Privacy

El Paso, TX - Toll Free: 1-800-575-8603 | Local: 1-915-626-5193

Tulsa, OK - Toll Free: 1-800-821-7237 | Local: 1-918-665-6400

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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

Our Legal Duty:

We are required by applicable federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.

 We reserve the right the change our privacy practices and the terms of this notice at any time, provided that such changes are permitted by applicable law. We reserve the right to make changes in our privacy practices and the new terms of our notice effective for all protected health information that we maintain, including medical information we created or received before we made the changes.

 You may request a copy of our notice (or any subsequent revised notice) at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.

 Uses and Disclosures  of Protected Health Information

 We will use and disclose your protected health information about you for treatment, payment, and health care operations.

Following are examples of the types of uses and disclosures of your protected health care information that may occur. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

 Treatment:

We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination of management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

 In addition, we may disclose your protected health information from time to time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment:

Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we 
recommend for you, such as: ,making a 
determination of eligibility or coverage for 
insurance benefits, reviewing services provided 
to you for protected health necessity, and 
undertaking utilization review activities. For 
example, obtaining approval for a hospital stay 
may require that your relevant protected health 
information be disclosed to the health plan to 
obtain approval for the hospital admission.

Health Care Operations:

We may use or 
disclose, as needed, your protected health 
information in order to conduct certain business 
and operational activities. These activities 
include, but are not limited to, quality 
assessment activities, employee review activities, 
training of students, licensing, and conducting or 
arranging for other business activities.

For example, we may use a sign-in sheet at 
the registration desk where you will be asked to 
sign your name. We may also call you by name 
in the waiting room when your doctor is ready to 
see you. We may use or disclose your protected 
health information, as necessary, to contact you 
by telephone or mail to remind you of your 
appointment.

We will share your protected health 
information with third party “business 
associates” that perform various activities (e.g., 
billing, transcription services) for the practice. 
Whenever an arrangement between our office 
and a business associate involves the use or 
disclosure of your protected health information, 
we will have a written contract that contains 
terms that will protect the privacy of your 
protected health information.

We may use or disclose your protected 
health information, as necessary, to provide you 
with information about treatment alternatives or 
other health-related benefits and services that 
may be of interest to you. We may also use and 
disclose your protected health information for 
other marketing activities. For example, your 
name and address may be used to send you a 
newsletter about our practice and the services we 
offer. We may also send you information about 
products or services that we believe may be 
beneficial to you. You may contact us to request 
that these materials not be sent to you.

Uses and Disclosures Based On Your 
Written Authorization:

Other uses and 
disclosures of your protected health information will be made only with your authorization, 
unless otherwise permitted or required by law as 
described below.

You may give us written authorization (0 
use your protected health information or to 
disclose it to anyone for any purpose. If you 
give us an authorization, you may revoke it in 
writing at any time. Your revocation will not 
affect any use or disclosures permitted by your 
authorization while it was in effect. Without 
your written authorization, we will not disclose 
your health care information except as described 
in this notice.

Others Involved in Your Health Care:

Unless you object, we may disclose to a member 
of your family, a relative, a close friend or any 
other person you identify, your protected health 
information that directly relates to that person’s 
involvement in your health care. 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 protected health information to notify or 
assist in notifying a family member, personal 
representative or any other person that is 
responsible for your care of your location, 
general condition or death.

Marketing:

We may use your protected 
health information to contact you with 
information about treatment alternatives that may 
be of interest to you. We may disclose your 
protected health information to a business 
associate to assist us in these activities. Unless 
the information is provided to you by a general 
newsletter or in person or is for products or 
services of nominal value, you may opt out of 
receiving further such information by telling us 
using the contact information listed at the end of this notice.

Research:

Death; Organ Donation: We 
may use or disclose your protected health 
information for research purposes in limited 
circumstances. We may disclose the protected 
health information of a deceased person to a 
coroner, protected health examiner, funeral 
director or organ procurement organization for 
certain purposes.

Public Health and Safety:

We may disclose your protected health information (0 the 
extent necessary to avert a serious and imminent threat to your health Or safety, or the health or 
safety of others. We may disclose your protected 
health information to a government agency 
authorized to oversee the health care system or 
government programs or its contractors, and to 
public health authorities for public health 
purposes.

Health Oversight:

We may disclose 
protected health information to a health oversight 
agency for activities authorized by law, such as 
audits, investigations and inspections. Oversight 
agencies seeking this information include 
government agencies that oversee the health care 
system, government benefit programs, other 
government regulatory programs and civil rights 
laws.

Abuse or Neglect:

We may disclose your 
protected health information to a public health 
authority that is authorized by law to receive 
reports of child abuse or neglect. In addition, we 
may disclose your protected health information if 
we believe that you have been a victim of abuse, 
neglect or domestic violence to the governmental 
entity or agency authorized to receive such 
information. In this case, the disclosure will be 
made consistent with the requirements of 
applicable federal and state laws.

Food and Drug Administration:

We may 
disclose your protected health information to a 
person or company required by the Food and 
Drug Administration to report adverse events, 
product defects or problems, biologic’ product 
deviations; to track products; to enable product 
recalls; to make repairs or replacements; or to 
conduct post marketing surveillance, as required.

Criminal Activity:

Consistent with applicable federal and state laws, we  may 
disclose your protected health information, if we believe that the use or disclosure is necessary to 
prevent or lessen a serious and imminent threat 
to the health or safety, of a person or the public. 
We  may  also  disclose  protected health 
information if it is necessary for law enforcement 
authorities to  identify  or  apprehend  an 
individual.

Required by Law:

We may use or disclose 
your protected health information when we are 
required to do so by law. For example, we must 
disclose your protected health information to the 
U.s. Department of Health and Human Services 
upon request for purposes of determining 
whether we are in compliance with federal 
privacy laws. We may disclose your protected 
health information when authorized by workers’ 
compensation or similar laws.

Process and Proceedings:

We may disclose your protected health information in 
response  to a  court or administrative  order, 
subpoena, discovery request or other lawful 
process,  under certain  circumstances. Under 
limited  circumstances, such as a court  order, 
warrant or  grand jury subpoena, we  may disclose your protected health information to law enforcement officials.

Law Enforcement:

We may disclose limited information to a law enforcement official 
concerning the protected health information of a 
suspect, fugitive, material witness, crime victim 
or  missing person. We  may disclose  the 
protected health  information of an inmate  or 
other  person  in lawful  custody to a law 
enforcement official or correctional institution 
under  certain circumstances. We may disclose 
protected health information where necessary to 
assist law enforcement officials to capture an 
individual who has admitted to participation in a 
crime or has escaped from lawful custody.

Patient Rights

Access:

You have the right to look at or get 
copies of your protected health information, with 
limited  exceptions. You must make a request in 
writing to the  contact person listed herein  to 
obtain  access  to your  protected  health 
information. You may  also request  access  by 
sending us a letter  to the address at the end  of 
this notice. If you request copies, we will charge you $__ for each page, $__ per hour for staff 
time to locate  and copy your  protected  health 
information, and postage if you  want the copies 
mailed  to you. If  you prefer, we will prepare a 
summary or  an explanation of  your  protected 
health information for a fee.  Contact us  using 
the information listed at the end of this notice for 
a full explanation of our fee structure.

Accounting of Disclosures:

You have the 
right to receive a list of instances in which we or 
our business associates disclosed your protected 
health information for purposes other than 
treatment, payment, health care operations and 
certain other activities after April 14, 2003. After 
April 14, 2009, the accounting will be provided 
for the past six (6) years. We will provide you 
with the date on which we made the disclosure, 
the name of the person or entity to whom we 
disclosed your protected health information, a 
description of the protected health information 
we disclosed, the reason for the disclosure, and 
certain other information. If you request this list 
more than once in a 12-month period, we may 
charge you a reasonable, cost-based fee for 
responding to these additional requests. Contact 
us using the Information listed at the end of this 
notice for a full explanation of our fee structure.

Restriction Requests:

You have the right 
to request that we place additional restrictions on 
our use or disclosure of your protected health 
information. We are not required to agree to 
these additional restrictions, but if we do, we will 
abide by our agreement (except in an 
emergency). Any agreement we may make to a 
request for additional restrictions must be in 
writing signed by a person authorized to make 
such an agreement on our behalf. We will not be 
bound unless our agreement is so memorialized 
in writing.

Confidential Communication:

You  have 
the  right to request  that we communicate with 
you in confidence about your protected health 
information  by alternative  means or to  an 
alternative  location. You must make  your 
request in writing. Vie must accommodate your 
request if  it is reasonable,  specifies  the 
alternative means or location, and continues to 
permit us to bill and collect payment from you.

Amendment:

You have the right to request 
that we amend your protected health information. 
Your request must be in writing, and  it must 
explain why the information should be amended. 
We may deny your request if we did not create 
the information you want amended or for certain 
other reasons. If we deny your request, we will 
provide you a written explanation. You  may 
respond with a statement of disagreement to be 
appended  to the  information you  wanted 
amended. If we accept your request to amend 
the information, we will make reasonable efforts 
to inform others, including people or entities you 
name, of  the amendment  and to include  the 
changes in any future  disclosures of that 
information.

Electronic Notice:

If you receive this notice on our website or by electronic mail (e- 
mail), you are entitled to receive this  notice in 
written form.  Please contact  us using  the 
information listed at the end of this  notice to 
obtain this notice in written form.

Department of Health and Human Services:

We 
will provide you with the address to file your 
complaint with the U.S. Department of Health 
and Human Services upon request.

 We support your right to protect the privacy 
of your protected health information. We will 
not retaliate in any way if you choose to file a 
complaint with us or with the U.S. Department 
of Health and Human Services.

Questions and Complaints

If you want more information about our 
privacy policy practices or have questions or concerns, 
please contact us using the information below.

If you believe that we may have violated 
your privacy rights, or you disagree with a 
decision we made about access to your protected 
health information or in response to a request 
you made, you may complain to us using the 
contact information below. You also may 
submit a written complaint to the U.S.

Reproductive Services of Tulsa, OK

Name of Contact Person: Executive Director
Telephone: (915) 665-6400
Fax: (918) 627-3693
Address: 6136 East 32nd Place, Tulsa, Oklahoma 74135

Reproductive Services of El Paso, TX

Name of Contact Person: Ms. Gerri Laster, Executive Administrator
Telephone: (915) 626-5193 or (800) 575-8603
Address: 1511 E Missouri Avenue, El Paso, Texas 79902