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: July 01 2017
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 treatment.
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 medical history
Example of Use of Your Health Information for Payment Purposes:
We do not participate with any third-party payer (health insurance), so we will not normally submit any of your protected health information for
However, if you have health insurance, and your insurer requires information about your protected health information, we may release it to
Example of Use of Your Health Information for Health Care Operations:
- Training of medical students
- Documentation, as required, for licensing or credentialing
- 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
- Request that you be allowed to inspect and copy your health record – you may exercise this right by delivering the request to our
- Appeal a denial of access to your protected health information, except in certain circumstances;
- 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 office;
- Is not part of the information that you would be permitted to inspect and copy; or,
- 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 the office.
- 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 state law.
If you want to exercise any of the above rights, please contact Paul Dibble MD at: 281-259-7400 or via mail at 827 S Magnolia Blvd Suite 6,
Magnolia, TX 77355 or in person or in writing, during regular business hours. You will be informed of the steps that need to be taken to exercise your rights.
Our office is required to:
- Maintain the privacy of your health information as required by law;
- 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; and,
- 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
Paul Dibble MD 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 Paul Dibble MD. 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 Uses
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 emergency.
- 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 death.
- 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 relief efforts.
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 (FDA)
- 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
- 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 approval.
- 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 Rights."
- This Notice is available on our website (www.stfhealth.com).