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PRIVACY POLICY 

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND  DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. 

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PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO  US. 

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Our Legal Duty

 

We are required by applicable federal and state laws to maintain the privacy of your protected  health information. We are also required to give you this notice about our privacy practices, our  legal duties, and your rights concerning your protected health information. We must follow the  privacy practices that are described in this notice while it is in effect. This notice takes effect  January 01, 2025, and will remain in effect until we replace it. 

We reserve the right to change our privacy practices and the terms of this notice at any time,  provided that such changes are permitted by applicable law. We reserve the right to make the  changes in our privacy practices and the new terms of our notice effective for all protected health  information that we maintain, including medical information we created or received before we  made the changes. 

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You may request a copy of our notice (or any subsequent revised notice) at any time. For more  information about our privacy practices, or for additional copies of this notice, please contact us  using the information listed at the end of this notice.

 

Uses and Disclosures of Protected Health Information 

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We will use and disclose your protected health information about you for treatment, payment, and  health care operations. The following are examples of the types of uses and disclosures of your  protected health care information that may occur. These examples are not meant to be exhaustive,  but to describe the types of uses and disclosures that may be made by our office. 

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Treatment: We will use and disclose your protected health information to provide, coordinate or  manage your healthcare and any related services. This includes the coordination or management of  your health care with a third party. For example, we would disclose your protected health  information, as necessary, to a home health agency that provides care to you. We will also disclose  protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to  ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time to time to another  physician or health care provider (e.g., a specialist or laboratory) who, at the request of your  physician, becomes involved in your care by providing assistance with your health care diagnosis or  treatment to your physician. 

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Payment: Your protected health information will be used, as needed, to obtain payment for your  health care services. This may include certain activities that your health insurance plan may  undertake before it approves or pays for the health care services we recommend for you, such as:  making a determination of eligibility or coverage for insurance benefits, reviewing services provided  to you for protected health necessity, and undertaking utilization review activities. For example,  obtaining approval for a hospital stay may require that your relevant protected health information  be disclosed to the health plan to obtain approval for the hospital admission. 

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Health Care Operations: We may use or disclose, as needed, your protected health information in  order to conduct certain business and operational activities. These activities include, but are not  limited to, quality assessment activities, employee review activities, training of students, licensing,  and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign  your name. We may also call you by name in the waiting room when your doctor is ready to see you.  We may use or disclose your protected health information, as necessary, to contact you by  telephone or mail to remind you of your appointment. We will share your protected health information with third party "business associates" that perform  various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement  between our office and a business associate involves the use or disclosure of your protected health  information, we will have a written contract that contains terms that will protect the privacy of your  protected health information. 

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We may use or disclose your protected health information, as necessary, to provide you with  information about treatment alternatives or other health-related benefits and services that may be  of interest to you. We may also use and disclose your protected health information for other  marketing activities. For example, your name and address may be used to send you a newsletter  about our practice and the services we offer. We may also send you information about products or  services that we believe may be beneficial to you. You may contact us to request that these  materials not be sent to you. 

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SMS/Phone Communications: By providing your phone number, you consent to receive appointment reminders, updates, and health-related communications from Richmond Premier Foot & Ankle Clinic via text or phone call. You understand that your phone carrier may charge for receiving text messages, regardless of the sender. Your phone number will not be shared with any third parties or affiliate companies for marketing purposes.

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Uses and Disclosures Based On Your Written Authorization: Other uses and disclosures of your  protected health information will be made only with your authorization, unless otherwise permitted  or required by law as described below. 

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You may give us written authorization to use your protected health information or to disclose it to  anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your  revocation will not affect any use or disclosures permitted by your authorization while it was in 

effect. Without your written authorization, we will not disclose your health care information except  as described in this notice. 

Others Involved in Your Health Care: Unless you object, we may disclose to a member of your  family, a relative, a close friend or any other person you identify, your protected health information  that directly relates to that person's involvement in your health care. If you are unable to agree or  object to such a disclosure, we may disclose such information as necessary if we determine that it  is in your best interest based on our professional judgment. We may use or disclose protected  health information to notify or assist in notifying a family member, personal representative or any  other person that is responsible for your care of your location, general condition or death. 

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Marketing: We may use your protected health information to contact you with information about  treatment alternatives that may be of interest to you. We may disclose your protected health  information to a business associate to assist us in these activities. Unless the information is  provided to you by a general newsletter or in person or is for products or services of nominal value,  you may opt out of receiving further such information by telling us using the contact information  listed at the end of this notice. 

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Research; Death; Organ Donation: We may use or disclose your protected health information for  research purposes in limited circumstances. We may disclose the protected health information of a  deceased person to a coroner, protected health examiner, funeral director or organ procurement  organization for certain purposes. 

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Public Health and Safety: We may disclose your protected health information to the extent  necessary to avert a serious and imminent threat to your health or safety, or the health or safety of  others. We may disclose your protected health information to a government agency authorized to  oversee the health care system or government programs or its contractors, and to public health  authorities for public health purposes. 

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Health Oversight: We may disclose protected health information to a health oversight agency for  activities authorized by law, such as audits, investigations and inspections. Oversight agencies  seeking this information include government agencies that oversee the health care system,  government benefit programs, other government regulatory programs and civil rights laws. 

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Abuse or Neglect: We may disclose your protected health information to a public health authority  that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose  your protected health information if we believe that you have been a victim of abuse, neglect or  domestic violence to the governmental entity or agency authorized to receive such information. In  this case, the disclosure will be made consistent with the requirements of applicable federal and  state laws. 

Food and Drug Administration: We may disclose your protected health information to a person or  company required by the Food and Drug Administration to report adverse events, product defects  or problems, biologic product deviations; to track products; to enable product recalls; to make  repairs or replacements; or to conduct post marketing surveillance, as required. 

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Criminal Activity: Consistent with applicable federal and state laws, we may disclose your  protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also  disclose protected health information if it is necessary for law enforcement authorities to identify or  apprehend an individual. 

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Required by Law: We may use or disclose your protected health information when we are required  to do so by law. For example, we must disclose your protected health information to the U.S.  Department of Health and Human Services upon request for purposes of determining whether we  are in compliance with federal privacy laws. We may disclose your protected health information  when authorized by workers' compensation or similar laws. 

 

Process and Proceedings: We may disclose your protected health information in response to a  court or administrative order, subpoena, discovery request or other lawful process, under certain  circumstances. Under limited circumstances, such as a court order, warrant or grand jury  subpoena, we may disclose your protected health information to law enforcement officials. 

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Law Enforcement: We may disclose limited information to a law enforcement official concerning  the protected health information of a suspect, fugitive, material witness, crime victim or missing  person. We may disclose the protected health information of an inmate or other person in lawful  custody to a law enforcement official or correctional institution under certain circumstances. We  may disclose protected health information where necessary to assist law enforcement officials to  capture an individual who has admitted to participation in a crime or has escaped from lawful  custody. 

Patient Rights 

 

Access: You have the right to look at or get copies of your protected health information, with limited  exceptions. You must make a request in writing to the contact person listed herein to obtain access  to your protected health information. You may also request access by sending us a letter to the  address at the end of this notice. If you request copies, we will charge you $15.00 for each page or $25.00 per hour to locate and copy your protected health information, and postage if you want the  copies mailed to you. If you prefer, we will prepare a summary or an explanation of your protected  health information for a fee. Contact us using the information listed at the end of this notice for a  full explanation of our fee structure. 

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Accounting of Disclosures: You have the right to receive a list of instances in which we or our  business associates disclosed your protected health information for purposes other than  treatment, payment, health care operations and certain other activities. We will provide you with  the date on which we made the disclosure, the name of the person or entity to whom we disclosed  your protected health information, a description of the protected health information we disclosed,  the reason for the disclosure, and certain other information. If you request this list more than once  in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these  additional requests. Contact us using the information listed at the end of this notice for a full  explanation of our fee structure. 

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Restriction Requests: You have the right to request that we place additional restrictions on our use  or disclosure of your protected health information. We are not required to agree to these additional  restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement  we may make to a request for additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is memorialized in writing. 

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Confidential Communication: You have the right to request that we communicate with you in  confidence about your protected health information by alternative means or to an alternative  location. You must make your request in writing. We must accommodate your request if it is  reasonable, specifies the alternative means or location, and continues to permit us to bill and  collect payment from you. 

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Amendment: You have the right to request that we amend your protected health information. Your  request must be in writing, and it must explain why the information should be amended. We may  deny your request if we did not create the information you want amended or for certain other  reasons. If we deny your request, we will provide you a written explanation. You may respond with a  statement of disagreement to be appended to the information you wanted amended. If we accept  your request to amend the information, we will make reasonable efforts to inform others, including  people or entities you name, of the amendment and to include the changes in any future  disclosures of that information. 

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Electronic Notice: If you receive this notice on our website or by electronic mail (e-mail), you are  entitled to receive this notice in written form. Please contact us using the information listed at the  end of this notice to obtain this notice in written form. 

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Questions and Complaints 

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If you want more information about our privacy practices or have questions or concerns, please  contact us using the information below. If you believe that we may have violated your privacy rights,  or you disagree with a decision we made about access to your protected health information or in  response to a request you made, you may complain to us using the contact information below. You  also may submit a written complaint to the U.S. Department of Health and Human Services. We will  provide you with the address to file your complaint with the U.S. Department of Health and Human  Services upon request. 

We support your right to protect the privacy of your protected health information. We will not  retaliate in anyway if you choose to file a complaint with us or with the U.S. Department of Health  and Human Services 

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Name of Contact Person: Richmond Premier Foot & Ankle Clinic 

Telephone: (832) 449 - 3520 

Address: 1601 Main St, STE 204, Richmond, TX 77469.

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