Notice of Privacy Practices
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information, to give you this notice of our legal duties and privacy practices with respect to your health information, and to notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the terms of the notice currently in effect. We will not use or share your information other than as described here unless you tell us we may in writing. If you tell us we may, you may change your mind at any time by notifying us in writing.
How we may use and share your health information
The following describes the ways we may use and disclose your protected health information. Not every use or disclosure in a category is listed.
Treatment
We use and share your health information to provide you with medical care. This includes sharing information with other providers involved in your care, with pharmacies that fill prescriptions we write, and with laboratories that perform testing we order.
Payment
We use and share your health information to bill and collect payment for the care we provide. Our practice is cash-pay and we do not bill insurance for our services. If you ask us to complete a prior authorization so that you may use your own pharmacy benefit for a medication we prescribed, we will share the information your plan requires for that purpose.
Health care operations
We use and share your health information to run our practice, improve the quality of care, evaluate the performance of our staff, and contact you about your care and appointments.
Business associates
We share information with vendors who perform services on our behalf, such as our electronic health record, our secure messaging platform, and our payment processor. Each is bound by a written business associate agreement requiring them to protect your information.
Appointment reminders and treatment information
We may contact you by telephone, text message, email, or through our patient portal with appointment reminders, treatment information, or information about health-related services we offer. You may ask us to stop at any time.
Others involved in your care
We may share information with a family member, friend, or other person you identify as involved in your care, when you agree or when we give you an opportunity to object and you do not object. If you are not present or are unable to agree, we may share information when, in our professional judgment, it is in your best interest.
Other uses and disclosures permitted or required by law
- As required by law. When federal, state, or local law requires disclosure.
- Public health activities. To prevent or control disease, report births and deaths, report reactions to medications or problems with products, or notify a person who may have been exposed to a disease.
- Victims of abuse, neglect, or domestic violence. To an appropriate government authority as permitted or required by law.
- Health oversight activities. To agencies conducting audits, investigations, inspections, or licensure activities, including state licensing boards and the Drug Enforcement Administration.
- Judicial and administrative proceedings. In response to a court or administrative order, or a subpoena, discovery request, or other lawful process where required assurances have been provided.
- Law enforcement. In response to a valid court order, warrant, subpoena, or summons, or as otherwise permitted by law.
- To avert a serious threat. When necessary to prevent a serious threat to your health or safety or that of another person or the public.
- Coroners, medical examiners, and funeral directors. As necessary for them to carry out their duties.
- Organ and tissue donation. To organizations that handle organ procurement or transplantation.
- Research. When an institutional review board or privacy board has approved the research and established protections for your information.
- Workers' compensation. As authorized by workers' compensation laws.
- Specialized government functions. For military and veterans activities, national security and intelligence, protective services, and correctional institutions, as permitted by law.
Uses and disclosures that require your written authorization
Uses and disclosures not described in this notice will be made only with your written authorization. In particular, we will not do any of the following without your written authorization:
- Use or share your information for marketing purposes where we receive payment from a third party.
- Sell your protected health information.
- Share psychotherapy notes, if any are maintained.
You may revoke an authorization in writing at any time. Revocation does not apply to information we have already used or shared in reliance on that authorization.
Your rights regarding your health information
Get a copy of your records
You may inspect and request a copy of your medical and billing records. Submit your request in writing. We will respond within 30 days and may charge a reasonable, cost-based fee as permitted by law. You may request an electronic copy, and you may ask us to send a copy to a person or entity you designate.
Ask us to correct your records
If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it. We may deny your request, and if we do we will tell you why in writing within 60 days.
Request confidential communications
You may ask us to contact you in a specific way, such as by a particular phone number, or to send mail to a different address. We will accommodate all reasonable requests and will not ask you the reason.
Ask us to limit what we use or share
You may ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree, and we may decline if it would affect your care.
If you pay for a service or item in full out of pocket, you may ask us not to share that information with your health insurer, and we are required to agree unless a law requires us to share it.
Get a list of those with whom we have shared your information
You may request an accounting of disclosures we have made of your health information for the six years prior to your request. This list does not include disclosures made for treatment, payment, or health care operations, or certain other disclosures. We will provide one accounting per twelve-month period at no charge.
Get a paper copy of this notice
You may request a paper copy of this notice at any time, even if you agreed to receive it electronically, and we will provide one promptly.
Be notified if there is a breach
We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
Choose someone to act for you
If you have given someone medical power of attorney, or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will verify that the person has this authority before we act.
Changes to this notice
We reserve the right to change this notice, and to make the revised notice apply to information we already have as well as information we receive in the future. The current notice will always be posted on our website at ascenttrt.com and is available from our office on request. The effective date appears at the top of this notice.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below.
You may also 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 SW, Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
Contact
Privacy Contact: Ronald Sturdivan, APRN, FNP-C
Next Phase Medical PLLC dba Ascent TRT & Weight Loss
112 SW Thomas St., Suite 104, Burleson, TX 76028
817-580-4763 | info@ascenttrt.com