Diplomate, American Board of Allergy, Asthma & Immunology
This notice describes how medical information about you may be used &
disclosed & how you can get access to this information. Please review it
This practice uses & discloses health information about you for treatment,
to obtain payment for treatment, for administrative purposes, & to evaluate
the quality of care that you receive. This notice describes our privacy
practices. You can request a copy of this notice at any time. For more
information about this notice or our privacy practices & policies, please
contact the Privacy Officer.
We may use & disclose your medical information to those involved in
providing, coordinating, or managing your treatment. For example, Dr. Hallett is
a specialist. When we provide treatment, we may request that your primary care
physician share some of your medical information with us. Also, we may provide
your primary care physician information about your particular condition so that
he or she can appropriately treat you for other medical conditions, if any. Your
care may require the involvement of another specialist. When we refer you to
another specialist, we will share some or all of your medical information with
that physician to facilitate the delivery of care.
We may use & disclose your medical information to confirm medical insurance
coverage or obtain reimbursement for services we provide to you. For example, we
may complete a claim form to obtain payment from your insurer. The form will
contain medical information, such as a description of the medical service
provided to you, which your insurer needs to approve payment to us.
We are permitted to use or disclose your medical information for the purposes of
health care operations, which are activities that support this practice &
ensure that quality care is delivered.
There are situations in which we are permitted by law to disclose or use your
medical information without your written authorization or an opportunity to
object. In other situations we will ask for your written authorization before
using or disclosing any identifiable health information about you. If you choose
to sign an authorization to disclose information, you can later revoke that
authorization, in writing, to stop future uses & disclosures. However, any
revocation will not apply to disclosures or uses already made or taken in
reliance on that authorization
We may disclose your medical information for public health activities. Public
health activities are mandated by federal, state, or local government for the
collection of information about disease, vital statistics (like births &
death), or injury by a public health authority. We may disclose medical
information, if authorized by law, to a person who may have been exposed to a
disease or may be at risk for contracting or spreading a disease or condition.
We may disclose your medical information to report reactions to medications,
problems with products, or to notify people of recalls of products they may be
We may also disclose medical information to a public agency authorized to
receive reports of child abuse or neglect. Texas law requires physicians to
report child abuse or neglect. Regulations also permit the disclosure of
information to report abuse or neglect of elders or the disabled.
We may disclose your medical information to a health oversight agency for those
activities authorized by law. Examples of these activities are audits,
investigations, licensure applications & inspections which are all
government activities undertaken to monitor the health care delivery system
& compliance with other laws, such as civil rights laws.
We may disclose your medical information in the course of judicial or
administrative proceedings in response to an order of the court (or the
administrative decision-maker) or other appropriate legal process. Certain
requirements must be met before the information is disclosed.
If asked by a law enforcement official, we may disclose your medical information
under limited circumstances provided that the information:
Is released pursuant to legal process, such as a warrant or subpoena;
Pertains to a victim of crime & your are incapacitated;
Pertains to a person who has died under circumstances that may be related to
Is about a victim of crime & we are unable to obtain the person’s agreement;
Is released because of a crime that has occurred on these premises; or
Is released to locate a fugitive, missing person, or suspect.
We may also release information if we believe the disclosure is necessary to
prevent or lessen an imminent threat to the health or safety of a person.
We may disclose your medical information as required by the Texas workers’
We may release your medical information to a correctional institution or law
enforcement officials if you are an inmate or under the custody of law
enforcement officials. This release is permitted to allow the institution to
provide you with medical care, to protect your health or the health & safety
of others, or for the safety & security of the institution.
We may disclose your medical information for specialized governmental functions
such as separation or discharge from military service, requests as necessary by
appropriate military command officers (if you are in the military), authorized
national security & intelligence activities, as well as authorized
activities for the provision of protective services for the President of the
United States, other authorized government officials, or foreign heads of state.
Research, Organ Donation, Coroners, Medical Examiners, & Funeral Directors
When a research project & its privacy protections have been approved by an
Institutional Review Board or privacy board, we may release medical information
to researchers for research purposes. We may release medical information to
organ procurement organizations for the purpose of facilitating organ, eye, or
tissue donation if you are a donor. Also, we may release your medical
information to a coroner or medical examiner to identify a deceased or a cause
of death. Further, we may release your medical information to a funeral director
where such a disclosure is necessary for the director to carry out his duties.
We may release your medical information where the disclosure is required by law.
The United States Department of Health & Human Services created regulations
intended to protect patient privacy as required by the Health Insurance
Portability & Accountability Act (HIPAA). Those regulations create several
privileges that patients may exercise. We will not retaliate against a patient
that exercises their HIPAA rights.
You may request that we restrict or limit how your protected health information
is used or disclosed for treatment, payment, or healthcare operations. Please
note that while we will try to honor your request & will permit requests
consistent with policies, we are not required to agree to any restriction.
To request a restriction, submit the following in writing: (a) The information
to be restricted, (b) what kind of restriction you are requesting (i.e. on the
use of information, disclosure of information or both), & (c) to whom the
limits apply. Please present a written request to the Privacy Officer.
You may also request that we limit disclosure to family members, other
relatives, or close personal friends that may or may not be involved in your
You may request that we send communications of protected health information by
alternative means or to an alternative location. This request must be made in
writing to the Privacy Officer. We are required to accommodate only reasonable
requests. Please specify in your correspondence exactly how you want us to
communicate with you. If you are directing us to send information to a
particular place, include the contact & address information.
You may inspect &/or copy health information that is within the designated
record set, which is information that is used to make decisions about your care.
Texas law requires that requests for copies be made in writing & we ask that
requests for inspection of your health information also be made in writing.
Please send your request to the Privacy Officer.
We can refuse to provide some of the information you ask to inspect or ask to be
copied if the information:
Includes psychotherapy notes.
Includes the identity of a person who provided information if it was obtained
under a promise of confidentiality.
Is subject to the Clinical Laboratory Improvements Amendments of 1988.
Has been compiled in anticipation of litigation.
We can refuse to provide access to or copies of some information for other
reasons, provided that we provide a review of our decision on your request.
Another licensed health care provider who was not involved in the prior decision
to deny access will make any such review.
Texas law requires that we are ready to provide copies or a narrative within 15
working days of your request. We will inform you of when the records are ready
or if we believe access should be limited. If we deny access, we will inform you
HIPAA permits us to charge a reasonable cost based fee. The Texas State Board of
Medical Examiners (TSBME) has set limits on fees for copies of medical records
that under some circumstances may be lower than the charges permitted by HIPAA.
In any event, the lower of the fee permitted by HIPAA or the fee permitted by
the TSBME will be charged.
You may request an amendment of your medical information in the designated
record set. Any such request must be made in writing to the Privacy Officer. We
will respond within 60 days of your request. We may refuse to allow an amendment
if the information:
Wasn’t created by this practice or the physician in this practice.
Is not part of the Designated Record Set.
Is not available for inspection because of an appropriate denial.
If the information is accurate & complete.
Even if we refuse to allow an amendment you are permitted to include a patient
statement about the information at issue in your medical record. If we refuse to
allow an amendment we will inform you in writing. If we approve the amendment,
we will inform you in writing, allow the amendment to be made & tell others
that we know have the incorrect information.
The HIPAA privacy regulations permit you to request, & us to provide, an
accounting of disclosures that are other than for treatment, payment, health
care operations, or made via an authorization signed by you or your
representative. Please submit any request for an accounting to the person listed
below. Your first accounting of disclosures (within a 12 month period) will be
free. For additional requests within that period we are permitted to charge for
the cost of providing the list. If there is a charge we will notify you &
you may choose to withdraw or modify your request before any costs are incurred.
We may contact you by telephone, mail, or both to provide appointment reminders,
information about treatment alternatives, or other health-related benefits &
services that may be of interest to you.
If you are concerned that your privacy rights have been violated, you may
contact the person listed below. You may also send a written complaint to the
United States Department of Health & Human Services. We will not retaliate
against you for filing a complaint with the government or us.
We are required by law & regulation to protect the privacy of your medical
information, to provide you with this notice of our privacy practices with
respect to protected health information, & to abide by the terms of the
notice of privacy practices in effect.
If you have any questions or want to make a request pursuant to the rights
described above, please contact:
Jeffrey S. Hallett, M.D.
ATTN: Privacy Officer
16000 Park Valley Drive, Ste #130
Round Rock, Texas 78681
This notice is effective April 14, 2003.
We may change our policies & this notice at any time & have those
revised policies apply to all the protected health information we maintain. If
or when we change our notice, we will post the new notice in the office where it
can be seen.