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 describes the privacy
practices of GYN PATH Services, Inc.
|II. Our Privacy
|We are required by law to maintain the
privacy of medical and health information about you ("Protected Health
Information" or "PHI") and to provide you with this Notice of our
legal duties and privacy practices with respect to PHI. When we use or
disclose PHI, we are required to abide by the terms of this Notice (or
other notice in effect at the time of the use or disclosure).
|III. Permissible Uses and
Disclosures Without Your Written Authorization
|Certain situations, which we will
describe in Section IV below, we must obtain your written
authorization in order to use and/or disclose your PHI. However, we do
not need any type of authorization from you for the following uses and
A. Uses and Disclosures For Treatment, Payment and Health Care
Operations. We may use and disclose PHI in order to treat you,
obtain payment for services provided to you and conduct our "health
care operations" (e.g., internal administration, quality improvement
and customer service) as detailed below:
• Treatment. We use and disclose PHI to provide treatment and other
services to you--for example, to diagnose and treat your injury or
illness. In addition, we may contact you to provide information
about treatment alternatives or other health-related benefits and
services that may be of interest to you. We may also disclose PHI to
other providers involved in your treatment. For example, we may send
a report about you to a physician so that the other physician may be
better able to treat you.
• Payment. We may use and disclose PHI to obtain payment for
services that we provide to you--for example, disclosures to claim
and obtain payment from your health insurer, HMO, or other company
that arranges or pays the cost of some or all of your health care
("Your Payor"), or to verify that Your Payor will pay for health
• Health Care Operations. We may use and disclose PHI for our health
care operations, which include internal administration and planning
and various activities that improve the quality and cost
effectiveness of the care that we deliver to you. For example, we
may use PHI to evaluate the quality and competence of our
physicians, nurses and other health care workers. We may disclose
PHI to our office manager in order to resolve any complaints you may
have and ensure that you have a pleasant visit with us.
We may also disclose PHI to your other health care providers when
such PHI is required for them to treat you, receive payment for
services they render to you, or conduct certain health care
operations, such as quality assessment and improvement activities,
reviewing the quality and competence of health care professionals,
or for health care fraud and abuse detection or compliance.
B. Disclosure to Relatives Close Friends and Other Caregivers. We
may use or disclose PHI to a family member, other relative, a close
personal friend or any other person identified by you when you are
present for, or otherwise available prior to, the disclosure. If you
object to such uses or disclosures, please notify the Office
If you are not present, you are incapacitated, or in an emergency
circumstance, we may exercise our professional judgment to determine
whether a disclosure is in your best interests. If we disclose
information to a family member, other relative or a close personal
friend, we would disclose only information that is directly relevant
to the person’s involvement with your health care or payment related
to your health care. We may also disclose PHI in order to notify (or
assist in notifying) such persons of your location, general
condition or death.
C. Public Health Activities. We may disclose PHI for the following
public health activities: (1) to report health information to public
health authorities for the purpose of preventing or controlling
disease, injury or disability; (2) to report child abuse and neglect
to public health authorities or other government authorities
authorized by law to receive such reports; (3) to report information
about products and services under the jurisdiction of the U.S. Food
and Drug Administration; (4) to alert a person who may have been
exposed to a communicable disease or may otherwise be at risk of
contracting or spreading a disease or condition.
D. Victims of Abuse, Neglect or Domestic Violence. If we reasonably
believe you are a victim of abuse, neglect or domestic violence, we
may disclose PHI to a governmental authority, including a social
service or protective services agency, authorized by law to receive
reports of such abuse, neglect, or domestic violence.
E. Health Oversight Activities. We may disclose PHI to a health
oversight agency that oversees the health care system and is charged
with responsibility for ensuring compliance with the rules of
government health programs such as Medicare or Medicaid.
F. Judicial and Administrative Proceedings. We may disclose PHI in
the course of a judicial or administrative proceeding in response to
a legal order or other lawful process.
G. Law Enforcement Officials. We may disclose PHI to the police or
other law enforcement officials as required or
permitted by law or in compliance with a court order or a grand jury
or administrative subpoena.
H. Decedents. We may disclose PHI to a coroner or medical examiner
as authorized by law.
I. Organ and Tissue Procurement. We may disclose PHI to
organizations that facilitate organ, eye or tissue procurement,
banking or transplantation.
J. Research. We may use and disclose PHI about you for research
purposes under certain limited circumstances. We must obtain a
written authorization to use and disclose PHI about you for research
purposed, except in situations where a research project meets
specific, detailed criteria established by the HIPPA Privacy Rule to
ensure the privacy of PHI.
K. Health or Safety. We may use or disclose PHI to prevent or lessen
a serious and imminent threat to a person’s or the public’s health
L. Specialized Government Functions. We may use and disclose PHI to
units of the government with special functions, such as the U.S.
military or the U.S. Department of State under certain circumstances
required by law.
M. Workers’ Compensation. We may disclose PHI as authorized by and
to the extent necessary to comply with laws relating to workers'
compensation or other similar programs.
N. As required by law. We may use and disclose PHI when required to
do so by any other law not already referred to in the preceding
|IV. Use and Disclosures
Requiring Your Written Authorization
A. Use or Disclosure with Your Authorization. For any purpose
other than the ones described in Section III, we only may use or
disclose PHI when (1) you give us your authorization on our
authorization form ("Your Authorization"). For instance, you will
need to execute an authorization form before we can send your PHI to
your life insurance company, to your child’s camp or school, or to
the attorney representing the other party in litigation in which you
B. Special Authorization. Confidential HIV-related information (for
example, information regarding whether you have ever been the
subject of an HIV test, have HIV infection, HIV-related illness or
AIDS, or any information which could indicate that you have ever
been potentially exposed to HIV) will never be used or disclosed to
any person without your specific written authorization, except to
certain other persons who need to know such information in
connection with your medical care, and, in certain limited
circumstances, to public health or other government officials (as
required by law), to persons specified in a special court order, to
insurers as necessary for payment for your care or treatment, or to
certain persons with whom you have had sexual contact or have shared
needles or syringes (in accordance with any specified process set
forth in Texas State law). There is only one type of disclosure of
confidential HIV related information which is permitted with Your
Authorization, as opposed to Your Special Authorization: disclosures
to a third party payor for any reason other than obtaining payment
for health care services rendered to you.
C. Marketing Communications. We must also obtain your written
authorization ("Your Marketing Authorization") prior to using your
PHI to send you any marketing materials. (We can, however, provide
you with marketing materials in a face-to-face encounter, without
obtaining Your Marketing Authorization. We are also permitted to
give you a promotional gift of nominal value, if we so choose,
without obtaining Your Marketing Authorization.) In addition, we may
communicate with you about products or services relating to your
treatment, case management or care coordination, or alternative
treatments, therapies, providers or care settings. We may use or
disclose PHI to identify health-related services and products that
may be beneficial to your health and then contact you about the
services and products.
|V. Your Individual Rights
A. For Further Information; Complaints. If you desire further
information about your privacy rights, are concerned that we have
violated your privacy rights or disagree with a decision that we
made about access to PHI, you may contact our Office Manager. You
may also file written complaints with the Director, Office for Civil
Rights of the U.S. Department of Health and Human Services. Upon
request, the Office Manager will provide you with the correct
address for the Director. We will not retaliate against you if you
file a complaint with us or the Director.
B. Right to Request Additional Restrictions. You may request
restrictions on our use and disclosure of PHI (1) for treatment,
payment and health care operations, (2) to individuals (such as a
family member, other relative, close personal friend or any other
person identified by you) involved with your care or with payment
related to your care, or (3) to notify or assist in the notification
of such individuals regarding your location and general condition.
All requests for such restrictions must be made in writing. While we
will consider all requests for additional restrictions carefully, we
are not required to agree to a requested restriction. If you wish to
request additional restrictions, please obtain a request form from
our Office Manager and submit the completed form to the Office
Manager. We will send you a written response.
C. Right to Receive Confidential Communications. You may request,
and we will accommodate, any reasonable written request for you to
receive PHI by alternative means of communication or at alternative
D. Right to Inspect and Copy Your Health Information. You may
request access to your medical record file and billing records
maintained by us in order to inspect and request copies of the
records. All requests for access must be made in writing. Under
limited circumstances, we may deny you access to your records. If
you desire access to your records, please obtain a record request
form from the Office Manager and submit the completed form to the
Office Manager. If you request copies, we may charge you a
reasonable fee for each page.
You should take note that, if you are a parent or legal guardian of
a minor, certain portions of the minor’s medical record will not be
accessible to you (e.g. records relating to venereal disease,
abortion, or care and treatment to which the minor is permitted to
consent himself/herself (without your consent) such as HIV testing,
sexually transmitted disease diagnosis and treatment, chemical
dependence treatment, prenatal care, care received by a married
minor, and contraception and/or family planning services).
E. Right to Revoke Your Authorization. You may revoke Your
Authorization, Your Special Authorization, or Your Marketing
Authorization, except to the extent that we have taken action in
reliance upon it, by delivering a written revocation statement to
the Office Manager identified below. [A form of Written Revocation
is available upon request from the Office Manager.]
F. Right to Amend Your Records. You have the right to request that
we amend PHI maintained in your medical record file or billing
records. If you desire to amend your records, please obtain an
amendment request form from the Office Manager and submit the
completed form to the Office Manager. All requests for amendments
must be in writing. We will comply with your request unless we
believe that the information that would be amended is accurate and
complete or other special circumstances apply.
G. Right to Receive An Accounting of Disclosures. Upon written
request, you may obtain an accounting of certain disclosures of PHI
made by us during any period of time prior to the date of your
request provided such period does not exceed six years and does not
apply to disclosures that occurred prior to April 14, 2003. If you
request an accounting more than once during a twelve (12) month
period, we may charge you a reasonable amount per page of the
H. Right to Receive Paper Copy of this Notice. Upon written request,
you may obtain a paper copy of this Notice, even if you agreed to
receive such notice electronically.
|VI. Effective Date and
Duration of This Notice
A. Effective Date. This Notice is effective on April 14, 2003.
B. Right to Change Terms of this Notice. We may change the terms of
this Notice at any time. If we change this Notice, we may make the
new notice terms effective for all PHI that we maintain, including
any information created or received prior to issuing the new notice. You may obtain any revised notice by
contacting the Office Manager.
|VII. Office Manager
|You may contact us at: Office
Manager, 8815 Dyer Street, Suite 200, El Paso, Texas 79904, 915-755-8478
(OFC), 915-755-9668 (FAX)