ANY WOMAN CAN, LLC

NOTICE OF PRIVACY PRACTICES

EFFECTIVE 1/1/2016

THIS NOTICE DESCRIBES HOW ANY WOMAN CAN MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO YOUR HEALTHCARE INFORMATION.

PLEASE REVIEW IT CAREFULLY.

Any Woman Can, LLC is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Any Woman Can, LLC or received by Any Woman Can, LLC from other healthcare providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice. Any Woman Can, LLC will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information.1

Any Woman Can, LLC reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain. Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of the current Notice of Privacy Practices from our office at any time.

Uses and Disclosures of Protected Health Information Not Requiring Your Consent:

Any Woman Can, LLC may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment, and healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration information and all other records concerning individuals who are receiving, or who at any time have received, services for mental illness, developmental disabilities, alcoholism, or drug dependence. There are also restrictions on disclosing HIV test results. 

Treatment Activities:

  • Providing, coordinating, and managing healthcare services by one or more healthcare providers
  • Consultations between healthcare providers concerning a patient
  • Referrals to other healthcare providers for treatment
  • Referrals to nursing homes or home health agencies

Example: Any Woman Can, LLC may share your information to refer you to a clinic for STI treatment (ex. Life Choices Medical Clinic, Metropolitan Health District) or to an agency for pregnancy case management services (ex. Nurse-Family Partnership).

Payment Activities:

  • Activities to obtain reimbursement for services provided
  • Collection activities to obtain past due payment for services provided
  • Determining eligibility for benefits or health insurance coverage
  • Obtaining pre-certification and pre-authorization of services to be provided
  • Managing claims and contacting insurance companies regarding payment
  • Reviewing healthcare services and discussing with insurance companies the medical necessity of

services or procedures, health plan coverage, appropriateness of care, and justification of charges

Note: Any Woman Can, LLC does not accept payment for services rendered through cash, check, or credit remittance or insurance reimbursement; all services are free-of-charge so we do not use or disclose health information for payment purposes.

Healthcare Operations Activities:

  • Contacting healthcare providers and patients about treatment alternatives
  • Conducting quality assessment and program improvement activities
  • Administering outcomes evaluations or the creation of clinical guidelines
  • Protocol development, case management, and coordination of patient care
  • Arranging for medical review, legal services, and/or auditing functions

Example: Any Woman Can, LLC may use your diagnosis, treatment, and outcome information to measure the quality of the services we provide, or to assess the effectiveness of your care when compared to patients in similar situations.

Any Woman Can, LLC may not disclose your protected health information to family members or friends who may be involved in your treatment or care without your written permission. However, health information may be disclosed without written permission to a parent, guardian, or legal custodian of a child; the guardian of an incompetent adult; the healthcare agent designated in an incapacitated patient’s healthcare power of attorney; or the personal representative or spouse of a deceased patient.

Any Woman Can, LLC may contact you either by phone, email, or mail to provide appointment reminders. You must notify our Client Services Director at the front desk if you do not wish to receive these appointment reminders.

There are additional situations when Any Woman Can, LLC is permitted or required to use or disclose your protected health information without your consent or authorization. Examples include the following:

As Required by Law:

In certain circumstances, we may be required to report individual health information to legal authorities such as law enforcement officials, court officials, and government agencies. We may be required to report child abuse or neglect; abuse of the unborn, disabled, or elderly; domestic violence involving imminent or substantial danger; and certain injuries such as gunshot wounds if there is reasonable cause to believe the wound occurred because of a crime. Mental health information may be disclosed to law enforcement authorities to report an apparent crime on our premises or if someone is in imminent danger.

For Public Health Activities:

We may release healthcare information to certain government agencies such as city and state public health departments as authorized by law. We are required to report all positive STI results to the Texas Department of State Health Services (DSHS) for public health and statistical purposes. DSHS does not release patient names or identifying information to the public. 

For Health Oversight Activities:

We may disclose healthcare records, including treatment records, in response to a written request by any federal or state government agency to perform legally authorized functions such as management audits, financial audits, program monitoring and evaluation, and individual or facility licensure or certification. The law does not allow for HIV test results to be released to government agencies without written permission, except to the state epidemiologist for efforts to control communicable diseases.

For Various Other Activities:

There are other situations that require the disclosure of protected health information including the following: to a court of law in response to a signed subpoena, to a medical examiner or coroner for completing a medical certificate or investigating a death, to the Department of Transportation if a patient’s condition affects their ability to safely operate a motor vehicle, and for Workers’ Compensation purposes.

Any Woman Can, LLC will not make any other use or disclosure of your protected health information without your written authorization. You may revoke such authorization at any time except to the extent that Any Woman Can, LLC has already acted on that authorization. Any revocation must be in writing.

Your Rights Regarding Your Protected Health information:

You have the right to request that restrictions be placed on certain uses or disclosures of your protected health information by Any Woman Can, LLC to carry out treatment, payment, or healthcare operations. You must request such restrictions in writing. We are not required to agree to your request but if we do agree, we must adhere to the restriction except when your protected health information is needed for emergency treatment. In this event, information may be disclosed only to the healthcare providers treating you. Restrictions do not apply when we are required by law to disclose healthcare information.

You have the right to review and obtain copies of your healthcare record, except for psychotherapy notes or information compiled for use, or in anticipation of use, in a civil, criminal, or administrative action or proceeding. We may charge a reasonable fee for copying your records. Any Woman Can, LLC may deny access to your records under other circumstances, in which case you have the right to have the denial reviewed.

You have the right to request that your protected health information is sent to you by alternative means or to an alternative location. You may also request that we do not send information to a specific address or that we do not contact you at a specific location. All requests must be submitted in writing and we will attempt to accommodate you if possible.

You have the right to request that portions of your healthcare record are amended, if such information is maintained by Any Woman Can, LLC. You must submit this request in writing, and under certain circumstances the request may be denied. 

You have the right to receive an accounting of disclosures of your protected health information made by Any Woman Can, LLC 6 years prior to the date of your request beginning with disclosures made on January 1, 2016. However, we are not required to record disclosures made pursuant to a signed consent or authorization.

You have the right to receive a paper or electronic copy of this Notice, even if you previously agreed to receive a different format.

Any person or patient may file a complaint with Any Woman Can, LLC or the Secretary of Health & Human Services if they believe their privacy rights have been violated. It is the policy of Any Woman Can, LLC that no retaliatory action will be taken against any individual who submits a complaint of suspected or actual non-compliance or violation of the privacy standards.

Contact the following to file a privacy complaint with Any Woman Can, LLC:

Privacy Officer

Any Woman Can, LLC

109 Gallery Circle, Ste. 115

San Antonio, TX 78258

(210) 370-3939

________________________________________

1This Notice is prepared in accordance with the Heath Insurance Portability & Accountability Act of 1996, 45 C.F.R. 164.520

 

ANY WOMAN CAN, LLC

PATIENT RIGHTS & RESPONSIBILITIES

ANY WOMAN CAN IS DEDICATED TO PROVIDING YOU WITH EXCEPTIONAL PATIENT CARE.

WE RESPECT YOUR RIGHTS AS A PATIENT AND WANT YOU TO UNDERSTAND YOUR

RESPONSIBILITIES AS A PARTNER IN YOUR HEALTHCARE.

PATIENT RIGHTS

Respect: Patients have the right to be treated with consideration, respect, and dignity, acknowledging their individuality and the values that affect their response to care. Patients are treated with kindness and compassion with honest and open answers.

Service: Patients have the right to be served without regard to age, income, race/ethnicity, nationality, religion, disability or other arbitrary circumstances.

Privacy: Patients have the right to expect that all those involved in their care will maintain their confidentiality and ensure the privacy of their medical records. Patient information is disclosed per AWC’s Notice of Privacy Practices.

Identification: Patients have the right to know the names, positions, and professional relationships of all individuals involved in their care. This includes the posting of state issued licenses for all medical and professional counseling personnel.

Information: Patients have the right to receive sufficient information, in terms they can understand, about their treatment and follow-up care. In special circumstances, this information may be provided to a person designated by the patient or a legally authorized representative.

Participation: Patients have the right to participate in the decisions affecting their healthcare in collaboration with Any Woman Can personnel.

Records: Patients have the right to inspect and obtain a copy of their personal medical records and to expect a reasonable and timely transfer of healthcare information from one provider to another.

Complaints: Patients have the right for complaints to be promptly investigated without compromising their future access to care.

Governance: Patients have the right to receive services per Any Woman Can’s articles of incorporation, by-laws, and mission. Medical services are provided in accordance with all applicable state and federal laws and medical best practices under the direction of a licensed physician.

Refusal of Services: Patients have the right to refuse medical services at any time and Any Woman Can has the right to refuse service to patients at any time, within the limits of the law.

PATIENT RESPONSIBILITIES

Appointments: Patients are responsible for arriving to their appointment on time or for canceling their appointment at least 24 hours in advance. This can be done by contacting the center and leaving a voicemail.

Respect: Patients are responsible for being considerate and respectful of others, including controlling the noise level, respecting property, and supervising all children and guests in the waiting area.

Records: Patients are responsible for providing accurate and complete information about their medical history and current healthcare needs. This includes reporting potential risks to their health and changes in their medical condition.

Discharge Plan: Patients are responsible for understanding and following their discharge care plan, which includes discussing alternative plans if needed. Patients are responsible for accepting the consequences of their healthcare decisions.

Contact the following to file a patient rights complaint with Any Woman Can, LLC:

Client Services Director

Any Woman Can, LLC

109 Gallery Circle, Ste. 115

San Antonio, TX 78258

(210) 370-3939