HIPAA Privacy Practices

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Medical Record Privacy Policy

This notice will describe the way Ascension Physio will treat stored medical records regarding your medical care. Keeping a record of your care including the diagnosis treatment services you receive and other information is required. Ascension Physio is required by law to protect your personal medical record by keeping it private and following certain rules that dictate whether and when we can use or disclose your information. This notice will inform you of these rules. It will also notify you of your rights and our obligations in our use and disclosure of your health information. We are also required to give you notice and to follow the terms of the notice that is currently in effect. We reserve the right to change this notice and apply those changes to the health information we currently have as well as information we may receive in the future. If we change this notice you will receive a new copy of this notice the next time you receive services from our practice.

Understanding Your Health Record

Each time you visit Ascension Physio, a record of your visit is made. Typically, this contains your symptoms, examination test results, diagnosis, treatment, and a plan for future care of treatment. This information, often referred to as your health or medical record, may serve as a:

• – Basis for planning you care and treatment
• – Legal document describing the care you received
• – Means by which you or a third party payer (such as your insurance company or HMO) can verify that services billed were actually provided
• – A source of data for medical research
• – A source of information for public health officials charged with improving the health of New Mexico and the nation
• – A source of data for planning
• – A tool for assessing and continually improving the care we render and the outcomes we achieve.

Your Rights Regarding Your Health Information

You have the right to:

• – Request the restricted use or disclosure of your health information for treatment, payment, or healthcare operations (as described in this notice)
• – Request that we restrict from disclosing information to family or friends
• – Request how you would like us to communicate with you
• – Inspect and copy certain health information, including most of your medical and billing records. This request must be made in writing to the Privacy Officer. A reasonable fee may be applied for copying, postage, or other expenses related to your request We may deny your request to inspect and or copy your health information. If we do, another licensed health care professional will review your request and we will comply with the outcome of the review.
• – Amend your health record as provided in 45 CFR 164,528
• – Obtain an accounting of disclosure of your health information as provided in 45 CFR 164,528
• – Obtain a paper copy of this notice upon request

NOTE: Ascension Physio is not required to agree to your requests. To request restrictions or limitations, you must make a written request to the Privacy Officer. The request must include (1) what information you want to limit, (2) whether you want to limit the use of the information and or disclosure of the information, (3) to whom the limitation or restriction will apply.

Ascension Physio is required to:

• – Maintain the privacy of your health information
• – Provide you with this notice as to our legal duties and privacy practices with respect to the information collected and maintained about you
• – Abide by the terms of this notice
• – Notify you if we were unable to agree to a requested restriction
• – Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Ascension Physio Privacy Officer at 505-750-8575. If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer or with the Office of Civil Rights U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office of Civil Rights.

The address for the OCR is listed below:

Office of Civil Rights U.S. Department of Health and Human Services
Independence Avenue S.W.
Room F HHH Building
Washington D.C.

How Your Health Information May Be Used and Disclosed

Your health information may be used and disclosed for a number of purposes in connection with your medical care and in running the practice. The following lists a number of typical uses and disclosures. Your health information will be used for the following:

Treatment

Your health information may be used to diagnose your illness or injury, provide you with services, or refer you to another practitioner. Your health information may be disclosed to doctors, nurses, technicians, medical students, or other personnel who are involved with your care.

Payment

Your health plan information regarding your diagnosis and treatment may be given out in order to be paid for your visits. Your health plan information may also be given out to determine whether your health plan pays for medical care you need and whether we need to get authorization from the health plan before treating you.

Health Care Operations

Your information may be used or disclosed for quality assessment and improvement activities to ensure that patients receive high-quality care. It may also be used or disclosed as part of a review, audit, or legal activities.

Appointment Reminders

Your information may be used or disclosed to contact you as a reminder that you have an appointment with our practice.

Individuals Involved in Your Care or Payment for Your Care

Your health information may be disclosed to a family member or friend who is involved in your medical care or who helps pay for your care. We may also tell your family or friends about your condition, for example, if you are admitted to the hospital or in the event of a disaster relief effort.

Public Health Risk

Your health information may be disclosed to report disease, injury, or disability; births and deaths; child abuse or neglect; defects, recalls, or problems with drugs, medical devices, or other products; to prevent or conditions. We may also notify authorities if we believe you have been the victim of abuse, neglect or domestic violence, if we are required by law to do so, or if you agree to the notification.

Health Oversight Activities

Your health information may be disclosed to agencies authorized by law for audits, investigations, inspections, and licensure.

Law Enforcement

Your health information may be disclosed when the following circumstances apply:

• – If you have incurred certain injuries or wounds that are legally required to be reported
• – In response to a court order, subpoena, warrant, summons, investigative demands, or similar process
• – To identify or locate a suspect, fugitive, material witness, or missing person
• – About the victim of a crime if under certain limited circumstances
• – About a suspicious death that we believe may be the result of criminal conduct
• – About criminal conduct on our premises
• – In emergency circumstances to report a crime, its location, or information about the person who may have committed the crime. Coroners, Medical Examiners, and Funeral Directors as necessary to carry out their duties.

Specialized Government Functions

Your health information may be disclosed to release information to military command authorities, upon you separation or discharge from military service to authorized officials. We may also disclose your health information to the appropriate government officials when it is necessary to conduct intelligence or other national security activities authorized by federal law. In addition, we may release your health information if it relates to the protection of the Presidents of the United States or foreign heads of state. Finally, we may disclose certain information related to members of the armed services and foreign military services to the appropriate personnel.

Workers’ Compensation for Work-Related Illness or Injury

Your health information may be disclosed in relation to workers’ compensation or similar programs established by law that provides benefits for work-related illness or injuries.

Other Uses of Your Health Information

Your health information may be disclosed when required by federal, state or local law, for treatment alternatives or health related benefits/services, organ and tissue donations, or to avert a serious threat to health or safety.

Last Updated: 10/31/2023