MAVERICK MANUAL THERAPY & PERFORMANCE

HIPAA NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

YOUR RIGHTS

When it comes to your health information, you have certain rights.  This section explains your rights and our responsibilities to help you.  Please contact us to exercise these rights.

Obtain an electronic or paper copy of your medical record
You may ask to see or obtain an electronic or paper copy of your medical record and other health information.  If requested, we will provide a copy or a summary of your health information, usually within 30 days of your request.  We may charge a reasonable, cost-based fee.

Ask us to amend your medical record
You may ask us to amend health information about you that you think is incorrect or incomplete.  We have the right to deny your request, but we will explain in writing within 60 days of your request.

Request confidential communications
You may ask us to contact you in a specific confidential manner (for example, home or office phone) or to send mail to a different address.  We will comply with reasonable requests.

Ask us to restrict what we use or share
You may ask us not to use or disclose certain health information for treatment, payment, or our health care operations.  We are not required to agree to your request, and we may decline if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, and if the information is to be disclosed for payment or healthcare operations, you may ask us not to share that information with your health insurer.  We will agree to this request unless a law requires us to share that information.

Obtain a list of those with whom we’ve shared information
You may ask for a list (accounting) of the times we’ve shared your health information, with whom we’ve shared it, and why, for six years prior to the date you make the request.  We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).  We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another accounting within 12 months.

Get a copy of this privacy notice
You may ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.  We will provide you with a paper copy promptly.

Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information.  We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated
You may complain if you feel your privacy rights have been violated by contacting us using the information on the last page.  Alternatively, you may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.  We will not retaliate against you for filing a complaint.

YOUR CHOICES
For certain health information, you may tell us your choices about what we share.  If you have a clear preference for how we share your information in the situations described below, please indicate your preferences.

We may use or disclose your health information in the following instances, provided you are informed in advance and you do not object:

• For purposes of sharing your information with your family, close friends, or others involved in your care.
• For purposes of sharing your information to assist in disaster relief efforts.

We may NOT use or disclose your health information in the following instances unless we obtain your written authorization:

• For purposes of marketing.
• For purposes of selling your information.
• For purposes of disclosing highly sensitive information that pertains to psychotherapy, mental health, and alcohol and drug treatment, sexually transmitted diseases, child abuse, genetics, and other highly confidential and sensitive characteristics.
• For purposes of other uses and disclosures not described in this notice.

You may revoke an authorization at any time, provided that the revocation is in writing, except to the extent that (i) we have taken action in reliance on the authorization; or (ii) if the authorization was obtained as a condition of obtaining insurance coverage.

OUR USES AND DISCLOSURES
How do we typically use or share your health information? We are permitted to use or disclose your health information for treatment, health care operations, or payment. In particular, we typically use or disclose your health information in the following ways:

Treatment
We may use your health information and share it with other professionals who are providing you medical treatment.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Business Operations
We may use and disclose your health information for our health care operations to manage our business and the services we provide to you.

Example: We use health information to conduct quality assessment and improvement activities.

Billing for your services
We may use and disclose your health information to bill and get payment.
Example: We provide information about you to your health insurance company and other entities so they will pay for your services.

How else may we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.  We have to meet many legal requirements before we can share your information for these purposes.

Help with public health and safety issues
We may share information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Conduct Research
We may use or disclose your information for health research only with your written permission.

Comply with the law
We will disclose information about you if State or Federal laws require it, including if Department of Health and Human Services, requests proof of compliance with federal privacy and security laws.

Respond to organ and tissue donation requests
We may disclose health information about you with organ procurement organizations upon your passing.

Work with a medical examiner or funeral director
We may disclose health information with a coroner, medical examiner, or funeral director in the event of death.

Address workers’ compensation, law enforcement, and other government requests
We may use or disclose health information about you:

• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official.
• With health oversight agencies for activities authorized by law.
• For special government functions, such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions
We may share health information about you in response to a court or administrative order, or in response to a subpoena.

Electronic Communications
We may disclose your health information in electronic communications which are (a) in our text messages, emails or other electronic communications to you or in response to text messages, emails or electronic communications from you to us; and (b) statements or inquiries that you have posted on our web page, Twitter page, Facebook page, Instagram, or other public domains.  Please note that the transmission and/or storage of text messages, emails, social media postings, and other electronic communications may not be encrypted or secure.  If you have a specific question regarding your medical condition, we encourage you to contact us directly to discuss.  

Electronic Disclosures
Maverick Manual Therapy and Performance is providing you with notice that your health information may be subject to electronic disclosure.  We may not electronically disclose your health information to any person without your authorization, which may be obtained electronically, in writing, or in oral form if it is documented by us. However, such authorization is not required for an electronic disclosure of health information if the disclosure is made: (i) to another health care provider, health plan, or covered entity as defined under Texas law for the purpose of: (a) treatment; (b) payment; (c) health care operations; or (d) performing an insurance or health maintenance organization function; or (ii) as otherwise authorized or required by state or federal law.

OUR RESPONSIBILITIES
We are required by law to maintain the privacy and security of your protected health information in compliance with federal and state law. We are required to notify you of this duty and of our privacy practices with respect to your protected health information.  We will let you know promptly if a breach occurs that may have compromised the privacy or security of your unsecured information.

We must follow the duties and privacy practices described in this notice and provide you a copy of it.  We will not use or disclose your information other than as described here unless you provide us with written permission.

Changes to the Terms of This Notice
We may change the terms of this notice, and the changes will apply to all protected health information we maintain. The new notice will be available on our website and upon request in our offices.

You may contact the Privacy Officer for Maverick Manual Therapy & Performance at:

Maverick Manual Therapy
5170 Broadway #10

San Antonio, Texas 78209

Email: cvlabus@maverickmanualtherapy.com

Telephone: (830) 299-0006

If you feel your rights are violated; you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/

The effective date of this notice is March 30, 2023