If you have any questions about this Notice please contact: our Privacy Officer.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or verbally, are kept confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, Highlander Surgical Associates prepared this summary explanation of how we are required to, and how this practice will maintain the privacy of your health information and how we may disclose your health information. A detailed explanation is available upon request from any of our office staff.

Highlander Surgical Associates may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.

I. Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would be referring you to another physician for a second opinion.
II. Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be submitting a claim, on your behalf, for your visit to your insurance company for payment to our office.
III. Health Care Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activity, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.

We may also create and distribute de-identified health information by removing all references to individually identifiable information.

We may contact you to provide you appointment reminders or information about treatment alternatives or other health-related benefits and services our practice offers that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization inwriting and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our Privacy Officer, Highlander Surgical Associates, 301 Highlander Blvd Ste 101 Arlington, Texas 76018:

I. The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
II. Right to request restriction – Individuals will have the right to request that a covered entity restrict the disclosure of their protected health information of the individual and the covered entity must comply with the requested restriction except if the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment).
III. The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
IV. The right to inspect and copy your protected health information.
V. The right to amend your protected health information.
VI. The right to receive an accounting of disclosures of protected health information and electronic versions of protected health information.
VII. The right to obtain a paper copy of this summary version, or a detailed version of the notice from our office upon request.
VIII. Right to Provide an Authorization for Other Uses and Disclosures.
IX. Right to File a Complaint.

We are required by law to maintain the privacy of your protected health information and to provide you with the notice of our legal obligations, duties and privacy practices with respect to your protected health information.

This notice is effective as of June 13, 2011 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with our Privacy Officer or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the associated policies and procedures of this office. We will not retaliate against you for filing a complaint.

For more information or to file a complaint with our Privacy Officer: Tel: 817/419-9200 during regular business hours or in writing at: Privacy Officer, Highlander Surgical Associates, 301
Highlander Blvd Ste 101 Arlington, Texas 76018.

For complaints involving covered entities located in Arkansas, Louisiana, New Mexico, Oklahoma, or Texas:
Region VI: Office for Civil Rights
US Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Voice Phone (214) 767-4056. FAX (214) 767-0432. TDD (214) 767-8940