NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND TREATMENT INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Winners Circle Group of Texas and its affiliated entities (collectively “Winners Circle”) use health information about you for treatment, to obtain payment for treatment, to evaluate the quality of care you receive, and for other administrative and operational purposes, as described in this Notice. Your health information is contained in records that are the physical property and responsibility of Winners Circle. This Notice describes the use and disclosure of protected health information (PHI) by employees, staff, personnel, volunteers and other professionals authorized to enter information into your record.
Your Rights
You have the following rights with respect to protected health information about you:
Right to Copy of Notice of HIPAA Privacy Practices. You have the right to a paper copy of this Notice at any time. To obtain a copy of our current Notice of HIPAA Privacy Practices, please contact the Winners Circle Privacy Officer at the address or phone number listed below.
Right to Inspect and Copy. You have the right to inspect and/or obtain a copy of health information that may be used to make decisions about your care. This includes medical and billing records but does not include psychotherapy notes. Your request must be in writing to the Winners Circle Privacy Officer at the address listed below. If you request a copy of your health information, we may charge you a reasonable fee to cover the costs associated with copying and mailing the information. If you request an electronic copy of your PHI that we maintain electronically, we will provide an electronic copy, and will do so in the electronic form or format you requested if the PHI is readily producible in that form or format. In certain limited circumstances, we may deny your request to inspect and copy your PHI. If you are denied access to your PHI, we will document our reasons in writing and explain any right to have the denial reviewed.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in writing and submitted to the Winners Circle Privacy Officer at the address listed below. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the medical information kept by or for Winners Circle;
- is not part of the information which you would be permitted to inspect and copy; or
- is accurate and complete.
If your request for an amendment is denied, we will explain our reasons in writing. You have the right to submit a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement when we disclose health information about you.
Right to an Accounting of Disclosures. You have the right to request an accounting or detailed listing of certain disclosures of your health information during the past six (6) years. Your request must be in writing to the Winners Circle Privacy Officer at the address listed below. If you request an accounting more often than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information about you that we use or disclose. Your request must be in writing to the Winners Circle Privacy Officer at the address listed below. If you have paid in full for a service and have requested we not share PHI related to that service with a health plan, we must agree to your request. For any other request to limit how we use or disclose your PHI, we will consider
your request, but are not required to agree to the restriction. If we agree to your request for a restriction, we will comply with it unless the information is needed for emergency treatment.
Right to Request Alternative Method of Contact. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. Your request must be in writing to the Winners Circle Privacy Officer at the address listed below. We will agree to the request to the extent that it is reasonable for us to do so. For example, you may request an alternative address for billing purposes.
Right to Receive Notice of Breach. We are required by law to notify you following a breach of your unsecured PHI. We will give you written notice in the event we learn of any unauthorized use of your PHI that has not otherwise been properly secured as required by HIPAA. We are required to notify you without unreasonable delay but no later than sixty (60) days after the breach has been discovered.
Winners Circle’ Obligations
We understand that medical information about you and your health is personal. We are committed to protecting your personal health information. We create a record of the care and services you receive at Winners Circle. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by Winners Circle. By law, we are required to:
- maintain the privacy of protected health information;
- provide you with this Notice of our legal duties and privacy practices with respect to your health information;
- abide by the terms of the Notice of Privacy Practices currently in effect;
Uses or Disclosures of Your Protected Health Information
We access, use and disclose PHI for a variety of reasons. This section offers descriptions and examples of our potential uses and disclosures of your PHI. Not every potential use or disclosure will be listed in this Notice; however, all of the ways we are permitted to use and disclose information fall within one of the categories below. Other uses and disclosures not described in this Notice will be made only with your authorization.
Treatment. We may use and disclose health information about you to provide behavioral health services. To this end, we may communicate with other health care providers, such as a psychiatrist, pediatrician or other ancillary medical provider, regarding your treatment. This information is necessary for your Winners Circle behavioral health provider to determine what treatment you should receive.
Payment. We may use and disclose health information about you to others for purposes of receiving payment for treatment and services that you receive. For example, we may release portions of your PHI to Medicare/Medicaid, a private insurer or group health plan to get paid for services that we delivered to you. We may release your PHI to the state Medicaid agency to determine your eligibility for publicly funded services.
Health Care Operations. We may use and disclose health information about you for administrative and operational purposes. Members of the Performance and Quality Improvement Team may use health information about you to assess the care and outcomes in your case and others like it. The results will be used internally to continually improve the quality of care for all Winners Circle clients. For example, we may combine outcome data from many clients to evaluate the need for new products, services or treatments. We may disclose PHI to health care professionals, students and other personnel for review and training purposes. We may also combine health information we have with other sources to see where we can make improvements. We may also use and disclose PHI to evaluate the performance of our staff and your satisfaction with our services.
Business Associates. We provide some services through contracts with business associates, such as consultants, cloud service providers, and vendors. When such services are contracted, we may disclose PHI about you to our business associates so that they can perform the tasks that we have assigned to them. To protect your PHI, we require the business associate to agree to appropriately safeguard PHI about you.
Alternative Treatments. We may use health information about you to provide you with information about alternative treatments or other health-related benefits and services that may be of interest to you.
Appointment Reminders. We may use health information about you to provide appointment reminders. We may contact you by mail, e-mail, or telephone. We may use the telephone number(s) you provide us to leave voice messages or send text messages.
Required by Law. We may disclose PHI when a law requires or allows us to do so. For example, we may report information about suspected abuse and/or neglect, relating to suspected criminal activity, for FDA-regulated products or activities, or in response to a court order. We must also disclose PHI to authorities monitoring compliance with these privacy requirements.
Law Enforcement. We may disclose health information about you to a law enforcement official in circumstances such as:
- in response to a court order, subpoena, warrant, summons or similar process;
- to identify or locate a suspect, fugitive, material witness or missing person;
- about a crime victim if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- about a death we believe may be the result of criminal conduct;
- about criminal conduct occurring on our premises; and
- in emergency circumstances to report a crime; the location of a crime or victims; or the identity, description or
- location of the person who committed the crime.
Public Health. We may use health information about you for public health activities or for other health oversight activities. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report births or deaths;
- to report reactions to medications or problems with products;
- to notify people of recalls of products that they may be using; and
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Research. We may use or disclose PHI about you for research purposes under certain circumstances. For example, we may disclose health information to a research organization if an institutional review board or privacy board has reviewed and approved the research proposal, after establishing protocols to ensure the privacy of your information.
To Avert a Threat to Health or Safety. In order to avoid a serious and imminent threat to the health or safety of an individual or the public, we may disclose PHI to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
Uses and Disclosures Requiring You to Have an Opportunity to Object. In the following situations, we may use or disclose your PHI if we tell you about the use or disclosure in advance and you have the opportunity to agree to, prohibit, or restrict the use or disclosure, and you do not object. However, if there is an emergency situation and you cannot be given the opportunity to agree or object, we may use or disclose your PHI if it is consistent with any prior expressed wishes and the use or disclosure is determined to be in your best interests; provided that you must be informed and given an opportunity to object to further uses or disclosures for patient directory purposes as soon as you are able to do so.
- To families, friends or others involved in your care: We may share with your family, your friends or others involved in your care information directly related to their involvement in your care or payment for your care. We may also share PHI with these people to notify them about your location, general condition, or your death.
- Disaster relief: In the event of a disaster, we may release your PHI to a public or private relief agency, for purposes of notifying your family and friends of your location, condition or death.
Relating to Decedents. We may use or disclose health information relating to an individual’s death to medical examiners, coroners, funeral directors, or organ procurement agencies to allow them to perform their lawful duties. If you are an organ or tissue donor, we may use or disclose health information about you to organizations that help with organ, eye and tissue donation and transplantation.
De-Identified PHI. We may de-identify your PHI as permitted by law. We may use or disclose to others the de-identified information for any purpose, without your further authorization or consent, including but not limited to research studies and health care/health operations improvement activities.
Government Functions. We may use or disclose health information about you for specialized government functions, such as protection of public officials, national security and intelligence activities, or reporting to the armed services.
Workers Compensation. We may use or disclose health information about you to comply with laws and regulations related to workers compensation.
Correctional Institutions. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose health information about you. Such information will be disclosed to the correctional institution or law enforcement official when necessary for the institution to provide you with health care and to protect the health and safety of others.
Effective Date, Restrictions and Changes to This Notice
This Notice, pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), is effective October 11, 2024. Winners Circle reserves the right to change the terms of this Notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will provide you with a revised Notice in person or by mail. We will post a copy of the current notice in the waiting
area at Winners Circle service locations.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Winners Circle Privacy Officer or with the Secretary of the Department of Health and Human Services. To file a complaint with Winners Circle, contact the Privacy Officer at the address or phone number listed below. You will not be penalized or retaliated against for filing a complaint.
Contact Information
If you have any questions, requests or concerns about your Winners Circle-related health information rights or our use and disclosure of health information, please contact: Privacy Officer, Winners Circle Group of Texas, 972-499-5066, kisha@winnerscirclegroupoftexas.com.