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VEIN CENTERS OF TEXAS

Charles J. Rodman, M.D., P.A.

Beaumont – # 7 Bayoubrandt, Beaumont, TX 77706 (409) 832-8323
Corpus Christi – 1756 Santa Fe, Corpus Christi, TX 78404 (361) 888-4435
Mesquite – 1600 Republic Parkway - Suite 200, Mesquite, TX 75150 (972) 279-8346
Plano – 4716 Alliance Boulevard - Suite 400, Plano, TX 75093 (972) 612-8346

NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations created as a result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Updated October 2009

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS OFFICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY!!

  1. Our Commitment to your Privacy

    This practice is dedicated to maintaining the privacy of your Individually Identifiable Health Information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning our IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. Please note that we reserve the right to amend this Notice at any time. A current copy of this Notice shall always be posted in our offices. Any change in this Notice will apply to medical information that we already have about you.

    We realize that these laws are complicated, but we must provide you with the following important information.
    • How we may use and disclose your IIHI
    • Your privacy rights with respect to your IIHI
    • Our obligations concerning the use and disclosure of your IIHI
       
  2. Questions? If you should have any questions about this notice, please contact Mark Bower at (361)888-4435.
  3. We may use and disclose your individually identifiable health information (IIHI) in the following ways:

    The following categories describe the different ways in which we may use and disclose your IIHI.
    1. Treatment – Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory test (such as blood work or urine tests) and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you or we might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our office – including, but not limited to, our doctors and nurses – may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may disclose your IIHI to other health care providers related to your treatment.
    2. Payment – Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits) and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We may also use and disclose your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services or items. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.
    3. Health Care Operations – Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use our IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.
    4. Appointment Reminders – Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
    5. Health-Related Benefits and Services – Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest to you.
    6. Release of Information to Family/Friends – Our practice may use and disclose your IIHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter will have access to this child’s medical information.
    7. Disclosures Required by Law – Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.
       
  4.  Use and Disclosure of your IIHI in Certain Special Circumstances
     
    The following categories describe unique scenarios in which we may use or disclose your identifiable health information.
    1.  Public Health Risks – Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
      • Maintaining vital records, such as births and deaths
      • Reporting child abuse or neglect
      • Notifying a person regarding potential exposure to a communicable disease
      • Notifying a person regarding potential risk for spreading or contracting a disease or condition
      • Reporting reactions to drugs or problems with products or devices
      • Notifying individuals if a product or device they may be using has been recalled
      • Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
      • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
    2.  Health Oversight Activities – Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary action; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor or government programs, compliance with the civil rights laws and the health care system in general.
    3. Lawsuits and Similar Proceedings – Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your IIHI in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
    4.  Law Enforcement - We may release your IIHI if asked to do so by a law enforcement official:
      • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
      • Concerning a death we believe has resulted from criminal conduct
      • Regarding criminal conduct at our office
      • In response to a warrant, summons, court order, subpoena or similar legal process
      • To identify/locate a suspect, material witness, fugitive or missing person
      • In an emergency, to report a crime (including the location of victim(s) of the crime, or the description, identity or location of the perpetrator)
    5.  Deceased Patients - Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
    6. Organ and Tissue Donation - Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
    7. Research - Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not be practicably be conducted without access to and use of the PHI.
    8. Serious Threats to Health or Safety - Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
    9. Military - Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
    10. National Security - Our practice may disclose your IIHI to federal official for intelligence and national security activities authorized by law. We may also disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
    11. Inmates - Our practice may disclose your IIHI to correctional institutions of law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
    12. Worker’s Compensation - Our practice may release your IIHI for Worker’s Compensation and similar programs.
       
  5.  Your Rights Regarding your IIHI

    You have the following rights regarding the IIHI that we maintain about you:
    1. Confidential Communications - You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.
    2. Inspection and Copies - You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including the psychotherapy notes. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
    3. Accounting of Disclosures - All of our patients have the right to request an “accounting of disclosures”. An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment, non-payment or non-operations purposes. Use of your IIHI as part of the routine patient care in our practice is not requited to be documented. For example, the doctor sharing information with the nurse; the billing department using your information to file your insurance claim. All requests for an “accounting of disclosures” must state a time period, with may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
    4. Right to Amend. If you feel that medical information maintained about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as your medical information is kept by us. To request an amendment, your request must be in writing and should be submitted to Mark Bower, Privacy Officer. In addition, you must provide in your written request a reason that supports the request being made. Please note that we may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (a) was not created by us; (b) is not a part of the medical information kept by us; (c) is not part of the information which you would be permitted to inspect and copy; or (d) is accurate and complete.
    5. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care of the payment for your care. Please note that we are not required to agree to your request. To request restrictions, you must make a request in writing to Mark Bower, Privacy Officer. In the request, you need to indicate: (1) what information you want to limit and (2) to whom you want the limits to apply.
    6. Right to a Paper Copy of This Notice - You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.
    7.  Right to File a Complaint - If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. Filing a complaint will not result in any retaliation against you.
    8. Right to Provide an Authorization for Other Uses and Disclosures - Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care for a certain amount of time.

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