This notice explains how your medical information may be used or disclosed and how you can access it. Please review it carefully. 

If you have any questions about this notice or if you need more information, please contact: 

Privacy Officer: Shonda (Nikki) St. Mary 

Phone: (337) 564-7546 

Address: 1936 Southwood Dr, Lake Charles, LA 70605 

We are required by law to protect your Protected Health Information (PHI) and explain our privacy practices. You have rights regarding your PHI, and we must comply with this notice. 

What is Protected Health Information? 

“Protected Health Information” is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care. 

How We May Use and Share Your Protected Health Information 

We may use and share your Protected Health Information in the following circumstances: 

For Treatment. We may use or disclose your Personal Health Information to provide medical services and coordinate care. 

For Payment. We may use and share your Protected Health Information to bill for the treatment and services we provide and to collect payments from you, your health plan, or other third parties. This may involve activities your insurance plan undertakes before approving or paying for recommended healthcare services, such as determining eligibility or coverage, reviewing the medical necessity of services provided, and conducting utilization reviews. 

For Health Care Operations: We may use and share Protected Health Information for our operational needs. For instance, we might review your information to assess the quality of the care you receive and evaluate our team’s performance. We may also share information with physicians, nurses, medical technicians, medical students, and other authorized staff for educational and training purposes. 

Appointment Reminders/Treatment Options/Health-Related Services: We may use and share Protected Health Information to remind you of upcoming medical appointments or to inform you about potential treatment options, alternatives, or health-related benefits and services that may be relevant to you. 

Minors: We may share the Protected Health Information of minor children with their parents or guardians, unless prohibited by law. 

Research: We may use and share your Protected Health Information for research purposes, but only if the research has been approved by an authorized institutional review board or privacy board that ensures your information’s privacy. Even without this approval, we may allow researchers to access your Protected Health Information to identify potential participants for their studies, provided they do not copy or remove any identifiable information. Additionally, we may share a limited data set that excludes personally identifiable information for research, but only under a data use agreement that requires the recipient to (1) use the data solely for the intended purpose, (2) maintain its confidentiality and security, and (3) refrain from identifying individuals or contacting them. 

As Required by Law: We will disclose your Protected Health Information when mandated by international, federal, state, or local laws. 

To Prevent Serious Threats: We may use and share your Protected Health Information if it is necessary to avert a serious threat to your health or safety, or that of others, and will only disclose it to someone who can help prevent the threat. 

Business Associates: We may share your Protected Health Information with business associates who perform services on our behalf, such as billing or consulting. These associates are contractually obligated to protect the privacy and security of your information. 

Organ and Tissue Donation: If you are an organ or tissue donor, we may use or share your Protected Health Information with organizations involved in organ procurement or transplantation as needed to facilitate this process. 

Military and Veterans: If you are part of the armed forces, we may disclose your Protected Health Information as required by military authorities. This also applies to members of foreign military services. 

Workers’ Compensation: We may use or share your Protected Health Information for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses. 

Public Health Risks: We may disclose your Protected Health Information for public health purposes, including reporting to the FDA, controlling disease, reporting births and deaths, or notifying individuals about product recalls.

Abuse, Neglect, or Domestic Violence: We may share your Protected Health Information with appropriate authorities if we believe you have been a victim of abuse, neglect, or domestic violence, provided you agree or if legally required. 

Health Oversight Activities: We may disclose your Protected Health Information to health oversight agencies for legally authorized activities, such as audits and investigations. 

Data Breach Notification: We may use or share your Protected Health Information to fulfill legal requirements for notifying you about unauthorized access or disclosure of your health information. 

Lawsuits and Disputes: If you are involved in legal proceedings, we may disclose your Protected Health Information in response to court orders or legal requests, while making efforts to inform you about such requests. 

Law Enforcement: We may share your Protected Health Information with law enforcement, provided all applicable legal requirements are met. 

Military Activity and National Security: If you are involved in military or national security activities, we may disclose your Protected Health Information to authorized officials for their legal responsibilities. 

Coroners, Medical Examiners, and Funeral Directors: We may share your Protected Health Information with coroners or medical examiners as necessary for them to perform their duties.

Inmates: If you are an inmate or under law enforcement custody, we may disclose your Protected Health Information to ensure you receive healthcare or to maintain the safety and security of the institution. 

Uses and Disclosures That Allow You to Object and Opt Out 

Individuals Involved in Your Care or Payment: Unless you object, we may share your Protected Health Information with family members, relatives, close friends, or others you designate who are involved in your care. If you are unable to consent or object, we may disclose this information if we believe it is in your best interest based on our professional judgment. 

Disaster Relief: We may share your Protected Health Information with disaster relief organizations to help coordinate your care or to inform family and friends of your status during a disaster. Whenever possible, we will give you the opportunity to agree or object to such disclosures. 

Fundraising Activities: We may use or disclose your Protected Health Information as needed to reach out to you for fundraising purposes. You have the right to opt out of these fundraising communications. 

Your Written Authorization is Required for Other Uses and Disclosures 

The following uses and disclosures of your Protected Health Information will be made only with your written authorization: 

1. Uses and disclosures of Protected Health Information for marketing purposes. 

2. Disclosures that constitute a sale of your Protected Health Information. 

Any other uses or disclosures of your Protected Health Information not addressed in this notice or required by law will only occur with your written consent. You can revoke this authorization at any time by submitting a written request to our Privacy Officer. Once revoked, we will stop disclosing your Protected Health Information as authorized. However, any disclosures made based on your authorization prior to its revocation will remain valid. 

Your Rights Regarding Your Protected Health Information 

Right to Inspect and Copy: You have the right to view and obtain copies of your Protected Health Information used for decisions about your care or payment. We will provide access within 30 days and may charge a reasonable fee for copying, mailing, or related supplies. 

Right to a Summary or Explanation: Instead of the full record, you can request a summary or explanation of your Protected Health Information, provided you agree to this format and cover any associated fees. 

Right to an Electronic Copy of Medical Records: If your Protected Health Information is in electronic format, you can request an electronic copy or have it sent to another individual or entity. We will strive to provide it in your preferred format if feasible; otherwise, we will provide it in our standard format or as a readable hard copy. A reasonable fee may apply for labor associated with this request. 

Right to Notification of a Breach: You have the right to be informed if there is a breach of any unsecured Protected Health Information about you. 

Right to Request Amendments: If you believe your Protected Health Information is inaccurate or incomplete, you can request an amendment. This request must be made in writing to the Privacy Officer, specifying the reasons. We may deny the request in certain cases, but you can file a statement of disagreement, and we may provide a rebuttal. 

Right to an Accounting of Disclosures: You can request a list of disclosures of your Protected Health Information, excluding those made for treatment, payment, or health care operations. The first request in a 12-month period is free; additional requests may incur reasonable costs, which we will communicate beforehand. 

Right to Request Restrictions: You can request limits on the Protected Health Information we use or disclose for treatment, payment, or healthcare operations. To do this, submit a written request to the Privacy Officer, detailing the specific restriction and to whom it applies. We are not obligated to agree, except for certain conditions related to out-of-pocket payments. 

Out-of-Pocket Payments: If you paid out-of-pocket in full for a specific service and requested that we not bill your health plan, you have the right to ask that your Protected Health Information related to that service not be disclosed to the health plan, and we will comply. 

Right to Request Confidential Communications: You can request that we communicate with you in specific ways to protect your privacy, such as contacting you at a particular address or phone number. Any such request must be made in writing, and we will accommodate reasonable requests without questioning the reasons. 

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time. You can request a copy whenever you need it. 

How to Exercise your Rights 

To exercise your rights outlined in this notice, please submit your request in writing to our Privacy Officer at the address provided at the beginning of this notice. We may ask you to complete a form that we will provide. For the right to inspect and copy your Protected Health Information, you may also reach out to your physician directly. To request a paper copy of this notice, please contact our Privacy Officer by phone or mail. 

Changes to this Notice 

We retain the right to modify this notice. Any changes will apply to the Protected Health Information we already possess as well as to any Protected Health Information we create or receive in the future. You can find a copy of our current notice posted in our office and on our website. 

Complaints 

You can file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. 

To file a complaint with us, please contact our Privacy Officer at the address provided at the beginning of this notice. Complaints must be submitted in writing within 180 days of when you became aware of the suspected violation. Rest assured, there will be no retaliation for filing a complaint. To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave., S.W., Washington, D.C. 20201. Call (202) 619-0257 or toll free (877) 696-6775 or go to the website of the Office for Civil Rights, www.hhs.gov/ocr/hippa/, for more information. There will be no retaliation against you for filing a complaint.