve the right to amend, change, or eliminate
provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our
Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional
information, or want to report a problem regarding the handling of your information, you may contact Dr. Paul Dibble at 281-259-7400 or at firstname.lastname@example.org .
Additionally, if you believe your privacy rights have
been violated, you may file a written complaint at our office by delivering the written complaint to Dr. Paul Dibble. You may also file a complaint by mailing it or e-mailing it to the Secretary of
Health and Human Services. (Further information can also be found at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html)
- We cannot, and will not, require you to waive the right to file a complaint with
the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office/hospital.
- We cannot, and will not, retaliate against you for filing a complaint with the
Secretary of Health and Human Services.
Other Disclosures and
Communication with Family
- Using our best judgment, we may disclose to a family member, other relative, close
personal friend, or any other person you identify, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an
- Unless you object, we may use or disclose your protected health information to
notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your
- We may disclose 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.
- We may use and disclose your protected health information to assist in disaster
Organ Procurement Organizations
- Consistent with applicable law, we may disclose your protected health information
to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Food and Drug Administration
- We may disclose to the FDA your protected health information relating to adverse
events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
- If you are seeking compensation through Workers Compensation, we may disclose your
protected health information to the extent necessary to comply with laws relating to Workers Compensation.
- As authorized by law, we may disclose your protected health information to public
health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify
a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse & Neglect
- We may disclose your protected health information to public authorities as allowed
by law to report abuse or neglect.
- We may release health information about you to your employer if we provide health
care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate
whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to your employer will
be made only if you execute a specific authorization for the release of that information to your employer.
- If you are an inmate of a correctional institution, we may disclose to the
institution or its agents the protected health information necessary for your health and the health and safety of other individuals.
- We may disclose your protected health information for law enforcement purposes as
required by law, such as when required by a court order, or in cases involving felony prosecution, or to the extent an individual is in the custody of law enforcement.
- Federal law allows us to release your protected health information to appropriate
health oversight agencies or for health oversight activities.
- We may disclose your protected health information in the course of any judicial or
administrative proceeding as allowed or required by law, with your authorization, or as directed by a proper court order.
- To avert a serious threat to health or safety, we may disclose your protected
health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
- We may disclose your protected health information for specialized government
functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
Coroners, Medical Examiners, and Funeral Directors
- We may release health information to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients of Covered Entities to funeral directors as necessary for
them to carry out their duties.
Marketing or Sale of PHI
- As required by law, we will not sell or market your protected health information without your prior
- Other uses and disclosures, besides those identified in this Notice, will be made
only as otherwise required by law or with your written authorization and you may revoke the authorization as previously provided in this Notice under "Your Health Information
- This Notice is available on our website (www.stfhealth.com).