• Treatment - Your PHI may be shared with other health care professionals in order to provide, coordinate, or manage your health care and any related service. These health care professionals could include other clinicians within the SHWC and appropriate referrals to specialists germane to your treatment.
• Payment - Your PHI, such as diagnosis, laboratory fees, or your demographic information, may be shared with the SHWC billing personnel in order to assure that you are properly charged for medical services provided to you. In addition, we will use and disclose PHI about you so that the treatment and services you receive may be billed and payment collected from you, an insurance company, or a third party. We may also tell your health plan about a treatment or procedure you are going to receive in order to obtain prior approval or to determine whether your plan will cover the services.
• Health Care Operations - Your PHI may be shared with billing/appointment personnel members in order to schedule an appropriate amount of time for your medical visit (ex: annual pap exam), for quality assurance or quality improvement efforts (ex: nurse call backs), or as is required by state or federal law (ex: subpoenas for records or reportable disease notification). These uses and disclosures are necessary to operate the SHWC in an efficient manner and ensure that all patients receive quality care.

• In order to contact the patient - Your PHI may be used in order to remind you of an appointment with a written reminder or a telephone reminder. It may also be used to provide the patient with information about suggested treatment choices
• Emergency situations - If you are in a life or death situation or you are unconscious and not able to provide authorization
• To carry out treatment, payment, or health care operations (as provided in the consent document)
• When required by state or federal law
• When substantial communication barriers exist (between the patient and the medical provider) that prevent clear consent, yet, in the opinion of the medical provider, consent is inferred from the circumstances, PHI may be released to provide appropriate care
• When the patient is a minor, the parent or legal guardian acts as the minor's personal representative and the parent or legal guardian is allowed access to the minor patient's PHI
• Law enforcement - We may release PHI if we are asked to do so by a law enforcement official in response to a court order, a warrant, summons, subpoena, or similar legal process
• Serious threats to health or safety - We may use and disclose PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
• Health Oversight Activities - We may disclose medical information to a health oversight agency for activities authorized by law. Health oversight agencies include public and private agencies authorized by law to oversee the health care system. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary to monitor the health care system, government programs, eligibility or compliance, and to enforce health-related civil rights and criminal laws.
• Worker's Compensation - We may release medical information about you for worker's compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
• Public Health Risks - We may disclose medical information about you for public health activities. These activities generally include the following:

• The right to request restrictions on the medical information the SHWC uses or discloses about you for treatment, payment, and health care operations. You also have the right to request a limit on the medical information the SHWC discloses about you to someone who is involved in your care or the payment of your care.

The SHWC is not required to agree to your request.


• The right to receive confidential communications about medical matters in a certain manner or at a certain location.
  
  To request that the SHWC communicate in a certain manner, you must make your request in writing to the Medical Records Supervisor for initial approval with final approval from the Privacy Officer. You do not have to state a reason for your request. The SWHC will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.


• The right to inspect and copy PHI. Usually this includes medical and billing records, but does not include psychotherapy notes.
  
  To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Supervisor for initial approval with final approval from the Privacy Officer. If you request a copy of the information, the SHWC may charge a fee established by the Texas Board of Medical Examiners for the costs of copying, mailing, or summarizing your medical records.
  
  The SHWC may deny your request to copy and inspect in certain very limited circumstances. If you are denied access to medical information, including psychotherapy notes, you may request that the denial be reviewed. Another licensed professional chosen by the SHWC will review your request and denial. The person conducting the review will not be the person who denied your request. The SHWC will comply with the outcome of the review.


• The right to amend your medical information maintained if you feel that it is incorrect. You have the right to request an amendment for as long as the information is kept by the SHWC.
  
  To request an amendment, your request must be made in writing and submitted to the Medical Records Supervisor for initial approval with final approval from the Privacy Officer. In addition, you must provide a reason that supports your request.
  
  The SHWC may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In some cases, you may need to provide documentation that supports your request. In addition, the SHWC may deny your request if you ask us to amend information that:
  
  1. Was not created by the SHWC, unless the person or entity that created the information is no longer available to make the amendment;
  2. Is not part of the medical information kept by the SHWC;
  3. Is not part of the information which you would be permitted to inspect and copy; or
  4. Is accurate and complete.
  


• The right to receive an accounting of disclosures of PHI. This is a list of the disclosures made of your medical information for purposes other than treatment, payment, or health care operations.
  
  To request this list you must submit your request in writing to the Medical Records Supervisor or designee for initial approval with final approval from the Privacy Officer. Your request must state a time period, which may not be longer than six (6) years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists within the 12-month period, you may be charged for the cost of providing the list. The SHWC will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.

• Provide a public notice that assures that the clinic is required by law to maintain the privacy of PHI
• Provide patients with notice of the clinic's privacy practices with respect to PHI
• State in the published Privacy Notice that the clinic is required to abide by the stipulations in the Privacy Notice that is currently in effect for the clinic
• Notify patients that the clinic reserves the right to change privacy practices that apply to all PHI: however, any changes in privacy practices must be described in an updated Privacy Notice before the changes are implemented. Any updated Privacy Notice will be available to patients upon request
• Post the Notice of Privacy Policy on the SHWC web site: http://www.healthcenter.unt.edu

• Any complaint must be in writing
• Any complaint must name the clinic or medical provider that is subject to the complaint
• Any complaint must be filed within 180 days of when the complainant knew or should have known that the act or omission occurred
• The complainant will not be subject to any retaliation for filing the complaint

How can I obtain additional information or clarification of the Privacy Notice?

For further information on UNT SHWC policies regarding Protected Health Information, please contact the following individual:

June Brownlee
Administrative Director
1155 Union Circle #305160
Denton, TX 76203-5017
940-565-2786
shwcweb@unt.edu

Revised: 1/17/2008