Notice of Privacy Practices
Effective Date: 09/01/11
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. PLEASE REVIEW IT CAREFULLY.
OUR PLEDGE REGARDING MEDICAL INFORMATION: Staff at Texas Scottish Rite Hospital for Children (TSRHC) create a record of the care and services you or your child receive(s) at TSRHC and use this record to provide you or your child with quality care as well as to comply with legal requirements. Because we understand that information about your or your child’s health is personal, we are committed to protecting that information, whether it is in written, verbal or electronic format.
This notice, which is required by law, describes the practices of TSRHC with respect to your or your child’s protected health information. It applies to all records of your or your child’s care generated by TSRHC. All TSRHC staff, volunteers, and students who are authorized to have access to your or your child’s health information are subject to the provisions of this Notice.
We are required by law to:
• abide by the terms of the Notice that is in effect at a given time.
• protect the privacy of your or your child’s health information.
• subject to certain exceptions under the law, provide notice of any unauthorized acquisition, access, use or disclosure of your or your child’s protected health information to the extent it was not otherwise protected.
We will not use or disclose your or your child’s health information without written authorization, except as described in this Notice. Use or disclosure pursuant to this Notice may include electronic transmittal of your or your child’s health information.
For each type of use or disclosure, we will explain what we mean and try to give some examples. Not every use or disclosure will be listed. However, all of the ways we are permitted to use and disclose information should fall within one of the following categories:
USE AND DISCLOSURE OF YOUR OR YOUR CHILD’S HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION:
For Treatment: While we are providing you or your child with health-care services, we may need to share your or your child’s health information with other health-care providers or other individuals who are involved in providing health care to you or your child. Examples include doctors, hospitals, nurses, therapists, pharmacists, and labs that are involved in your or your child’s care, whether inside or outside TSRHC.
For Payment: Health information may be sent to a third party payer. The information may include information that identifies you or your child’s diagnosis, procedure, and/or supplies used. If your or your child’s physician feels it is necessary for you or your child to have a procedure or test that is not available at our hospital, we may refer you to another facility for this care/treatment. In this case, we may use and disclose health information about you or your child to justify the medical need for the procedure/test so that the third party payer will reimburse you or the outside facility for the procedure/test we requested.
For Health Care Operations: TSRHC may need to share health information about you or your child in the course of conducting health-care business activities that are related to providing health care to you or your child. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you or your child. We may also combine health information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.
Appointment Reminders and Treatment Alternatives: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest.
Business Associates: There are some services provided at TSRHC through contracts with business associates such as medical transcription and computer software services. We require business associates to protect your or your child’s health information.
Fundraising Activities: We may contact you as part of a fundraising effort.
Hospital Directory: Unless you notify us that you object, we will use your or your child’s name, location in the hospital, your or your child’s general condition (e.g., fair, stable, etc.) and your or your child’s religious affiliation for directory purposes while you are or your child is a patient at TSRHC. The directory information, except for your or your child’s religious affiliation, may also be released to people who ask for you or your child by name.
Individual Involved in Your Care or Payment for Your Care: Unless you notify us that you object, we may release health information about you or your child to a friend or family member who is involved in your or your child’s medical care or payment for your or your child’s medical care. This may include your or your child’s condition and location in the hospital.
Disaster Relief Efforts: We may disclose medical information about you or your child to an entity assisting in a disaster relief effort so that your family can be notified about your or your child’s condition, status and location if such a situation arises.
Research: Under certain circumstances, we may use and disclose medical information about you or your child for research purposes.
To Avert a Serious Threat to Health or Safety: As required by law, and standards of ethical conduct, we may release your or your child’s 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.
Organ and Tissue Donation: In the event of your or your child’s death, we may release your or your child’s health information to organizations involved with obtaining, storing, or transplanting organs, eyes, or tissue to determine your or your child’s donor status.
Military, Veteran, National Security, or Incarceration/Law Enforcement Custody: We may be required to release your or your child’s health information to the military or for national security or intelligence activities or if you are in the custody of law enforcement officials.
Public Health Activities: As required by law, we may report your or your child’s health information to public health or legal authorities to help prevent or control disease, injury or disability.
Health Oversight Activities: We may be required to release health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in health care, 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 or your child’s death.
As Required or Allowed By Law: Sometimes we must report some of your or your child’s health information to legal officials or authorities such as law enforcement officials, court officials or governmental agencies or attorneys.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD: Although your or your child’s medical record is the physical property of TSRHC, the information belongs to you. You have the following rights regarding medical information we maintain about you or your child:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your or your child’s care as provided by law. Usually, this includes medical records, but does not include psychotherapy notes. If you wish to inspect and copy medical information that may be used to make decisions about you or your child, you must submit your request in writing to the Medical Records Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
NOTICE: We may dispose of your or your child’s medical record on or after the date of the patient’s 20th birthday or on or after the 10th anniversary of the date on which the patient was last treated, whichever date is later.
Right to Request an Amendment: If you feel that medical information we have about you or your child is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to TSRHC’s Medical
Records Department. We will notify you if we are unable to grant your request to amend the record.
Right to Obtain an Accounting of Disclosures: You have the right to obtain an accounting of disclosures made of your or your child’s protected health information as provided by law. Requests for such accounting can be made to the TSRHC Medical Records department.
Right to Request Restrictions: You have the right to request a restriction on the medical information we use or disclose about you or your child for treatment, payment or health care operations and as to disclosures permitted to persons including family members who are involved in your or your child’s care or the payment for your or your child’s care as provided by law. However, we are not required by law to agree to a requested restriction and will notify you if we are unable to agree to the requested restriction. If we do agree, we will comply with your request unless the information is needed to provide you or your child emergency treatment. To request restrictions, you must make your request in writing to the TSRHC Privacy Officer.
Right to Request Confidential Information: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all reasonable requests and will not ask you the reason for your request.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Privacy Notice. You may also obtain a copy of this notice at our website, www.tsrhc.org.
Right to Revoke Authorization: If you have provided us with authorization to use or disclosure medical information about you or your child, you have a right to revoke that authorization in writing except to the extent that action has already been taken in reliance on your authorization.
CHANGES TO THIS NOTICE: We reserve the right to change our practices and to make the revised or changed provisions effective for all protected health information we maintain. You may request a copy of the current notice by writing to the TSRHC Privacy Officer, or by requesting a copy from the TSRHC staff when you visit the hospital for an appointment or for admission. The revised notice will also be posted at the hospital as well as on the TSRHC web page. The effective date of the notice will be on the top right hand corner of the first page.
QUESTIONS: If you have any questions and would like additional information, you may contact the TSRHC Privacy Officer at 214-559-5000.
COMPLAINT: If you believe your or your child’s privacy rights have been violated, you can file a complaint with TSRHC or with the Secretary of the Department of Health and Human Services. Complaints may be submitted in writing to the:
Texas Scottish Rite Hospital for Children
2222 Welborn Street
Dallas, Texas 75219
You will not be penalized in any manner for filing a complaint.