Jay M. Shenaq, M.D. – Notice of Privacy Practice
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.
Dr. Jay Shenaq is required by law to maintain the privacy of Protected Health Information and to provide individuals with notice of our legal duties and privacy practices with respect to Protected Health Information. This document is being provided to you in fulfillment of theses obligations.
Protected Health Information, or PHI, as it may be referred to in this document, is information about your identity (e.g. – your name, address, social security number, etc) your past, present or future medical or mental condition (e.g. – history of illnesses, current medications, future appointments, etc) past, present or future related health care services (e.g. – procedures performed, lab tests ordered, etc) and past, present or future payment for medical services (e.g.- insurance carrier, deductibles, payments made, etc).
Dr. Shenaq reserves the right to amend or change its practices, policies or procedures with regards to PHI at any time, and to make such changes effective for all PHI in our possession, including any PHI that may have been created or received prior to such changes. In event of such a change Dr. Shenaq will post a new revision of this notice in the office and make a copy of it available to you upon request.
Dr. Shenaq is required to make sure that at all times our office operates in a manner that is consistent with the provisions of the most current revision of this notice. If at any time you believe Dr. Shenaq has acted in a manner inconsistent with his most current Notice of Privacy Practices, or you feel your right to privacy have been violated in any way, you are entitled to file a complaint with this office or with the Secretary of the Department of Health and Human Services. To file a complaint with this office or for further information with regards to this notice or Dr. Shenaq’s privacy practices, please contact the Privacy Officer at 713-778-9909. Dr. Shenaq will not retaliate in any way against any individual who files a complaint either with his office or with the Secretary of the Department of Health and Human Services.
Use or Disclosure of PHI for Treatment, Payment and Operations
Dr. Shenaq may use or disclose your PHI without your authorization in the following situations:
- Treatment – We may use or disclose your PHI in coordinating treatment among our staff or with other providers such as primary care physicians or specialists.
- Payment – We may use or disclose your PHI to your insurance company as required to obtain payment for any services that have been rendered.
- Operations – We may use or disclose your PHI for quality assurance purposes, as part of employee performance evaluations or to help train new employees.
Other Uses or Disclosures of PHI Permitted or Required Without Your Authorization
Dr. Shenaq may also use or disclose your PHI without your written authorization in the following situations:
- To You: Dr. Shenaq may disclose your PHI to you;
- Incidental to an otherwise permitted use or disclosure: Accidental disclosure of your PHI that occur in the course of making an otherwise permitted use or disclosure are permitted as long as Dr. Shenaq has taken appropriate safeguards to try to protect the confidentiality of your PHI, and has satisfied the requirements to use the minimum amount of PHI necessary for any permitted use or disclosure of your PHI;
- Appointment reminder: Dr. Shenaq may use or disclose your PHI to contact you to provide appointment reminders, information about treatment alternatives that may apply to you and other health related services or benefits that may be of interest to you;
- Disclosure to Others Involved in Your Care: PHI may be used or disclosed to family members or others designated by you as being involved in your care. This may include notifying such individuals who are waiting for you while you are being treated in our office or leaving telephone messages concerning your condition, you treatment or your account on answering machines or with family members. Such disclosure will be limited to minimum information necessary or to the extent of the person’s involvement in you care. You have the right to object to such disclosures. Please notify the Privacy Officer if you wish to object;
- Disaster Relief/Response: Dr. Shenaq may disclose your PHI to a public or private entity that is authorized by law or by its charter to assist with disaster relief efforts (i.e. – the Red Cross);
- Required by the Secretary of Health & Human Services: PHI may be used or disclosed to demonstrate our compliance with the HIPAA, if so directed by the Secretary;
- Required by law: PHI may be used or disclosed to the extent required by law such as for purposes of reporting abuse or neglect, in response to a judicial or administrative proceeding or as may be required for law enforcement purposes. Such disclosure will be limited to the minimum information required by the law;
- For Public Health Activities: PHI may be used or disclosed for public health activities such as; preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting necessary for the Food and Drug Administration (FDA); to notify someone who may have been exposed to a communicable disease; or reports to employers about work related injuries or workplace surveillance;
- To Report Victims of Abuse, Neglect or Domestic Violence: PHI may be used or disclosed to agencies authorized by law to receive reports about abuse, neglect or domestic violence;
- For Health Oversight Activities: PHI may be used or disclosed to a health oversight agency for activities authorized by law, including audits, licensure activities, investigators, etc;
- Judicial or Administrative Proceedings: PHI may be used or disclosed in response to an order of the court or administrative tribunal, subpoena, discovery request or other lawful process;
- For Law Enforcement: In certain circumstances, PHI may be used or disclosed to law enforcement officials for law enforcement purposes;
- To Coroners and Funeral Directors: PHI about decedents may be used or disclosed to a coroner, medical examiner or funeral directors to allow them to carry out their duties as authorized by law;
- For Organ and Tissue Donation: PHI may be used or disclosed to organizations authorized in procurement, banking or transplantation of cadaver organs or tissue;
- For Research: PHI may be used or disclosed for research studies that have been approved by an institutional review board as having established the necessary protocols to protect the privacy of PHI;
- To Prevent an Imminent Threat to a Person or the Public: PHI may be used or disclosed in situations where it is believed in good faith to be necessary to prevent or diminish the threat of imminent harm to the health or safety of a person or the public;
- For Specialized Government Functions: PHI may be used or disclosed in very special circumstances involving; armed forces personnel, national security or intelligence activities; as necessary of the protection of the President or other authorized persons; to determine medical stability for State Department service; concerning inmates of a correctional institution; government programs that provide public benefits;
- For Worker’s Compensation Programs: PHI may be used or disclosed as required to comply with worker’s compensation and other similar problems;
- To Business Associates: Dr. Shenaq may disclose your PHI to a business associate (a third party) whom we have a contract with to perform a function on our behalf (such as billing or collection), as long as our contract requires that our business associate safeguard your PHI and keep it confidential.
Uses or Disclosures That Require Your Written Authorization
Any other use or disclosure of your PHI, not previously identified, will only be made upon receipt of your written authorization Such authorization will be requested by Dr. Shenaq as needed. Your receipt of care may not be conditioned upon your approval of an authorization unless the sole reason for health care is to provide PHI to a third party (e.g. -Physical examination for insurance eligibility) or treatment is part of a research study requiring your authorization.
You are entitled to revoke any authorization at any time, provided the revocation is in writing and except to the extent that Dr. Shenaq has already taken action in reliance on your authorization or if the authorization was a condition of obtaining insurance coverage. To revoke an authorization, please submit your written request to the Privacy Officer.
Your Rights with Respect to Your Protected Health Information
- Right to Request Restrictions: You have the right to request reasonable restrictions on use of your PHI, including uses and disclosures for treatment, payment and operations. Dr. Shenaq is not obligated to honor your requests, however, we will attempt to make reasonable accommodation. To request a restriction, please see our Privacy Officer for the proper form.
- Right to Confidential Communications: You have the right to request confidential communications by alternative means or at alternative locations. For example you may request that we not contact you by phone or not at your work location. Dr. Shenaq will accommodate reasonable requests. To Request confidential communications, please see the Privacy Officer for the proper form.
- Right to Inspect and Copy Your Protected Health Information: With some exceptions, you have the right to inspect or copy your PHI that exists in a designated record set, for as long as that information is in the possession of Dr. Shenaq. To inspect or copy your PHI, please see the Privacy Officer for the proper form.
- Right to Amend Your Protected Health Information: You have the right to request an amendment be made to your PHI that exists in a designated record set, for as long as that information is in the possession of Dr Shenaq. If you would like to request an amendment to your PHI, please see the Privacy Officer for the proper form.
- Right to Receive Account of Disclosures: You have the right to receive an accounting of disclosures of your PHI that were made, with certain exceptions, within the six (6) years prior to the date of request. If you would like to receive an accounting of disclosures, please see the Privacy Officer for the proper form.
- Right to Receive Copies of This Notice of Privacy Practices: You have the right to receive a paper copy of our most current Notice of Privacy Practices at any time. If you would like to receive a new copy, please ask the front desk.