Notice of Privacy Practices

This Notice describes the privacy practices of Dallas Men’s Health PLLC (“DMH”), including how we may use and disclose medical information about you and how you can access your medical information.

Get an electronic or paper copy of your medical record

• You can ask to see or get an electronic or paper copy of your medical records and other health information we have about you. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• We will provide a copy or a summary of your health information in accordance with applicable state and federal requirements. We may charge a reasonable, cost-based fee.
• You may revoke an authorization to use or disclose your health information, except to the extent that action has already been taken in reliance on your authorization. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• We may say “no” to your request, and we will tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, via text, call, to a home or office phone) or send mail to a specific address. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree to your request. For example, we may say “no” if it would affect your care. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with and why. See Office of HIPAA Compliance below for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• We will include all the disclosures except for those about treatment, payment, health care operations and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy Notice

• You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically.
• You may also view a copy of this Notice on our website [/notice-of-privacy-practices/].

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your privacy rights have been violated

• You can complain if you feel we have violated your privacy rights by contacting us using the Office of HIPAA Compliance contact information below.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1.877.696.6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Office of HIPAA Compliance

Clinic

To get an electronic or paper copy of your medical records, contact the Medical Records Custodian at the clinic where you received care.

For questions or other complaints, you may also contact the Compliance Officer directly or the Medical Director at the clinic where you received care at 214-894-1008.

Office of HIPAA Compliance

For requests relating to an authorization, amendment, confidential communication, restriction, list of those with whom we’ve shared information, revocation of an authorization, opting in or out of the HIE, or to file a complaint, contact us at:

214-894-1008;

– or- 

admin@dallasmenshealth.com
or DMH Office of HIPAA Compliance
3626 North Hall Street, Ste 905
Dallas, Texas 75219

Your Choices

For certain health information, you may tell us your choices about what we share.

You have the right to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation

We never share your information unless you give us written permission to do so for:

• Marketing purposes
• Sale of your information, as this activity is defined under HIPAA

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Treat

We can use your health information and share it with other professionals who are treating you, and for purposes of recommending treatment alternatives, care coordination, and alternative settings of care.

Run our organization

We can use and share your health information to run our organization and improve patient/member care.

Example: We can use and share your health information to support programs and activities to improve the quality of treatment services and provide customer service. For example, we may combine health information about many patients to evaluate the need for new services or treatments to improve the quality of patient care.

Bill for our services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

For payment

We can use and share your health information for payment of premiums due to us, to determine your coverage, and for payment of health care services you receive.

Example: We might tell a doctor if you are eligible for coverage and what percentage of the bill might be covered.

For underwriting

We may use or share your health information for underwriting purposes; however, we will not use or share your genetic information for such purposes.

For Part 2 Records

If we receive information relating to your diagnosis, prognosis, or treatment for a substance use disorder subject to 42 CFR Part 2 (“Part 2 Records”), we will not use or disclose your Part 2 Records, or provide testimony relaying the content of your Part 2 Records, in any civil, criminal, administrative, or legislative proceeding against you unless you have provided written consent to this disclosure (separate from your consent for any other use or disclosure), or a court order after notice and an opportunity to be heard is provided to you or us (as the lawful holder of the Part 2 Record), as provided by 42 CFR Part 2. A court order authorizing the use or disclosure of this information must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested information is used or disclosed.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as the ways mentioned below. We have to meet certain conditions in the law before we can share your information for these purposes. For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Public health and safety

We can share health information about you for certain situations such as:

• Preventing Disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Research

• We can use or share your information for health research under certain circumstances.

Compliance with the law

• We will share information about you if federal, state, or local law or regulations require it, including with the Department of Health and Human Services, if it wants to see that we’re complying with federal privacy law.

Workers’ compensation, law enforcement and other governmental entities

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security and presidential protective services

Service provider

• We can share health information about you with service providers that assist us and who have the same contractual obligation to safeguard the information.

De-identified information

• We may use health information about you to create de-identified information. This is information that has gone through a rigorous process so that the risk that the information can identify you is very small. Once health information is de-identified in compliance with HIPAA, we may use or disclose it for various purposes, such as research or development of new health care technologies, and the de-identified information will no longer be subject to this Notice or your rights described herein. We may receive payment for the de-identified information.

Lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Electronic Health Information Exchange (“HIE”)

• We use HIEs to exchange electronic health information about you with other health care providers or entities that are not part of our health care system. Information exchanged between providers or entities may be stored in their own systems.
• Our health care system and these other providers or entities can use the HIEs to see your electronic health information for the purposes described in this Notice, to coordinate your care and as allowed by law.
• We monitor who can view your information within our health care system, but other individuals and entities who use the HIEs may disclose your information to others subject to each HIE’s rules.
• You may opt-out of all HIEs by providing a written request to the DMH Office of HIPAA Compliance. If you opt-out, others may still request your information through the HIEs, but your information will not be viewable through the HIEs. You may opt back in to the HIEs at any time. See Office of HIPAA Compliance above for how to do this. [https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf]
• You do not have to participate in any HIE to receive care.

For more information, see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• We will not use or share your information other than as described here, unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our websites.