Effective Date: 10/20/2017
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.
Texas Scottish Rite Hospital for Children (TSRHC) creates a record of the care and services you receive and uses this record to provide you with quality care and comply with legal requirements. Because we understand that information about your health is personal, we are committed to protecting that information, whether it is in written, verbal, or electronic format.
This Notice of Privacy Practices, which is required by law, informs you of your rights and our obligations with respect to your protected health information (PHI). PHI is the information that you provide to TSRHC, or that TSRHC creates or receives about your healthcare. PHI can include your age, race, gender, and other personal information related to your past, present, or future physical or mental health.
Generally, when this Notice uses the words “you” or “your” it is referring to the patient who is the subject of patient information. However, when this Notice discusses rights regarding patient information, including rights to access or authorize the disclosure of patient information, “you” and “your” may refer to a minor-patient’s parent(s), legal guardian or other personal representative, or, as applicable, an adult patient or adult patient’s representative.
This Notice applies to all records of your care generated by us. All TSRHC staff, volunteers, and students who have access to your PHI will follow the terms of this Notice.
We are required by law to:
- Maintain the privacy of your PHI, subject to certain exceptions under the law;
- Provide you with notice of our legal duties and privacy practices with respect to PHI;
- Notify affected individuals following a breach of unsecured PHI; and
- Abide by the terms of the Notice that is currently in effect
The following sections explain the various purposes for which TSRHC may use and disclose your PHI. A use or disclosure described in this Notice may include electronic transmittal of your PHI.
A. Permitted Uses and Disclosures of PHI
1. Treatment. We may disclose your PHI to other healthcare providers or individuals who are involved in providing you healthcare. Examples include doctors, hospitals, nurses, therapists, pharmacists, and labs that are involved in your care, whether inside or outside TSRHC.
2. Payment. We may use or disclose your PHI in connection with payment for services you received. For example, we may contact and share information with an insurance company, the government, or other third parties to determine eligibility status, obtain prior approval, determine if your health plan will pay for treatment, and to file claims. If you pay out-of-pocket in full for services provided, you may request that TSRHC not provide your PHI to your insurance company.
3. Healthcare Operations. We may use or disclose your PHI in connection with our healthcare operations, including, for example, quality assessment activities, reviewing the competence or qualifications of healthcare providers, evaluating healthcare provider performance, training healthcare and non-healthcare professionals, accreditation and credentialing activities, business planning and development, creating de-identified health information or a limited data set, and other business operations.
4. Business Associates. We may share your PHI with our business associates. Business associates are individuals and entities that perform functions on our behalf that require access to PHI. To protect your PHI, we require these business associates protect your PHI in compliance with all applicable laws.
5. As Required or Permitted by Law. Sometimes we may, or as required by law, must, report some of your PHI to legal officials or authorities such as law enforcement officials, court officials, or governmental agencies or attorneys.
6. Public Health Activities. As required by law, we may disclose your PHI to public health or other legal authorities to help prevent or control disease, injury, or disability.
7. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These activities include audits; civil, administrative, or criminal investigations or proceedings; inspections; licensure or disciplinary actions; or other activities necessary for government oversight of the healthcare system, government programs, and compliance with civil rights laws.
8. Activities Related to Death. We may release your PHI to coroners, medical examiners, and funeral directors so they can carry out their duties related to your death.
9. Organ and Tissue Donation. In the event of your death and if you are an organ donor, we may disclose your PHI to organ procurement organizations to facilitate organ, eye, or tissue donation and transplantation.
10. Research. We may disclose your PHI for certain research purposes if we have certain protections and protocols in place to ensure your PHI’s privacy.
11. Serious Threat to Health or Safety. As required by law and standards of ethical conduct, we may disclose your PHI 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.
12. Specialized Government Activities. If you are active military or a veteran, we may disclose your PHI as required by military command authorities. We may also be required to disclose PHI to authorized federal officials for the conduct of intelligence or other national security activities.
13. Workers Compensation. We may disclose your PHI to comply with laws relating to workers compensation or other similar programs.
B. Uses and Disclosures of PHI Requiring Your Opportunity to Agree or Object
1. Hospital Directory. Unless you notify us that you object, we will use your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation for directory purposes while you are a patient at TSRHC. The directory information, except for your religious affiliation, may also be released to people who ask for you by name.
2. Individual Involved in Your Care or Payment for Your Care. Unless you notify us that you object, we may release your PHI to a friend, family member, or other person who is involved in your medical care or payment for your medical care. This may include your condition and location in the hospital.
3. Disaster Relief Efforts. Unless you notify us that you object, we may disclose your PHI to an entity (such as FEMA or Red Cross) assisting in a disaster relief effort so that your family can be notified about your condition, status and location if such a situation arises.
4. Fundraising Activities: We may use or disclose certain portions of your PHI, including your name, address, phone number, email address, age, gender, date of birth, the dates you received treatment or services at TSRHC, department(s) of service, treating physician(s), outcome information, and health insurance status to contact you for fundraising efforts to support our programs and operations. You can choose not to receive these communications, and we will inform you how to opt out within each fundraising communication that we send to you.
C. Uses and Disclosures of PHI Requiring Your Written Authorization
1. Not Otherwise Permitted. Any use or disclosure of your PHI not described in Sections A and B of this Notice will be made only with your written authorization.
2. Psychotherapy Notes. We must receive your written authorization to disclose your psychotherapy notes, except for certain treatment, payment, or healthcare operations activities.
3. Marketing and Sale of PHI. We must receive your written authorization for any disclosure of your PHI for marketing purposes or for any disclosure that is a sale of PHI.
D. Your Rights
1. Right to Request Restrictions. You have the right to request a restriction on the PHI we use or disclose about you for treatment, payment or healthcare operations. Further, you have the right to request restrictions on the PHI we disclose to individuals who are involved in your care or the payment for your care. 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 with emergency treatment. To request restrictions, make your request in writing to the TSRHC Privacy Officer (2222 Welborn Street, Dallas, TX 75219).
2. Right to Confidential Communications: You have the right to request that we communicate with you about your PHI by certain means or at certain locations. We will accommodate all reasonable requests and will not ask you the reason for your request.
3. Right to Inspect and Copy. You have the right to inspect and copy PHI that may be used to make decisions about your care. Usually, this includes medical records, but does not include psychotherapy notes. If you wish to inspect and copy PHI that may be used to make decisions about you, you must submit your request in writing to our Health Information Management Department (Texas Scottish Rite Hospital for Children, attn.: Health Information Management Department, 2222 Welborn Street, Dallas, TX 75219). 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 limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed.
4. Right to Request an Amendment. If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information for as long as we maintain your medical record. To request an amendment, your request must be made in writing and submitted to our Health Information Management Department (Texas Scottish Rite Hospital for Children, attn.: Health Information Management Department, 2222 Welborn Street, Dallas, TX 75219). We will notify you if we are unable to grant your request to amend the record.
5. Right to Receive an Accounting of Disclosures. You have the right to receive an accounting (or record) of disclosures of PHI made by us (with some exceptions, including disclosures made for treatment, payment or healthcare operations purposes) during the six years prior to the date of your request. Requests for such accounting can be made to our Health Information Management Department (Texas Scottish Rite Hospital for Children, attn.: Health Information Management Department, 2222 Welborn Street, Dallas, TX 75219).
6. Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice of Privacy Practices. You may also obtain a copy of this notice at our website, www.tsrhc.org/privacy-policy.
7. Right to Opt Out of Receiving Fundraising Communications. From time to time, we may contact you to raise funds for our hospital. We will inform you how to opt out within each fundraising communication that we send to you.
8. Right to Revoke Authorization. If you have provided us with authorization to use or disclose PHI about you, 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.
E. Changes to this Notice
We reserve the right to change our practices and to make the revised or changed provisions effective for all PHI we maintain. You may request a copy of the current notice by writing to the TSRHC Privacy Officer (Texas Scottish Rite Hospital for Children, attn.: Privacy Officer, 2222 Welborn Street, Dallas, TX 75219), 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 at www.scottishritehospital.org/privacy-policy. The effective date of the notice will be on the top right hand corner of the first page.
If you believe your 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 to TSRHC may be submitted in writing to:
Texas Scottish Rite Hospital for Children
2222 Welborn Street
Dallas, Texas 75219
You will not be penalized in any manner for filing a complaint.
G. For More Information
If you have any questions and would like additional information, you may contact the TSRHC Privacy Officer at 214-559-8510.