Notice of Health Information Practices

YOU ARE WELCOME AT ANY TIME TO RECEIVE A COPY OF THE COMPLETE NOTICE OF HEALTH INFORMATION PRACTICES.

Introduction

At Metroplex Medical Centres, we are committed to treating and using protected health information about you responsibly. This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 13, 2003 and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information

Each time you visit one of our medical centers, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your health or medical record.

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.

Your Health Information Rights

Although your health record is the physical property of our medical centers, the information belongs to you. You have the right to:

• Obtain a paper copy of this notice of information practices upon request
• Inspect and copy your health record as provided for in 45 CFR 164.524
• Amend your health record as provided in 45 CFR 164.528
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
• Request communications of your health information by alternative means or at alternative locations
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities

Metroplex Medical Centre is required to:

• Maintain the privacy of your health information
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or Reporting a Problem

If you have any questions or want to make a request pursuant to the rights described above, please contact the practice’s Privacy Officer in writing:

Privacy Officer
C/O Practice Manager
700 N Pearl St, Suite N510
Dallas, TX 75201

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

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