Notice of Privacy Practices

Who follows this notice

This notice applies to BaliMedi Medical Group P.A., its clinicians and staff, and companies that help us provide care and run our practice under business associate agreements, including our management company, Pellegrin Health Management Group, LLC, and our patient platform, Healthie.

Your rights

When it comes to your health information, you have the right to:

• Get a copy of your medical record, on paper or electronically. We will usually provide it within 30 days of your request, and electronic health records within 15 business days of a written request, as Texas law requires. We may charge a reasonable, cost-based fee.
• Ask us to correct your medical record if you think it is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications, such as contacting you at a different phone number or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will agree unless a law requires us to share it.
• Get a list of those we’ve shared information with for six years before your request, excluding disclosures for treatment, payment, health care operations and certain others. One list a year is free.
• Get a copy of this notice at any time, on paper or electronically.
• Choose someone to act for you, such as a medical power of attorney or legal guardian. We will confirm the person has this authority before we act.
• File a complaint if you feel your rights are violated. Contact our Privacy Officer (below), or the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue S.W., Washington, D.C. 20201, 1-877-696-6775, or www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Your choices

You can tell us whether to share information with family, close friends or others involved in your care, or in a disaster relief situation. If you cannot tell us your preference, for example if you are unconscious, we may share information if we believe it is in your best interest, or to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes, sell your information, or share psychotherapy notes unless you give us written permission.

How we use and share your health information

• To treat you: for example, sending a prescription to the pharmacy that will dispense it, or sharing information with another provider involved in your care.
• To run our practice: for example, quality review, training and managing our services.
• To bill and get paid: for example, processing your payment for a visit.

We are also allowed or required to share information in other ways, usually for the public good, when we meet the conditions of the law. These include public health and safety (such as reporting adverse reactions to medications or preventing a serious threat), research, complying with the law (including requests from the Department of Health and Human Services), organ and tissue donation, medical examiners and funeral directors, workers’ compensation, law enforcement, health oversight agencies, special government functions, and responding to lawsuits, legal actions, court orders and subpoenas.

Texas law

Texas law may give you added protections. Your health information may be shared electronically, for example through our patient platform, electronic prescribing and secure messaging with other providers involved in your care. Under Texas law, we will not electronically disclose your health information to anyone for purposes other than treatment, payment, health care operations, or as otherwise authorized or required by state or federal law without your authorization.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• 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 in writing that we can. You may change your mind at any time by letting us know in writing.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on this website, in the Healthie patient portal and on request.

Privacy Officer

BaliMedi Medical Group P.A., Attention: Privacy Officer