THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Main Uses and Disclosures
We may use and disclose health information about you without your specific authorization for purposes of treatment, payment and health care operations.
AOM may disclose information about you to other professionals involved in your care about the services ordered by your doctor. Information may be shared in order to coordinate or consult with health professionals about your care. Information can be shared with your doctor to determine the best course of treatment for you.
We may disclose health information for activities required to obtain payment from you or your insurance carrier for the services provided to you by AOM. Examples of these activities are eligibility determination, pre-certification, billing and collection.
Health Care Operations
Health care operations include review of your protected health information by members of AOMs’ professional staff to ensure compliance with all federal and state regulations. This information will be used to improve the quality of our services provided to you by AOM. Health care operations also include AOMs’ business management and general administrative activities.
Other Uses and Disclosures
There are a limited number of other purposes for which we may use or disclose your health information without a written authorization from you.
Preventing Disease or Injury: Reporting required in situations such as communicable diseases or reporting safety concerns to the Food and Drug Administration.
Abuse or Neglect: For your wellbeing if we suspect you are a victim of abuse, neglect or domestic violence.
Improving Services and Patient Safety: For audits and surveys aimed at health oversight such as licensing inspections and audits.
To comply with the Law: In response to a court order, subpoena or for law enforcement purposes.
Unless you object, we may disclose to a member of your family, another relative, a close personal friend, or any other person identified by you, the protected health information directly relevant to that person’s involvement with your health care or payment for your health care.
For purposes of clinical research.
To Respond to Organ and Tissue Donation Requests – health information can be shared with organ procurement organizations.
Medical Examiner or Funeral Director – We can share health information with a coroner, medical examiner, or funeral director when the individual dies.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
We must obtain your prior authorization for uses and disclosures of your protected health information for marketing purposes and any sale of your protected health information.
We will obtain your authorization for any use or disclosure of your protected health information for purposes other than those summarized above.
You may revoke an authorization at any time, except to the extent we have acted in reliance on the authorization, by sending a written notice of revocation to the address on the last page of this notice.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights concerning your protected health information.
You can request additional restrictions to the disclosure of your protected health information for treatment, payment or health care operations. We must honor your request to restrict disclosure of your protected health information to your health plan if it is for care or services for which you have paid out of pocket.
We normally contact you by telephone or mail at your home address. You may request that we contact you at some other address or telephone number, or by some other method, such as e-mail. We will accommodate reasonable requests.
You may obtain a copy of protected health information that is used to make decisions about your care or payment for your care. If you request copies of records, we may charge you a reasonable fee for the copies.
You have the right to changes to your protected health information that we have. If we deny your request, you have the right to submit a statement disagreeing with our decision and to have the statement attached to the record.
You may request an accounting of certain disclosures we have made of your protected health information. This accounting doesn’t include disclosures for treatment, payment, or health care operations, disclosures to persons involved in your health care or payment, disclosures for notification purposes, or disclosures with your written authorization.
You have the right to receive notification in the event of an unpermitted use or disclosure of your unsecured protected health information.
You have the right to obtain a paper copy of this notice upon request.
AMENDMENT OF THIS NOTICE
We reserve the right to change the terms of this Notice of Privacy Practices, and to make the new notice provisions effective for all protected health information that we maintain. If we amend the terms of this notice, it will be posted here on our website and you may obtain a copy of the revised notice by sending a request to the address below.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information about our privacy practices, please call or write:
6310 Southwest Blvd, Suite 204
Fort Worth, TX 76109
Attn: Corporate Privacy Officer
Telephone: (800) 747-0407
You may also file a complaint with the Secretary of Health and Human Services by writing or calling:
Office for Civil Rights
U.S. Department of Education
Office for Civil Rights
Lyndon Baines Johnson Department of Education
Building 400 Maryland Avenue, SW
Washington, DC 20202-1100
Office of Civil Rights Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
For further information, please contact our Privacy Officer at (800) 747-0407.