TEXARKANA-BOWIE COUNTY FAMILY HEALTH CENTER

HIPAA PRIVACY STATEMENT

• How we use and release your health information.
• Your rights concerning your health information.
• Our responsibilities to protect your health information.

• Texarkana-Bowie County Family Health Center employees
• Nursing students receiving training thru TBCFHC
• Any member of a volunteer group who may help you while at TBCFHC

• 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, nurses that are involved in your care. .
• PAYMENT PURPOSES
  TBCFHC 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 - TBCFHC 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. PAYMENT PURPOSES TBCFHC 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 - TBCFHC 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
  
  Claims - TBCFHC and businesses we work with share health information for billing and payment purposes. TBCFHC must submit a claim form to get paid, and the claim form must contain certain health information.
  
  
• HEALTH-CARE OPERATIONS PURPOSES
  TBCFHC 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 - TBCFHC 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 information on issues such as women and men’s health.
  
  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 outside organization. This may require the release of your health information to these agencies.
  
  Appointment Reminders - We may use your health records to remind you of recommended services, treatments or scheduled appointments.
  
  Audits - TBCFHC may use or release your health information to make sure that its business practices comply with the law and TBCFHC’s policies. Examples include audits involving quality of care, medical billing or patient confidentiality.
  
  Students and Trainees - Student and other trainees may access your health information as part of their training and educational activities at TBCFHC.
  
  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 other 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.
  
  Avoid 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 under the custody of law enforcement officials.
  
  

• Right to Receive This Notice of Privacy - 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.txkusa.org.
• Right to Request Confidential Communications - you have the right to ask that TBCFHC 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.
• 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.
• 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 information gathered for court proceedings or 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. This office will provide you with the necessary forms and assistance. 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, we will give you the reason in writing.
• 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 April 14, 2003. If you request a record of releases more than once per year, TBCFHC 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.