Notice Of Privacy Practices

Notice of Privacy Practices


Protected Health Information (PHI) about you is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services. Our practice must maintain the privacy of PHI under a federal law known as the Health Insurance Portability and Accountability Act (hereafter “HIPAA”) and requirements called the “Privacy Rule.” Certain types of health information, such as regarding HIV, AIDS, mental health, substance abuse and genetic information, may also have additional protections under applicable state law. Under HIPAA and the Privacy Rule, our practice must provide you with this Notice of its legal duties and privacy practices with respect to PHI and must follow the terms of the Notice that is currently in effect. This Notice explains how our practice provides that protection. This Notice applies to The GI Alliance and its HIPAA-covered subsidiaries and affiliates which are under common control and/or common ownership, designated for HIPAA purposes as an affiliated covered entity.

Your Rights Under The Privacy Rule

Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required by law to follow the terms of this Notice. We will provide you with a paper copy of our current Notice if you call our office and request that a copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location in the practice, and on the GI Alliance website at :  We reserve the right to change the terms of the Notice and to make the new Notice provisions effective for all PHI that we maintain. A revised Notice will be available at the practice and on the GI Alliance website.

You have the right to authorize other use and disclosure – This means your PHI will not be disclosed to anyone without your express written authorization, except as indicated in the section below titled How We May Use or Disclose PHI Without your Authorization or Consent. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or for a sale of PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider or our practice has already taken action in reliance on the use or disclosure indicated in the authorization.

You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, fax, telephone), and/or to a destination (i.e., cell phone number, alternative address, etc.) designated by you.  Your request must be in writing, signed by you or your personal representative, and must inform us how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.

You have the right to inspect and obtain a copy your PHI* – This means you may submit a written request to inspect or obtain a copy of your complete health record, or to direct us to disclose your PHI to a third party. If your health record is maintained electronically, you also have the right to request a copy in electronic format. We have the right to charge a reasonable, cost-based fee for paper or electronic copies. In certain cases, we may deny your request, and you may have the right to appeal that decision. If we approve your request, we are required to provide you with access to your records within 30 days of your written request unless an extension is necessary. In such cases, we will notify you of the reason for the delay and the expected date when the request will be fulfilled.

You have the right to request a restriction of your PHI* – You may ask us, in writing, not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations, or with certain persons involved in your care (such as members of your family, other relatives or close personal friends). If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We must agree to this specific requested restriction for payment or healthcare operations purposes, unless disclosure is otherwise required by law. You have the right to request termination of an existing restriction.

You have the right to request an amendment to your PHI* – You may submit a written request to amend your PHI for as long as we maintain this information. Your written request must be signed by you or your personal representative and must state the reasons for the amendment/correction request. In certain cases, we may deny your request.

You have the right to request an accounting of disclosures* – You may submit a written request, signed by you or your personal representative, for a listing of certain disclosures made by us of your PHI. We will not charge a fee for the first accounting provided in a 12-month period; however, we may charge you a fee for each subsequent accounting you request within the same 12-month period.

You have the right to receive a privacy breach notice – You have the right to receive written notification if the practice discovers a Breach of your Unsecured PHI, as defined by HIPAA, and determines through a risk assessment that notification is required by law.

* If you have questions regarding your privacy rights, or would like to submit any type of written request described above, please contact our Privacy Officer. Contact information is provided at the end of this Notice.

How We May Use or Disclose PHI Without your Authorization or Consent 

As permitted by HIPAA, our practice can use or disclose your PHI, without your written consent or authorization, for the purposes listed below. We have provided a description and example below, but this list is not exhaustive; not every particular use or disclosure in every category will be listed.

Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other healthcare providers who may be involved in your care and treatment.

Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. For example, this may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits.

Healthcare Operations – We may use or disclose your PHI, as needed, in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, training, medical review, legal services, auditing functions and patient safety activities.

Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests, provide information that describes or recommends treatment alternatives regarding your care, or provide information about health-related benefits, products and services that may be of interest to you. We may contact you regarding fundraising, but you have the right to opt-out of receiving further fundraising communications. Each fundraising notice will include instructions for opting out.

Health Information Organization – The practice may use a health information organization, or other such organization, to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person that you identify, your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative** or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of PHI (e.g., unconscious or in a disaster relief situation), then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed. **A personal representative is a person permitted by law to make health care decisions on your behalf, such as someone who has a court order to do so or who has signed a valid power of attorney that includes the right to make health care decisions.

Other Permitted and Required Uses and Disclosures – We may disclose your PHI without your written consent or authorization when required by law or as otherwise permitted under HIPAA. Some examples of such disclosures include, but are not limited to: if required by state or federal law; for public health activities and safety issues (e.g. a product recall); for health oversight activities; in cases of abuse, neglect, or domestic violence; to avert a serious threat to health or safety; for research purposes; in response to a court or administrative order, and subpoenas/discovery requests that meet certain requirements; to a coroner, medical examiner or funeral director; to respond to organ and tissue donation requests; to address worker’s compensation, law enforcement and certain other government requests, and for specialized government functions (e.g., military, veterans, inmates, correctional institutions, national security, etc.); with respect to a group health plan, to disclose information to the health plan sponsor for plan administration; to assist in disaster relief efforts; to Business Associates; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.

Incidental Disclosures – Subject to applicable law, we may make incidental uses and disclosures of PHI; these are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.


Privacy Complaints

You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Services, if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint. You may ask questions about your privacy rights, file a complaint or submit a written request (for access, restriction, amendment of your PHI, or to obtain an accounting of disclosures) by notifying our Privacy Officer in writing at Facsimile: 682-477-4367  OR  550 Reserve Street, Suite 550, Southlake, TX 76092:


Effective Date:  10/29/2019