Tel. 512-257-0898    E-mail:    Main Office: 4501 Spicewood Springs Road, Suite 1022 Austin, Texas 78759

Effective April 14, 2003
Amended September 1, 2012
Amended February 2, 2018

This notice describes how medical information about you may be used or disclosed and how you can get access to this information.

Please review it carefully.

Under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) we are required to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy practices with respect to such protected health information. We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of our notice at any time and to make the new notice provisions effective for all protected health information that we maintain. If we change our Notice of Privacy Practices, we will post the new notice in our office and have copies available in our office.
How we may disclose your health information:
The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; recording information about treatment or services provided; recording information about actions taken in the course of your treatment and how you respond; sending reports concerning treatment or services to a referring health care professional; getting copies of your health information from another professional. Examples of how we use or disclose information for payment purposes are: asking you about your health care plans, or other sources of payment; contacting health care plans to determine coverage or eligibility; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency). Health care operations means those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; business planning; and storage of records.
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up in our office at all. Such uses or disclosures are:

  • When a state or federal law mandates that certain health information be reported for a specific purpose;
  • For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the Federal Food  and Drug Administration regarding drugs or medical devices;
  • Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
  • Uses and disclosures for health oversight activities, such as for licensing, audits, or investigation of possible violations of health care laws;
  • Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
  • Disclosures for law enforcement purposes such as to provide information about someone who is or is suspected to be a victim of a crime to provide information about a crime at our office; or to report a crime that happened somewhere else;
  • Uses or disclosures for health related research;
  • Uses and disclosures for specialized government functions, such as for the      protection of the president or high ranking officials;
  • Disclosures of de-identified information;
  • Disclosures relating to worker’s compensation programs;
  • Disclosures  of a limited data set for research, public health, or health care operations;
  • Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
  • Disclosures to business associates who perform health care operations for us and who commit to respect the privacy of your health information.

We may call, write, or e-mail to remind you of scheduled appointments. Unless you tell us otherwise, we may mail you an appointment reminder on a post card, leave you a reminder message on your voice mail or with someone who answers your phone, and/ or e-mail an appointment reminder. We will not make any other uses or disclosures of your health information unless you sign a written “authorization form.”
Your rights regarding your health information:
You may ask us to restrict our uses and disclosures for purposes of treatment, payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the address shown at the beginning of this Notice. You may ask us to communicate with you in a confidential way, such by phoning you at work rather that at home, by mailing health information to a different address, or by using e-mail to your personal e-mail address. We will accommodate these requests if they are reasonable, and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the address listed on our contact page. You may ask to see or to get photocopies of your health information.  If you want to review or get photocopies of your health information, send a written request to the address shown at the beginning of this Notice. You will be charged for this service. Photocopies $.25 per page and cost of postage. You may pick up copies rather than have them mailed. Payment must be made prior to copying.
You may ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. If you want to ask us to amend your health information, send a written request to the address shown at the beginning of this Notice.
You may obtain a list of the disclosures that we have made of your health information within the past six years. By law, the disclosure will not include: disclosures for purposes of treatment, payment or health care operation; disclosures with your authorization; incidental disclosures; communications with family and friends; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists you will have to pay for them in advance. If you want a list, send a written request to the address shown at the beginning of this Notice.
You may obtain additional copies of this Notice upon request.
How to file a complaint:
If you think that your privacy rights have been violated, you are free to complain to us or to the US Department of Health and Human Services Office for Civil Rights. We will not retaliate against you if you make a complaint.
Amendment to HIPPA Procedures
If we use electronic health records (we currently do not) you have the right to request copies in writing.
We do not sell protected health information for any reason.
Your protected health information is subject to electronic disclosure for treatment, payment and healthcare operations, insurance or HMO functions or as required or authorized by federal or state law. This Practice uses fax, email and electronic billing to transmit protected health information for the purpose of treatment, payment and health care operations. We also use these forms of electronic transmission to communicate with you. You have the right to opt out of any of these forms of communication. To opt out, submit a written request to the address listed on our contact page.
In addition to filing a complaint with the US Department of Health and Human Services, you may also file a complaint on the Texas Attorney General’s web site.