Notice of Privacy Practices for Patients of LifeSpring Pediatrics


1.Purpose: LifeSpring Community Health follows the privacy practices described in this Notice. LifeSpring Community Health maintains your health information in records that are kept in a confidential manner, as required by law. LifeSpring Community Health must use and disclose or share your health information as necessary for treatment, payment, and health care operations to provide you with quality health care.

2.What Are Treatment, Payment, and Health Care Operations? Treatment includes sharing information among health care providers involved in your care. For example, your health care provider may share information about your condition with the pharmacist to discuss medications, or with radiologists or other consultants to make a diagnosis. LifeSpring Community Health may use your health information as required by your insurer or HMO to obtain payment for your treatment. LifeSpring Community Health may use and disclose your health information to improve the quality of care and for education and training purposes of UTHSCSA students, residents, and faculty. 

3.How Will LifeSpring Community Health Use and Disclose My Health Information? Your health information may be used for the following purposes unless you ask for restrictions on a specific use or disclosure: Note: You will have the opportunity to refuse some of these communications about your health information, indicated by (*). •LifeSpring Community Health directories, which may include your name and general condition. •Family members or close friends involved in your care or payment for treatment. * •Disaster relief agency if you are involved in a disaster relief effort. * •To inform you of treatment alternatives or benefits or services related to your health. * •Appointment reminders. •Public health activities, including disease prevention, injury or disability; reporting births and deaths; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect, or domestic violence. •Health oversight activities, such as audits, inspections, investigations, and licensure. •Law enforcement. •Coroners, medical examiners, and funeral directors. •Organ and tissue donation. •Certain research projects. •To prevent a serious threat to health or safety. •To military command authorities if you are a member of the armed forces or a member of a foreign military authority. •National security and intelligence activities to authorized persons to conduct special investigations. •Workers’ Compensation. Your medical information regarding benefits for work-related injuries and illnesses may be released as appropriate. •Alcohol and drug abuse information has special privacy protections. LifeSpring Community Health will not disclose any information identifying an individual as being a patient or provide any health information relating to the patient’s substance abuse treatment unless the patient consents in writing; to carry out treatment, payment, and operations; or as required by law. •To carry out health care treatment, payment, and operations functions through business associates, such as to install a new computer system. 

4.Your Authorization Is Required for Other Disclosures. Except as described above, we will not use or disclose your medical information, unless you allow LifeSpring Community Health in writing to do so. For example, we will not use your photographs for presentations outside LifeSpring Community Health without your written permission. You may withdraw or revoke your permission, which will be effective only after the date of your written withdrawal. 

5.You Have Rights Regarding Your Health Information. You have the following rights regarding your medical information, if requested on the form(s) provided by LifeSpring Community Health: •Right to request restriction. You may request limitations on your health information that we use or disclose for health care treatment, payment, or operations, although we are not required to comply with your request. For example, you may ask us not to disclose that you have had a particular procedure. We will release the information if necessary for emergency treatment. •Right to confidential communications. You may request communications of your health information in a certain way or at a certain location, but you must tell us how or where you wish to be contacted. •Right to inspect and copy. You have the right to review and obtain a copy of your medical or health record. We may charge a fee for copying, mailing, and supplies. Under limited circumstances, your request may be denied; you may request review of the denial by another licensed health care professional chosen by LifeSpring Community Health. LifeSpring Community Health will comply with the outcome of the review. Right to request amendment. If you believe that the health information we have about you is incorrect or incomplete, you may request an amendment on the form provided by LifeSpring Community Health. LifeSpring Community Health is not required to accept the amendment. •Right to accounting of disclosures. You may request a list of the disclosures of your health information that have been made to persons or entities for disclosures unrelated to health care treatment, payment, or operations within the past six (6) years, but not prior to April 14, 2003. After the first request, there may be a charge. 

6.Requirements Regarding This Notice. LifeSpring Community Health is required by law to provide you with this Notice. We will comply with this Notice for as long as it is in effect. LifeSpring Community Health may change this Notice, and these changes will be effective for health information we have about you, as well as any information we receive in the future. 

7.Complaints. If you believe your privacy rights have been violated, you may file a complaint with LifeSpring Community Health or with the Secretary of the United States Department of Health and Human Services. We will not penalize or retaliate against you in any way for making a complaint to the Department of Health and Human Services.