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 CAREFULLY

In order to manage the care you receive, a record of your visit is created each time you visit any medical facility. AFHP understands that your medical information that is recorded or received about you and your health is personal. Federal and State laws protect the confidentiality of your health information. This Notice describes how AFHP may use and disclose your information and the rights that you have regarding your health information.

Uses and Disclosures

Treatment

Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For examples, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment

Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated. Your information may also be released to collection agencies if payments are not received by the final notice date.

Healthcare Operations

Your health information may be used as necessary to support the day-to-day activities and management of Arlington Family Health Pavillion. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law Enforcement

Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law- enforcement investigations, and to comply with government-mandated reporting.

Public Health Reporting

Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Other uses and disclosures that may require your authorization

Unless you give notice of an objection, and in accordance with your Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information

Appointment RemindersYour health information will be used by our staff members to send you appointment reminders.

Individual Rights

You have certain rights under the federal privacy standards. These include:

The right to request restrictions on the use and disclosure of your protected health information
The right to receive confidential communications concerning your medical condition and treatment
The right to inspect and copy your protected health information
The right to amend or submit corrections to your protected health information The right to receive an accounting of how and to whom your protected health information has been disclosed
The right to receive a printed copy of this notice

Arlington Family Health Pavilion Duties

We are required by law to:

Maintain the privacy of your protected health information.
Provide you with a copy of the “Notice of Privacy Practices”
Abide by the privacy policies and practices that are currently in effect, and outlined in this notice.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted federal regulation, we require that request to inspect or copy protected health information be submitted in writing.

You may obtain a form to request access to you records by contacting our office personnel. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

According to HIPAA guidelines our office has up to 30 days to issue the records you requested if your request was accepted. If for any reason we are unable to meet those requirements, we will submit to you a letter in writing explaining why we were unable to and when they will be available for you.

Be advised that our office is legally allowed and will most likely charge a copying fee of at least $25 per request per patient. This will vary upon the request.

Complaints

If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Alexis Alwood

Arlington Family Health Pavillion, P.A.

707 N. Fielder Road, Suite A

Arlington, Texas 76012

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address.

Privacy Policies

Arlington Family Health Pavilion

Your trusted local Primary Care Physician