Uses and Disclosures of Protected Health Information Requiring Your Permission.

• In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required.
• Unless you object, we will use and disclose in our USMD Hospital at Arlington in-patient directory your name, the location at which you are receiving care, your condition (in general terms) and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people who ask for you by name. Only members of the clergy will be told your religious affiliation.
• Right to Request Confidential Communications
  • You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests when possible.
• Right to Request Amendment
  • If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment
• Right to an Accounting of Disclosures
  • You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. The disclosure must have been made after April 14, 2003, and no more than six years from the date of request. This right excludes disclosures made to you, for a USMD Hospital at Arlington directory; to family members or friends involved in your care or notification. The right to receive this information is subject to additional exceptions, restrictions and limitations as described earlier in this notice.
• Right to Obtain a Copy of this Notice
  • You may obtain a paper copy of this notice from USMD Hospital at Arlington or view it electronically at the Department of Health and Human Services website: http://www.os.dhhs.gov/ocr/hipaa
• Federal Privacy Laws
  • This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPPA.) There are several other privacy laws that also apply including the Freedom of Information Act, the Privacy Act and the Alcohol, Drug Abuse and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information.
• Complaints
  • If you believe these privacy rights have been violated, you may file a written complaint with the USMD Hospital at Arlington Privacy Officer, the TMA Privacy Officer, or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.
• Contact Information
  • You may contact you local USMD Hospital at Arlington Privacy Officer for further information about the complaint process or for further explanation of this document. The USMD Hospital at Arlington Privacy Officer may be contacted at:
    • USMD Hospital at Arlington
      801 West I-20
      Arlington, TX 76017
      817-472-3400