The University of Texas Rio Grande Valley

Privacy Notice

This Notice Describes How Health Information About You May Be Used And Disclosed And
How You Can Get Access To This Information.
Effective Date: April 2015

Please review it carefully

  1. Purpose:
    The Health Service (HS) clinic follows the privacy practices described in this Notice. The HS clinic maintains your health information in records that are kept in a confidential manner, as required by law. The HS clinic must use and disclose or share your health information as necessary for treatment, payment, and health care operations (TPO) to provide you with quality health care.
  2. What Are Treatment, Payment, and Health Care Operations (TPO)?
    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 a specialist to make a diagnosis, treatment plan or referral. The HS clinic may use your health information as required by your insurer or HMO to obtain payment for your treatment. Our clinic may use and disclose your health information to improve the quality of care in our clinic operations.
  3. Access and Disclosure: Protected Health Information (PHI):
    Is any medical information that could in any way identify a patient. PHI may be used and disclosed for purposes of TPO. PHI may be disclosed in certain other situations, listed in paragraphs 5 & 6.
  4. Authorization:
    Before we use or disclose PHI for purposes not related to TPO, and not required by law, we must obtain written patient authorization, signed and dated.
  5. Which Disclosures Can Be Made Without Your Authorization?
  •  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, including the report of an on-campus assault or rape, which, by law, must be reported anonymously to the police authorities if patient does not want to disclose his/her identity.
  • Workmen Compensation(note: we do not provide care, other than first aid and referral, for patients who are injured in a work-related incident, as is noted in the exclusion policy of HS
  • Research, Organ donation, Coroners, Medical examiners, and Funeral directors.
  • 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.

        6. Permitted Use or Disclosure if the Covered Entity Gives the Person An Opportunity to Object.

  •  Religious Affiliation to a hospital chaplain or member of the clergy
  • Family members or close friends involved in your are or payment for treatment (See HS detailed privacy policies on family/friends)
  • 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: HS has a strict policy in regards to notifying patients personally and providing no medical information (See HS confidentiality policy).

        7. You Have Rights Regarding Your Health Information.

  • You have the following rights regarding your medical information, if requested on the form(s) provided by our clinic:
  • 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.
  • 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 the HS clinic. The HS clinic 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 the HS clinic. The HS clinic 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 disclosure 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.
  • Right to a copy of this Notice. You may request a paper copy of this Notice at any time. A more detailed Notice is also available, if you would like more information of our clinic's privacy policies.

8. Requirements Regarding This Notice.
The HS clinic is required by law to provide you with this Notice. We will comply with this Notice for as long as it is in effect. The HS clinic 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.

9. Complaints.
If you believe your privacy rights have been violated, you may file a complaint with the HS clinic (956-665-2511) 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 HS clinic or to the Department of Health and Human Services.

Contact the HS clinic's Privacy Officer, Mr. Rick Gray, at (956) 665-2511 if:

*You have any questions about this Notice

*You wish to request restrictions on uses and disclosures for health care treatment, payment or operations.

*You wish to obtain a form to exercise your individual rights described in paragraph 7.

*You wish to receive a copy of a more detailed privacy policy (HIPAA) or a copy of HS clinic's complete Privacy and Confidentiality Policy