THIS NOTICE DESCRIBES HOW MEDICAL AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment
Bloemfontein Care Services LLC is required by law to maintain the privacy of protected health information ("PHI"), provide individuals with this Notice of our legal duties and privacy practices with respect to PHI, and abide by the terms of the Notice currently in effect.
How We May Use and Disclose PHI
We may use and disclose PHI without your written authorization for the following purposes:
- Treatment — to provide, coordinate, or manage your care, including with other providers and your support team.
- Payment — to obtain reimbursement from Medicaid, Medicaid Waiver programs, or other payers.
- Health Care Operations — for quality improvement, staff training, licensing, audits, and HHSC oversight.
- Required by Law — including reporting of abuse, neglect, or exploitation, public health activities, and judicial or administrative proceedings.
- To Family Members, Guardians, or Legally Authorized Representatives involved in your care, consistent with your wishes and applicable law.
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures — including most uses for marketing, the sale of PHI, and most disclosures of psychotherapy notes — will only be made with your written authorization. You may revoke an authorization at any time, in writing.
Your Rights
- Inspect and Copy your PHI in our designated record set.
- Request Amendment of PHI you believe is inaccurate or incomplete.
- Receive an Accounting of certain disclosures we have made.
- Request Restrictions on certain uses and disclosures (we will accommodate reasonable requests where required by law).
- Request Confidential Communications by alternative means or at an alternative location.
- Receive a Paper Copy of this Notice on request.
- Be Notified of any breach of unsecured PHI.
Our Responsibilities
- We are required by law to maintain the privacy and security of your PHI.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this Notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing.
Changes to This Notice
We reserve the right to change this Notice and to make the revised Notice effective for all PHI we maintain. Updated notices will be posted on our website and available at our office.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.
Contact / Privacy Officer
Bloemfontein Care Services LLC — Privacy Officer
Phone: 325-669-6604
Email: info@bleomfonteincare.com
This Notice is provided for informational purposes and does not constitute legal advice. Please contact our Privacy Officer with any questions about your rights or this Notice.