FAMILY
SERVICE CENTER OF GALVESTON COUNTY, TEXAS
NOTICE OF PRIVACY PRACTICES
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. THE PRIVACY OF YOUR HEALTH INFORMATION
IS IMPORTANT TO US.
OUR
LEGAL DUTY
We are required by applicable federal and state law to maintain
the privacy of your health information. We are also required to
give you this Notice about our privacy practices, our legal duties,
and your rights concerning your health information. We must follow
the privacy practices that are described in this Notice while
it is in effect. This notice takes effect August 1, 2006, and
will remain in effect until we replace it.
We
reserve the right to change our privacy practices and the terms
of this Notice at anytime, provided such changes are permitted
by applicable law. We reserve the right to make the changes in
our privacy practices and the new terms of our Notice effective
for all health information that we maintain, including health
information we created or received before we made the changes.
Before we make a significant change in our privacy practices,
we will change this Notice and make the new Notice available upon
request.
You
may request a copy of our Notice at any time. For information
about our privacy practices, or for additional copies of this
Notice, please contact us using the information listed at the
end of this Notice.
USES
AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment,
payment, and healthcare operations. For example:
Treatment:
We may use or disclose your health information to a physician
or other healthcare provider providing treatment to you.
Payment:
We may use and disclose your health information to obtain payment
for services we provide to you.
Healthcare Operations:
We may use and disclose your health information in connection
with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competence
or qualifications of healthcare professionals, evaluating practitioner
and provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your
Authorization:
In addition to our use of your health information for treatment,
payment or healthcare operations, you may give us written authorization
to use your health information or to disclose it to anyone for
any purpose. If you give us an authorization, you may revoke it
in writing at anytime. Your revocation will not affect any use
or disclosures permitted by your authorization while it was in
effect. Unless you give us a written authorization, we cannot
use or disclose your health information for any reason except
those described in this Notice.
To Your Family and Friends:
We must disclose your health information to you, as described
in the Patients Rights section of this Notice. We may disclose
your health information to a family member, friend, or other person
to the extent necessary to help with your healthcare or with payment
for your healthcare, but only if you agree that we may do so.
Persons Involved In Care:
We may use or disclose health information to notify, or assist
in the notification of (including identifying or locating) a family
member, your personal representative, or another person responsible
for your care, of your location, your general condition, or death.
If you are present, then prior to use or disclosure of your health
information, we will provide you with an opportunity to object
to such uses or disclosures. In the event of your incapacity or
emergency circumstances, we will disclose health information that
is directly relevant to the person's involvement in your healthcare.
Marketing Health-Related Services:
We will not use your health information for marketing communications
without your written authorization.
Required by Law:
We may use or disclose your health information when we are required
to do so by law.
Abuse or Neglect:
We may disclose your health information to appropriate authorities
if we reasonably believe that you are a possible victim of abuse,
neglect, or domestic violence or the possible victim or other
crimes. We may disclose your health information to the extent
necessary to avert a serious threat to your health or safety or
the health or safety of others.
National Security:
We may disclose to military authorities the health information
of Armed Forces personnel under certain circumstances. We may
disclose to authorized federal officials health information required
for lawful intelligence, counterintelligence, and other national
security activities. We may disclose to correctional institutions
or law enforcement officials having lawful custody, the protected
health information of an inmate-patient under certain circumstances.
CLIENT
RIGHTS
Access:
You have the right to look at or get copies of your health information,
with limited exceptions. You may request that we provide copies
in a format other than photocopies. We will use the format you
request unless we cannot practicably do so. (You must make a request
in writing to obtain access to your health information. You may
obtain a form to request access by using the contact information
listed at the end of this Notice. We will charge you a reasonable
cost-based fee for expenses such as copies and staff time. You
may also request access by sending us a letter to the address
at the end of this Notice. If you request copies, we will charge
you $10.00 plus $ .25 for each page copied. Also a $10.00 handling
fee for processing the request and postage will be added if you
request that the documents to be mailed. If you request an alternative
format, we will charge a cost-based fee for providing your health
information in that format. If you prefer, we will prepare a summary
or an explanation of your health information for a fee. Contact
us using the information listed at the end of this Notice for
a full explanation of our fee structure.)
Disclosure Accounting:
You have the right to receive a list of instances in which we
or our business associates disclosed your health information for
purposes, other than treatment, payment, healthcare operations
and certain other activities, for the last 6 years, but not before
June 1, 2006. If you request this accounting more than once in
a 12-month period, we may charge you a reasonable, cost-based
fee for responding to these additional requests.
Restrictions:
You have the right to request that we place additional restrictions
on our use or disclosure of your health information. We are not
required to agree to these additional restrictions, but if we
do, we will abide by our agreement (except in an emergency).
Alternative Communication:
You have the right to request that we communicate with you about
your health information be alternative means or to alternative
locations. (You must make your request in writing.) Your request
must specify the alternative means or location, and provide satisfactory
explanation how payments will be handled under the alternative
means or location you request.
Amendment:
You have the right to request that we amend your health information.
(Your request must be in writing, and it must explain why the
information should be amended.) We may deny your request under
certain circumstances.
Electronic Notice:
If you receive this Notice on our Web site or by electronic mail
(e-mail), you are entitled to receive this Notice in written form.
