Privacy Policy
 

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 APPLIES TO ALL OF THE RECORDS OF YOUR CARE GENERATED BY THE CENTER, WHETHER MADE BY THE CENTER OR AN ASSOCIATED ENTITY.

Our staff understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a medical record that details the care and services you receive. We refer to this as protected health information (PHI). We need that record in order to provide you with quality care and to comply with certain legal requirements. This notice applies to any medical records generated by our office. While we may sometimes care for you during a hospital stay the hospital may have different policies and/or procedures and a separate notice about your medical information.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; performing a physical examination; performing therapeutic or diagnostic tests; referring you to another doctor or clinic for additional or specialist services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health insurance coverage or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). "Health care operations" mean those administrative and managerial functions that we have to do in order to run the Practice or the Center more efficiently and make sure that all of our patients receive quality care. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; reviewing our treatment and services to evaluate the performance of our staff; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.

In order to maintain the communications that allow for quick, effective, and high quality health care, we may release medical information about you to a family member or friend who accompanies you to your appointment unless you tell us not to.

Under most circumstances, we are not required to obtain a signed consent for Treatment, Payment, or Operations. However, we will ask you to sign an authorization for certain purposes such as release of PHI to a referring provider or for claims payment in order to comply with state regulations.

We routinely use your health information inside the Practice and/or the Center for these purposes without any special permission. We will ask for special written permission in the following situations: research, legal requests, and marketing. We will also ask for your written authorization before we disclose PHI that pertains to HIV, AIDS, mental health treatment or substance abuse.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office or Center at all. Such uses or disclosures are:

  • When a state or federal law mandates that certain health information be reported for a specific purpose;
  • For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the Federal Food and Drug Administration regarding drugs or medical devices;
  • Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
  • Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
  • We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  • Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
  • Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at the Center; or to report a crime that happened somewhere else;
  • Disclosure to a correctional institution or law enforcement officials if you are an inmate or under the custody of a law enforcement official;
  • Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
  • Uses or disclosures for health related research;
  • Uses and disclosures to prevent a serious threat to health or safety;
  • Uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;
  • Disclosures of de-identified information;
  • Disclosures of a "limited data set" for research, public health, or health care operations;
  • Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
  • Disclosures to "business associates" who perform health care operations for us and who commit to respect the privacy of your health information.
  • APPOINTMENT REMINDERS

    We may call, write, or email to remind you of scheduled appointment that it is time to make a routine appointment or to follow up after a procedure. We may also call or write to notify you of other treatments or services available at our Center that might help you. Unless you object, this contact may be on an answering machine or other method, which could (potentially) be received or intercepted by others. This call or message may be to a home or work number. In writing, you can ask us to use other methods and we will consider your request and determine our ability to comply.

    OTHER USES AND DISCLOSURES

    We will not make any other uses or disclosures of your health information unless you sign a written "authorization form." Federal law determines the content of an "authorization form". Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it is your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form or you can use one of ours.

    If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign the authorization, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the contact person named at the beginning of this Notice.

    YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION The law gives you many rights regarding your health information.

  • Restrictions: You can ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the contact person at the address shown at the beginning of this Notice.
  • Communications: You can ask us to communicate with you in a confidential way, such as phoning you at work rather than at home, by mailing health information to a different address, or, at some point in the future, we may be able to email to your personal email address. We will accommodate these requests if they are reasonable and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the contact person at the address shown at the beginning of this Notice.
  • Photocopies: You can ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or receiving a copy of your health information. For the most part, however, you will be able to review or receive a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You will be asked to pay a reasonable charge in advance for such access or copies. If we deny your request, we will send you a written explanation and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30-day extension of the time for us to give you access or photocopies if we send you a written notice of extension. If you want to review or get photocopies of your health information, send a written request to the contact person at the address shown at the beginning of this Notice.
  • Amendments: You can ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information and others that you specify. If we do not agree, you can write a statement of your position and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have on 30-day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the office contact person at the address shown at the beginning of this Notice.
  • Disclosures: You can get a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include: disclosures for purposes of treatment, payment, or health care operations; disclosures that were made with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30-day extension of time if we notify you of the extension in writing. If you want a list, send a written request to the contact person at the address shown at the beginning of this Notice.
  • Notice: You can get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the contact person at the address shown at the beginning of this Notice.

    OUR NOTICE OF PRIVACY PRACTICES

    By law, we must abide by the terms of this Notice of Privacy Practices. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our Center, have copies available in our office and post it on our website.

    COMPLAINTS

    If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the contact person at the address shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.

    FOR MORE INFORMATION

    If you want more information about our privacy practices, call or visit the contact person at the address or phone number shown at the beginning of this Notice.

    HIPAA Privacy Policy

    THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

    PLEASE REVIEW IT CAREFULLY.

    WHAT IS THIS NOTICE?

    This notice tells you: How we use and release your health information. Your rights concerning your health information. Our responsibilities to protect your health information.

    TO WHOM DOES THIS NOTICE APPLY? This notice applies to all members and employees of Kip Queenan MD, PLLC.

    WHAT ARE OUR RESPONSIBILITIES TO YOU? Your health information is personal. We are required by law to protect the privacy of your health information and will only release your health information as allowed by law or with special written permission (authorization) from you. We use the least amount of health information needed to do our work. Only those who need your health information to provide services are allowed to use it. We protect your information whether verbal, on paper or electronic.

    WHEN IS THE NOTICE EFFECTIVE? This notice is effective on October 1, 2007. Kip Queenan MD, PLLC reserves the right to change this notice after the effective date. We reserve the right to make the revised notice apply for all health information that we already have about you, as well as any information we receive in the future. The current notice will be available on our Web site at www.kipqueenanmd.com.

    Business Activities - We may use or release your health information to perform internal business activities. Examples include: business planning, computer systems maintenance, legal services and customer service.

    OTHER PURPOSES Required By Law - Sometimes we must report some of your health information to legal officials or authorities, such as law enforcement officials, court officials, governmental agencies or attorneys. Examples include: reporting suspected abuse or neglect, reporting domestic violence or certain physical injuries, or responding to a court order, subpoena, warrant or lawsuit request.

    Public-Health Activities - We may be required to report your health information to authorities to help prevent or control disease, injury or disability. Examples include: reporting certain diseases, injuries, birth or death information; information of concern to the Food and Drug Administration; or information related to child abuse or neglect. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety.

    Health Oversight Agencies - We may be required to release health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health-care system, or for governmental benefit programs.

    Activities Related to Death - We may be required to release health information to coroners, medical examiners and funeral directors so they can carry out their duties related to your death. Examples include: identifying the body, determining the cause of death, or, in the case of funeral directors, carrying out funeral preparation activities.

    Organ, Eye or Tissue Donation - In the event of your death, we may release your health information to organizations involved with obtaining, storing or transplanting organs, eyes or tissue to determine your donor status.

    HOW DO WE USE AND RELEASE YOUR HEALTH INFORMATION?

    Kip Queenan MD, PLLC has to use and release some of your health information to conduct its business. The following section explains some of the ways we are permitted to use and release health information without authorization from you.

    USE AND RELEASE OF YOUR HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION:

    TREATMENT PURPOSES While we are providing you with health-care services, we may need to share your health information with other health-care providers or other individuals who are involved in your treatment. Examples include: doctors, hospitals, pharmacists, therapists, nurses and labs that are involved in your care.

    PAYMENT PURPOSES Kip Queenan MD, PLLC may need to share a limited amount of health information to obtain or provide payment for the health-care services provided to you. Examples include:

    Eligibility - Kip Queenan MD, PLLC may contact the company or government program that will be paying for your health care. This helps us determine if you are eligible for benefits, and if you are responsible for paying a co- payment or deductible.

    Claims - Kip Queenan MD, PLLC and businesses we work with share health information for billing and payment purposes. For example, your doctor must submit a claim form to get paid, and the claim form must contain certain health information.

    HEALTH-CARE OPERATIONS PURPOSES Kip Queenan MD, PLLC may need to share your health information in the course of conducting health-care business activities that are related to providing health care to you. Examples include:

    Quality Improvement Activities - Kip Queenan MD, PLLC may use and release health information to improve the quality or the cost of care. This may include reviewing the treatment and services provided to you. This information may be shared with those who pay for your care, or with other agencies that review this data.

    Health Promotion and Disease Prevention - We may use your health information to tell you about disease prevention and health-care options. For instance, we may send you health-care information on issues such as women's health, cancer or asthma.

    Case Management and Referral - If you have a health problem or a health- care need is identified by you or one of your providers, you may be referred to an organization such as a home health agency, medical-equipment company or other community or government program. This may require the release of your health information to these agencies.

    Appointment Reminders - Kip Queenan MD, PLLC may use your health records to remind you of recommended services, treatments or scheduled appointments.

    Business Associates - There are some services provided at Kip Queenan MD, PLLC through contracts with business associates such as medical transcription services and record storage. We require business associates to protect your health information.

    Audits - Kip Queenan MD, PLLC may use or release your health information to make sure that its business practices comply with the law and Kip Queenan MD, PLLC's policies. Examples include audits involving quality of care, medical bills or patient confidentiality.

    Research Purposes - At times, we may use or release health information about you for research purposes; however, all research projects require a special approval process before they begin. This process may include asking for your authorization. In some instances, your health information may be used but your identity is protected.

    To Avoid a Serious Threat to Health or Safety - As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to anyone's health or safety.

    Military, National Security or Incarceration/Law Enforcement Custody - We may be required to release your health information to the proper authorities so they may carry out their duties under the law. This may be the case if you are in the military or involved in national security or intelligence activities, or if you are in the custody of law-enforcement officials.

    Worker's Compensation - We may be required to release your health information to the appropriate persons to comply with the laws related to workers' compensation or other similar programs that provide benefits for work-related injuries or illness.

    USE AND RELEASE OF YOUR HEALTH INFORMATION REQUIRING YOUR AUTHORIZATION

    Persons Involved in Your Care - In certain situations, we may release health information about you to persons involved with your care, such as friends or family members. We may also give information to someone who helps pay for your care. You have the right to approve such releases, unless you are unable to function, or if there is an emergency.

    WHEN IS YOUR AUTHORIZATION REQUIRED?

    Except for the types of situations listed above, we must obtain your authorization for any other types of releases of your health information. If you provide us authorization to use or release health information about you, you may cancel that authorization in writing at any time. Any authorization you sign may be cancelled by following the instructions described on the authorization form. You may receive more information about this by contacting the privacy officer.

    WHAT ARE YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION?

    Kip Queenan MD, PLLC wants you to know your rights regarding your health information.

    Right to Receive This Notice of Privacy Practices... You have the right to receive a paper copy of this notice at any time. You may obtain a copy of the current notice in all clinical areas or by visiting our Web site at www.kipqueenanmd.com.

    Right to Request Confidential Communications... You have the right to ask that Kip Queenan MD, PLLC communicate your health information to you in different ways or places. For example, you can ask that we only contact you by telephone at work, or that we only contact you by mail at home. We will do this whenever it is reasonably possible. You can find out how to make such a request by contacting the clinic manager or the privacy officer.

    Right to Request Restrictions...You have the right to request restrictions or limitations on how your health information is used or released. We have the right to deny your request. You may obtain information on how to ask for a restriction on the use or release of your information by contacting the clinic manager or the privacy officer. Right to Access... With a few exceptions, you have the right to review and receive a copy of your health information. Some of the exceptions include: Psychotherapy notes; Information gathered for court proceedings; And any information your provider feels would cause you to commit serious harm to yourself or to others.

    You can get a copy of your health information by submitting a request in writing to Kip Queenan MD, PLLC. The phone number is 469-484-4264. We may charge you a fee to copy and/or mail your health record to you. If you are denied access to your health record for any reason, Kip Queenan MD, PLLC will tell you the reasons in writing. We will also give you information about how you can file an appeal if you are not satisfied with our decision.

    Right to Amend... You have the right to ask that Kip Queenan MD, PLLC's information in your health record be changed if it is not correct or complete. You must provide the reason why you are asking for a change. You may request a change by sending a request in writing to Kip Queenan MD, PLLC. The phone number is 469-484-4264. We may deny your request if: We did not create the information; We do not keep the information; You are not allowed to see and copy the information; or The information is already correct and complete.

    Right to a Record of Releases... You have the right to ask for a list of releases of your health information by sending a request in writing to the privacy officer at the address at the end of this notice. Your request may not include dates before October 1, 2007. If you request a record of releases more than once per year, Kip Queenan MD, PLLC may charge a fee for providing the list. The list will contain only information that is required by law. This list will not include releases for treatment, payment, health-care operations or releases that you have authorized

    WHAT CAN YOU DO IF YOU HAVE A COMPLAINT ABOUT HOW YOUR HEALTH INFORMATION IS HANDLED?

    If you believe that your privacy rights have been violated, you may file a complaint with Kip Queenan MD, PLLC or with the Secretary of Health and Human Services. To receive help in filing a complaint with Kip Queenan MD, PLLC, you may contact our privacy officer at the address at the end of this notice. You will not be denied treatment or penalized in any way if you file a complaint.

    PRIVACY OFFICER CONTACT INFORMATION

    Kip Queenan MD, PLLC Kip E. Queenan, MD - Privacy Officer 16479 Dallas Parkway, Suite 320 Addison, TX 75001 469-484-4264

    The terms "Kip Queenan MD, PLLC," "we" and "our" refer to Kip Queenan MD, PLLC, a professional limited liability corporation.

    If you have any questions about this notice, please call the Kip Queenan MD, PLLC privacy officer at 469-484-4264.

    Kip Queenan MD, PLLC is required by law to provide you with this notice and to abide by the terms of its current notice.

    Updated June 25, 2016

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