Privacy Policy

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This notice applies to Texas Hill Country TMS and its clinical associates

NOTICE

The privacy of your health information is important to us. We will maintain the privacy of

your health information and will not disclose your information to others without your

permission, or unless the law authorizes or requires us to do so.

The federal law HIPAA requires that we take additional steps to keep you informed about

how we may use the information gathered to provide health care services to you. As part

of this process, we are required to provide you with a Notice of Privacy Practices and

to request that you sign a written acknowledgment that you received a copy of our

Notice of Privacy Practices.

The Notice of Privacy Practices describes how we may use and disclose your protected

health information to carry out treatment, or payment, or health care operations, and for

other purposes that are permitted or required by law. It also describes your rights

regarding health information that we maintain about you, and a brief description of how

you may exercise your rights.

If you have any questions about this notice, please contact:

Texas Hill Country TMS

Fax: 512-588-6013

What is Protected Health Information?

Protected Health Information is information that relates to:

(1) Your past, present or future physical or mental health or condition;

(2) The provision of health care including mental health care to you;

(3) The past, present, or future payment for the provision of health care including mental

health care to you; and includes

(4) Demographic information that identifies you or that could be used to identify you.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU

MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by federal and state law to maintain the privacy of your health

information. We are also required to give you this Notice about our privacy practices, legal

obligations, and your rights concerning your health information (“Protected Health

Information” or “PHI”). We must follow the privacy practices that are described in this

Notice, which may be amended from time to time.

For more information about our privacy practices, or for additional copies of this Notice,

please contact us using the information listed in Section II G of this Notice.

I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

a. Permissible Uses and Disclosures Without Your Written Authorization – We

may use and disclose PHI without your written authorization, excluding Psychotherapy

Notes as described in Section II, for certain purposes as described below. The examples

provided in each category are not meant to be exhaustive, but instead are meant to

describe the types of uses and disclosures that are permissible under federal and state

law.

i. Payment: We may use or disclose PHI so that services you receive are

appropriately billed to, and payment is collected from, your health plan. For

example, we may disclose PHI to permit your health plan to take certain actions

before it approves or pays for treatment services.

ii. Health Care Operations: We may use or disclose PHI in connection with my

health care operations, including quality improvement activities, training programs,

accreditation, certification, licensing, or credentialing activities.

iii. Communications: We may use or disclose PHI to contact you regarding

missed appointments or if we need to change our appointment time. We may leave

messages on your answering machine unless you have directed me otherwise.

When we communicate by cell phone or computer, be aware that the information

is not always secure from access by third parties.

iv. Treatment: We may use PHI to diagnose and treat you. We may use PHI to

inform you about treatment alternatives or other related topics. We may also use

or disclose PHI for clinical coverage during periods of my absence.

v. Required or Permitted by Law: We may use or disclose PHI when we are

required or permitted to do so by law. For example, we may disclose PHI to

appropriate authorities if we reasonably believe that you are a possible victim of

Texas Hill Country TMS

213 S. Pierce St.

Burnet, TX 78611

Ph. 512-588-6011

F. 512-588-6013

abuse, neglect, or domestic violence, or the possible victim of other crimes. In

addition, we may disclose PHI to the extent necessary to avert a serious threat to

your health or safety or the health of safety of others. Other disclosures permitted

or required by law include the following: disclosures for public health activities;

health oversight activities including disclosures to state or federal agencies

authorized to access PHI; disclosures to judicial and law enforcement officials in

response to a court order or other lawful process; disclosures for research when

approved by an institutional review board; and disclosures to military or national

security agencies, coroners, medical examiners, and correctional institutions or

others as authorized by law.

b. Uses and Disclosures Requiring Your Written Authorization

1. TMS Therapy, Counseling, and Psychotherapy Notes: Notes recorded by

our clinician(s) documenting the contents of a counseling or treatment session with

you (“Psychotherapy Notes” / “Counseling Notes”) or during TMS therapy

treatment will be used only by your clinician and will not otherwise be used or

disclosed without your written authorization.

2. Treatment: We will not use or disclose PHI to other health providers without

your written consent.

3. Marketing Communications: We will not use your health information for

marketing communications without your written authorization.

4. Other Uses and Disclosures: Uses and disclosures other than those described

in Section I A above will only be made with your written authorization. For example,

you will need to sign an authorization form before we can send PHI to your life

insurance company, to a school, or to your attorney. You may revoke any such

authorization at any time.

II. YOUR INDIVIDUAL RIGHTS

a. Right to Inspect and Copy. You may request access to your medical record

and billing records maintained by us to inspect and request copies of the records.

All requests for access must be made in writing. Under limited circumstances, we

may deny access to your records. We may charge a fee for the costs of copying

and sending you any records requested. If you are a parent or legal guardian of a

minor, please note that certain portions of the minor’s medical record will not be

accessible to you.

b. Right to Alternative Communications. You may request, and we will

accommodate, any reasonable written request for you to receive PHI by alternative

means of communication or at alternative locations.

c. Right to Request Restrictions. You have the right to request a restriction on

PHI used for disclosure for treatment, payment, or health care operations. You

must request such restriction in writing addressed to the Privacy Officer as

indicated below. We are not required to agree to such restriction you may request.

d. Right to Accounting Disclosures. Upon written request, you may obtain an

accounting of certain disclosures of PHI made by us. This right applies to

disclosures for purposes other than treatment, payment, or health care

operations and excludes disclosures made to you or disclosures otherwise

authorized by you and is subject to other restrictions and limitations.

e. Right to Request Amendment. You have the right to request that we amend

your health information. Your request must be in writing, and it must explain why

the information should be amended. We may deny your request under certain

circumstances.

f. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice

by submitting a request to the Privacy Officer at any time.

g. Questions and Complaints. If you desire further information about your

privacy rights or are concerned that we have violated your privacy rights, you may

contact the designated Privacy Officer at 512-588-6011. You may also file

written complaints with the Director, Office for Civil Rights of the United States

Department of Health and Human Services. We will not retaliate against you if

you file a complaint with the Director or myself.

III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE

a. Effective Date. This Notice is effective immediately.

b. Changes to this Notice. We may change the terms of this Notice at any time.

If we change this Notice, we may make the new notice terms effective for all PHI

that we maintain, including any information created or received prior to issuing the

new notice. If we change this Notice, we will post the revised notice in the waiting

area of our office. You may also obtain any revised notice by contacting the Privacy

Officer.