Notice of Privacy Practices
This Notice of Privacy Practices describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully.
Your Rights
You have the right to:
– Request restrictions on certain uses and disclosures of your health information.
– Receive confidential communications.
– Inspect and copy your health information.
– Request an amendment to your health information.
– Receive an accounting of disclosures of your health information.
– Obtain a paper copy of this notice.
Uses and Disclosures of Health Information
We may use and disclose your medical information for treatment, payment, and healthcare operations. Examples include:
- Treatment: We may share your health information with other healthcare providers involved in your care.
- Insurance Payment: We may use your health information to obtain payment for services rendered.
- Healthcare Operations: We may use your information to evaluate the quality of care you receive.
Additional Uses and Disclosures
We may also disclose your health information without your consent in certain situations, including:
– As required by law.
– In response to a court order or subpoena.
– To avert a serious threat to health or safety of yourself and others.
– To inform your healthcare insurance provider of your treatment progress or compliance if requested.
Changes to This Notice
We reserve the right to change the terms of this Notice and make the new provisions effective for all protected health information we maintain. You will receive a revised Notice in the mail or via email if we make significant changes.
Contact Information
If you have questions about this Notice or wish to file a complaint, please contact our Privacy Officer:
Maria Eva Olan-Rogers
Grace Psychiatry LLC
610 Uptown Blvd. Suite 2000, Cedar Hill, TX 75104
469-242-0262
[email protected]
You have the right to file a complaint with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.
Acknowledgment of Receipt
You will be asked to sign a form acknowledging that you have received this Notice of Privacy Practices.