| 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.
Purpose of this Notice
We are required by law to maintain the privacy of your protected
health information (PHI). This notice applies to all records of
the health care and services you received at UTMB. This notice
will tell you about the ways in which we may use and disclose
your PHI. This notice also describes your rights and certain obligations
we have regarding the use and disclosure of your PHI.
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Who Will Follow this Notice
This notice describes UTMB’s privacy practices, as well
as the privacy practices of:
- any health care professional authorized to enter information
into your UTMB medical record;
- all departments, sections and units of UTMB;
- any member of a volunteer group that interacts with you while
you are at UTMB; and
- all employees, staff, students and other UTMB personnel.
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UTMB’s Commitment
We are required by law to:
- make sure that your PHI is kept private;
- give you this notice of our legal duties and privacy practices
with respect to your PHI;
- follow the terms of this notice as long as it is currently
in effect. If we revise this notice, we will follow the terms
of the revised notice as long as it is currently in effect;
- train our personnel concerning privacy and confidentiality;
and
- mitigate (lessen the harm of) any breach of privacy/confidentiality.
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Understanding Your Health Record
Each time you visit a UTMB hospital, physician or affiliated
health care provider, a record of your visit is made. Typically,
this record contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for care or treatment. This information,
often referred to as your health or medical record, serves as
a:
- basis for planning your care, treatment and any follow up
care you may need;
- means of communication among the many health professionals
who contribute to your care;
- legal document describing the care you received;
means by which you or a third-party payer (for example, insurance
carriers, Medicare, Medicaid) can verify that services billed
were actually provided;
- tool in educating heath professionals;
- source of information for medical research;
source of information for public health officials charged with
improving the health of the nation;
- source of information for facility planning and marketing;
and
- tool which can be used to assess and continually improve the
care rendered and the results achieved.
Understanding what is in your record and how your health information
is used helps you to:
- ensure its accuracy;
- better understand who, what, when, where and why others may
access your health information; and
- make more informed decisions when authorizing disclosure to
others.
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How We May Use and Disclose Information about
You
The following categories (listed in bold-face print, below)
describe different ways that we use and disclose your protected
health information (PHI). For each category of uses or
disclosures we will explain what we mean and give you some examples.
Not every use or disclosure in a category will be listed. However,
all of the ways we are permitted to use and disclose information
fall within the categories below.
For
Treatment. We are permitted to use and disclose
your PHI to doctors, nurses, technicians, medical students or
other personnel who are involved in taking care of you at UTMB
or provide you with medical treatment or services. For example,
a doctor treating you for a broken leg may need to know if you
have diabetes because diabetes may slow the healing process. In
addition, the doctor may need to tell the dietitian if you have
diabetes so that the dietitian can arrange for appropriate meals.
Different departments of UTMB also may share your PHI in order
to coordinate the different services that you need, such as lab
work, x-rays, and prescriptions. We also may disclose your PHI
to health care providers outside UTMB who may be involved in your
medical care, such as physicians who will provide follow-up care,
physical therapy organizations, medical equipment suppliers, and
skilled nursing facilities.
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For
Payment.
We are permitted to use and disclose your PHI
so that the treatment and services you receive at UTMB may be
billed to (and payment may be collected from) your insurance company
or a third party. For example, we may need to give your health
plan information about the surgery you received at UTMB so your
health plan will pay us or reimburse you for the surgery. We also
may tell your health plan about a treatment you are going to receive
to obtain prior approval or to determine whether your plan will
cover the treatment.
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For
Health Care Operations. We are permitted to use
and disclose your PHI for our business operations. These uses
and disclosures are necessary to run UTMB and to make sure that
all of our patients receive quality care. For example, we may
use PHI to review our treatment and services and to evaluate the
performance of our staff in caring for you. We also may disclose
information to faculty physicians, nurses, technicians, house
staff (including residents and interns), medical students, and
other UTMB personnel to conduct training programs. We also may
combine certain PHI about several UTMB patients as part of a study
to determine what additional services UTMB should offer, what
services are not needed, and whether certain new treatments are
effective. We also may remove all information that identifies
you from a set of PHI so that others may use that information
to study health care and health care delivery without learning
who the specific patients are.
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To
Business Associates for Treatment, Payment and Health Care Operations.
We are permitted to disclose your PHI to our business associates
in order to carry out treatment, payment or health care operations.
For example, we may disclose your PHI to a company we hire to
bill insurance companies on our behalf to help us obtain payment
for the health care services we provide.
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Hospital
Directory. Unless you express an objection, we
are allowed to include certain limited information about you in
the Patient Directory while you are a patient in a UTMB hospital.
This information may include your name, your location at UTMB
(for example, Intensive Care Unit, Labor & Delivery), your
general condition (for example, fair, stable, good) and your religious
affiliation. The directory information, except for your religious
affiliation, also may be released to people who ask for you by
name. Your religious affiliation may be given to a member of the
clergy, such as a priest or rabbi, even if the clergy member does
not ask for you by name. The purpose of the Patient Directory
is to allow your family, friends and clergy to visit you at UTMB
and know how you are doing. If you cannot provide your objection
to these uses and disclosures because of incapacity or an emergency
treatment circumstance, we may use or disclose some or all of
this information if that disclosure is consistent with what you
have told us previously and if the disclosure is in your best
interest as determined in the exercise of our professional judgment.
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Individuals
Involved in Your Care or Payment for Your Care.
We may release your PHI to a family member, other relative or
close personal friend who is involved in your medical care if
the PHI released is directly relevant to the person’s involvement
with your care. We also may release information to someone who
helps pay for your care. We also may tell your family or friends
that you are at UTMB and what your general condition is. In addition,
we may disclose your PHI to a group assisting in a disaster relief
effort so that your family can be notified about your location
and general condition.
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Appointment
Reminders. We may use and disclose medical information
to contact you as a reminder that you have an appointment for
treatment or medical care at UTMB.
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Treatment
Alternatives. We may use and disclose medical
information to give you information about treatment options or
alternatives that may be of interest to you.
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Health-Related
Benefits and Services. We may use and disclose
medical information to tell you about health-related benefits
or services that may be of interest to you.
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Fund
raising Activities. We may use certain allowable
PHI to contact you in an effort to raise money for UTMB and its
operations. This limited PHI includes demographic information
about you (for example, your name, address, phone number), and
the dates you received treatment or services at UTMB. If you do
not want us to contact you for our fund raising efforts, please
contact the Office of University Advancement at (409)772-3951.
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Special
Situations
As
Required By Law. We will disclose your PHI when
required to do so by federal, state, or local law.
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Public
Health Activities. We may disclose your PHI for
public health activities. For example, public health activities
generally include:
- preventing or controlling disease, injury or disability;
- reporting births and deaths;
- reporting child abuse or neglect;
reporting reactions to medications or problems with products;
- notifying patients of recalls of products they may be using;
- notifying a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or
condition; or
- notifying the appropriate government authority if we believe
a patient has been the victim of abuse, neglect or domestic
violence. We will only make this disclosure if you agree or
when required or authorized by law.
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Health
Oversight Activities. We may disclose PHI to a
health oversight agency for activities authorized by law such
as audits, investigations, inspections and licensure. These activities
are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
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Lawsuits
and Disputes. If you are involved in a lawsuit
or a dispute, we may disclose your PHI in response to a court
or administrative order. We may also disclose your PHI in response
to a subpoena, discovery request or other lawful process by someone
else involved in the dispute, but only if efforts have been made
to tell you about the request or to obtain an order protecting
the information requested.
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Law
Enforcement. We may release PHI if asked to do
so by a law enforcement official:
- in response to a court order, subpoena, warrant, summons or
similar process;
- to identify or locate a suspect, fugitive, material witness
or missing person, but only if limited information (e.g., name
and address, date and place of birth, Social Security number,
blood type and RH factor, type of injury, date and time of treatment,
and date and time of death, if applicable) is disclosed;
- about the victim of a crime if, under certain limited circumstances,
we are unable to obtain the victim’s agreement;
- about a death we believe may be the result of criminal conduct;
- about criminal conduct we believed occurred on UTMB’s
premises; and
- in emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location
of the person who committed the crime.
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Coroners,
Medical Examiners and Funeral Directors. We may
release PHI about patients of UTMB to a coroner or medical examiner
to identify a deceased person or to determine the cause of death.
We may also release PHI about patients of UTMB to funeral directors
as necessary to help them carry out their duties.
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Organ
and Tissue Donation. We may release PHI to organizations
that handle organ procurement or organ, eye or tissue transplantation
or to an organ donation bank to facilitate organ or tissue donation
and transplantation.
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Research.
Under certain circumstances, we may use and disclose your PHI
for research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received
one medication to those who received another for the same condition.
Most research projects, however, are subject to a special approval
process. This process requires an evaluation of the proposed research
project and its use of PHI, and balances these research needs
with our patients' need for privacy. Before we use or disclose
PHI for research, the project will have been approved through
this special approval process. However, this special approval
process is not required when we allow researchers who are preparing
a research project to look at information about patients with
specific medical needs, so long as the PHI they review does not
leave UTMB.
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To
Avert a Serious Threat to Health or Safety. We
may use and disclose your PHI when necessary to prevent a serious
threat to your health and safety or the health and safety of the
public or another person. Any disclosure, however, would only
be to law enforcement in order to help prevent the threat.
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Armed
Forces and Foreign Military Personnel. If you
are a member of the armed forces, we may release your PHI as required
by military command authorities. We may also release PHI about
foreign military personnel to the appropriate foreign military
authority.
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National
Security and Intelligence Activities. We may release
your PHI to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by law.
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Protective
Services for the President and Others. We may
disclose your PHI to authorized federal officials so they may
provide protection to the President of the United States, other
authorized persons or foreign heads of state, or to conduct special
investigations.
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Inmates.
If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release your PHI
to the correctional institution or law enforcement official under
specific circumstances such as (1) for the institution to provide
you with health care; (2) to protect your health and safety or
the health and safety of others; or (3) for the safety and security
of the correctional institution.
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Workers'
Compensation. We may release your PHI for workers'
compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
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When Your Authorization
is Required
Uses or disclosures of your PHI for other purposes or activities
not listed above will be made only with your written authorization
(permission). If you provide us authorization to use or disclose
your PHI, you may revoke your authorization in writing at any
time. If you revoke your authorization, we will no longer use
or disclose your PHI for the reasons covered by your written permission.
However, we are unable to take back any disclosures we have already
made with your permission.
An authorization form is available electronically at http://www.utmb.edu/compliance/hipaa.
You may obtain a paper authorization form by contacting:
UTMB Health Information Management
301 University Blvd.
Galveston, Texas 77555-0782
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Special Protections
for Alcohol and Drug Abuse Information
Alcohol and drug abuse information has special privacy protections.
UTMB will not disclose or provide any PHI relating to the patient’s
substance abuse treatment unless: (1) there is a patient authorization;
(2) a court order requires disclosure of the information; (3)
medical personnel need the information to meet a medical emergency;
(4) qualified personnel use the information for the purpose of
conducting scientific research, management audits, financial audits
or program evaluation; or (5) it is necessary to report a crime
or a threat to commit a crime, or to report abuse or neglect as
required by law.
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Your Rights
You have the following rights regarding the PHI we maintain
about you.
Right
to Request Restrictions. You have the right to
request a restriction or limitation on the PHI we use or disclose
about you for treatment, payment or health care operations. You
also have the right to request a limit on the PHI we disclose
about you to someone who is involved in your care or the payment
for your care, such as a family member or friend. We are not required
to agree with your request. If we do agree, we will comply with
your request unless the information is needed to provide you with
emergency treatment. UTMB will notify you in writing whether we
agree or do not agree with your request.
In your request, you must tell us: (1) what information you want
to limit; (2) whether you want to limit UTMB’s use and/or
disclosure of the information; (3) to whom you want the limits
to apply (for example, disclosures to your spouse); and (4) your
contact address. A restriction request form is available electronically
at http://www.utmb.edu/compliance/hipaa.
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Right
to Request Confidential Communications. You have
the right to request that we communicate with you about medical
matters in a certain way or at a certain location. For example,
you can ask that we only contact you by telephone at work or that
we only contact you by mail at home. Your request must specify
how or where you wish to be contacted. We will accommodate all
reasonable requests.
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Right
to Inspect and Receive a Copy. You have the right
to inspect and receive a copy of PHI that may be used to make
decisions about your care. Usually, this includes medical and
billing records. Psychotherapy notes may not be inspected or copied.
If you request a copy of your PHI, 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 or receive a copy
in certain very limited circumstances. If you are denied access
to PHI, we will notify you in writing, and you may request that
the denial be reviewed. Another licensed health care professional
chosen by UTMB will review your request and the denial. The person
conducting the review will not be the person who denied your request.
We will comply with the outcome of the review.
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Right
to Amend. If you believe that PHI we have about
you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the
information is kept by or for UTMB. You must include a reason
that supports your request. In order to ensure that we collect
the information we need, UTMB provides a form electronically at
http://www.utmb.edu/compliance/hipaa.
We may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition,
we may deny your request if you ask us to amend information that:
(1) was not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
(2) is not part of the PHI kept by or for UTMB; (3) is not part
of the information that you would be permitted to inspect and
copy; or (4) is accurate and complete. UTMB will notify you in
writing whether we agree or do not agree with your amendment request.
Additionally, if we grant the request, we will make the correction
and distribute the correction to those who need it and those you
identify that you want to receive the corrected information. If
we deny your request for an amendment, we will notify you how
you may file a complaint with UTMB or the Department of Health
and Human Services.
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Right
to an Accounting of Disclosures. You have the
right to request an "accounting of disclosures” that
have been made by UTMB in the past six (6) years. The accounting
(or list) of disclosures will include: (1) the date of the disclosure;
(2) the name of the entity or person who received the PHI and,
if known, the address; (3) a brief description of the PHI disclosed;
and (4) a brief statement of the purpose of the disclosure.
Your request must state a time period not longer than six (6)
years and may not include dates before April 14, 2003. The first
list you request within a twelve (12) month period will be free
of charge. For additional lists, we will charge you for the costs
of providing the list. We will notify you of the cost involved
and you may choose to withdraw or modify your request at that
time before any costs are incurred.
Contact information for these rights.
Any requests related to these rights should be directed to:
UTMB Health Information Management
301 University Blvd.
Galveston, Texas 77555-0782
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Right
to a Paper Copy of This Notice. You have the right
to a paper copy of this notice. You may ask us to give you a copy
of this notice at any time. Even if you have agreed to receive
this notice electronically, you are still entitled to a paper
copy of this notice. To obtain a paper copy of this notice, contact
the UTMB Privacy Office at (409)747-8708.
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Access
to Electronic Copy of This Notice. You may obtain
an electronic copy of this notice here .
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Changes to this Notice
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for medical information
we already have about you as well as any information we receive
in the future. We will post a copy of the current notice on UTMB
premises, and on UTMB’s web site. The notice will contain
on the first page, in the lower right-hand corner, the effective
date. In addition, each time you register at or are admitted to
UTMB for treatment or health care services as an inpatient or
outpatient, you may request a copy of the current notice in effect.
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For More Information
or to Report a Problem
If you have questions or would like additional information,
you may contact UTMB’s Chief Privacy Officer at
(409) 747-8708.
If you believe your privacy rights have been violated, you can
file a complaint with:
UTMB’s Chief Privacy Officer at
(409) 747-8708
or in writing to:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
There will be no retaliation for filing a complaint.
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