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 INFORMATION
We are required to maintain the privacy of your protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). Your "protected health information" is information about you created and received by us, including demographic information, that may reasonably identify you and relates to your past, present or future physical or mental health condition, or payment for the provision of your health care.
If other federal laws or state laws provide more stringent protection for the privacy of your medical information, we will follow those other laws.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some responsibilities to help you.
You have the right to:
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say "no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way about your medical information (for example, home or office phone) or to send your medical record information to a different address.
We will say, "yes" to all reasonable request.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree to your request, and we may say "no" if it would not affect your care.
If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.
Get a copy of those with whom we've shared information
You can ask for a list(accounting) of the times we've shared (disclosed) your health information, for up to six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you ask 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 one within 12 months.
Get a copy of this privacy notice
You can ask for a 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.
Chose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise 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 can file a complaint with us is you feel we have violated your rights by contacting our HIPAA contact person or office. We will not retaliate against you for filing a complaint.
To file a complaint with our organization, please submit your request in writing to:
Traci Tippen, Administrative Assistant
501 E. Kolstad St., Palestine, TX 75801
903.723.3250
You can file a complaint with the U.S. Department of Health and Human Services' Office for Civil Rights by send a letter to 200 Independence Avenue. S. W. Washington, D.C. 20201, by calling 877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situation described below, contact us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us:
If you are not able to tell us your preference — for example, if you are unconscious, we may share your information if we believe it is in your best interest to do so. We may also share your information when we need to lessen a serious and imminent threat to health of safety.
In these following cases, we never share your information unless you give us written permission:
In the case of fundraising:
OUR USES AND DISCLOSURES
We typically use or share your health information in the following ways:
Treatment
We may share your information for treatment activities of another provider involved in your care.
Example: A doctor treating you for an injury, ask another doctor about your overall health condition.
Payment
We can use and share your health information to bill and get payment from health plans or other entities or individuals.
Example: We give information about you to your health insurance plan so it will pay for your services
Health Care Operations
We may use and share your medical information for our health care operations, and to contact you when necessary. A few examples are using information about you for:
We may also share your protected health information with people or companies (called business associates) we use to help us with our operations.
How else can 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 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:
Do research
We may use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, and we may share it when those laws allow it. For example, if the Department of Health and Human Services wants to see that we're complying with federal privacy law.
Respond to organ and tissue request
We may share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement and other government request
We may use or share health information about you:
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.
Proof of immunization
We must disclose proof of immunization to a school that is required to have it before admitting a student where you have agreed to the disclosure on behalf of yourself or department.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose information necessary for your health and health and safety of other individuals to the institution.
42 CFR Part 2 Substance Use Disorder Records
Part 2 SUD records are records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance use disorder education, prevention, training, treatment, rehabilitation, or research, which is conducted, regulated or directly or indirectly assisted by any department or agency of the United States.
Written patient consent is required for uses and disclosures of Part 2 substance use disorder records (SUDs) for treatment, payment, and healthcare operations (TPO). This consent may be on a single consent from. Non- TPO disclosures of these SUD require sperate, specific consent.
We will only use of disclose Part 2 SUD records in a civil, criminal, administrative, or legislative proceeding against you when:
Our Responsibilities
Other Uses and Disclosures of Health Information
Other ways we share and use your health information not covered by this notice will be made only with your written authorization. If you authorize us to use or disclose your health information, you may cancel that authorization, in writing, at any time, However, the cancellation will not apply to information we have already used and disclosed based on the earlier authorization.
Changes to the Terms of this Notice
We may change the terms of this notice at any time and the changes will apply to all health information we have about you. The current notice will be available upon request and on our website.
Effective: 07.15.2026