Privacy Notice

NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER, INC.

NOTICE OF PRIVACY PRACTICES

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.

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record.

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information within 15 days of your request.  We may charge a reasonable, cost-based fee.

Ask for corrections to your medical record.

• You can ask, in writing, for corrections to be made to your medical record, if you think it is incorrect or incomplete.

• If we say “no” to your request, a written response will be provided to you within 60 days, explaining the reasons why the request for correction was denied.

Ask for  confidential communications.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to reasonable requests.

Ask for limits on how your information is used or shared.

• You can ask us not to use or share certain confidential information for treatment, payment or operations. We are not required to agree with your request, and can say “no” if it would affect your care.
• If you pay in full, out-of-pocket, for a service or healthcare item, you can ask us not share that information with your insurance company for the purpose of payment or operations. You may be asked to sign a form at the time you make this request. We will say “yes” to your request unless we are required by law to share that information.

Get a list of those with whom we have shared your health information.

• You can ask for a list of the times we have shared your information for up to six years prior to the date of the request, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment or operations, and certain disclosures that you have requested.
• You can receive one list for free but any additional requests within a 12 month period will be provided to you at a reasonable cost.

Notice of Privacy Practices.

• You can ask for a copy of this privacy notice at any time, even if you have agreed to receive the notice electronically. We will promptly give you a paper copy.

Choose someone to act for you.

• If you have given someone medical power of attorney, or you have a legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure that the person has the authority and can act for you before we take any action.

For certain information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations listed below, talk to us and let us know what you want us to do, and we will follow your instructions.

In these cases you have the right and it is your choice to tell us:

• To share information with family, friends, or others involved in your care.
• To share information in a disaster relief situation.
• To include your information in any directories that we create.
• To contact you regarding any fundraising efforts.

If you are not able to tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest, or if needed lessen a serious or immediate threat to health or safety.

In these cases, we will never share your information without your written permission.

• Marketing purposes (i.e. – Advertising, Brochures, Radio, TV, Signs)
• Social Media (i.e. – Facebook, Twitter, LinkedIn)
• Sale of your information
• Most sharing of mental health (psychotherapy) notes.

In the case of fundraising efforts.

• You have the right to tell us not to contact you anymore.

How do we typically use or share your health information?  We typically use or share your health information (electronic, written, or oral) in the following ways.

To treat you

• We can use your health information and share it with other professionals such as specialists who are treating you.

For payments

• We can use or share your health information to bill and get payment from insurance companies for the health care services you received.

• We can use or share your health information to run our practice, improve your care, and contact you as necessary.

How else can we use or share your health information?  We are allowed or required to share your information in other ways—usually in ways that contribute to the public good such as public health and research.  We have to meet many conditions of the law before we can share your information for these purposes. For more information, see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health or safety issues.

• We can share information about you for certain situations such as:
• Preventing diseases
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected cases of abuse, neglect or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Health research

• We can use or share your information for health research.

Required by law

• We will share your information when required to do so by federal or state laws. When requested, your information will be shared with the Department of Health and Human Services if it wants to see if we are complying with the law.

Tissue and organ bank requests

• We can share health information about you with organ banks.

Requests from medical examiner or funeral director

• We can share health information with the medical examiner, coroner, justice of the peace, or funeral director, when you die.

Worker’s compensation, law enforcement, or other government requests

• We can share health information about you:
• For worker’s compensation claims
• For law enforcement investigations
• Health oversight agencies for activities authorized by law.
• For special government functions such as military, national security, and presidential protective services.

Response to lawsuits legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

We are required by law to maintain the privacy and confidentiality of your health information.  We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.  We must follow the duties and privacy practices described in this notice and give you a copy of it.  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

How can you file a complaint if you think your rights have been violated?  If you think your health information has been accessed, used or shared inappropriately, you can file a complaint.  We will not retaliate against you for filing a complaint.

You can file a complaint with the Compliance Office at Community Healthcare Center by sending a letter to:

Community Healthcare Center

Attn:  Compliance Officer

200 Martin Luther King Jr. Blvd.

Wichita Falls, TX 76301

 Or by calling (940) 766-6306, or online at chcwf.com

You can file a complaint by sending a letter to:

U.S. Department of Health and Human Services Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

(CHC Notice of Privacy Practices, Rev. 10/2015)