TEXAS ORTHO & PAIN CENTER 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: 

Treatment 

We are permitted to use and disclose your medical information to those involved in your treatment. For example, the physician in this practice is a specialist. When we provide treatment, we may request that your primary care physician share your medical information with us. Also, we may provide your primary care physician information about your particular condition so that he or she can appropriately treat you for other medical conditions, if any. 

Payment 

We are permitted to use and disclose your medical information to bill and collect payment for the services provided to you. For example, we may complete a claim form to obtain payment from your insurer or HMO. This form will contain medical information, such as a description of the medical service provided to you, that your insurer or HMO needs to approve payment to us. 

Health Care Operations 

We are permitted to use or disclose your medical information for the purpose of health care operations, which are activities that support this practice and ensure that quality care is delivered. For example, we may ask another physician to review this practice’s charts and medical records to evaluate our performance so that we may ensure that only best health care is provided by this practice. 

Disclosures That Can Be Made Without Your Authorization 

There are situations in which we are permitted by law to disclose or use your medical information without your written authorization, or an opportunity to object. ln other situations we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization, in writing, to stop future uses and disclosures. However, any revocation will not apply to disclosures or uses already made or taken in reliance on that authorization. 

Additional Uses or Disclosures 

• Public Health, Abuse or Neglect and Health Oversight 
• Legal Proceedings and Law Enforcement 
• Military, National Security and Intelligence Activities, Protection of The President 
• Research Organ Donation, Coroners, Medical Examiners, and Funeral Directors 

Workers’ Compensation

We may disclose your medical information as required by the Texas workers’ compensation law. 

Inmates 

If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official. This release is permitted to allow the institution to provide you with medical care)to protect your health or the health and safety of others, or for the safety and security of the institution. 

Required by Law 

We may release your medical information where the disclosure is required by law. 

Your Rights Under Federal Privacy Regulations 

The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA). Those regulations create several privileges that patients may exercise. We will not retaliate against a patient that exercises their HIPAA rights. 

Requested Restrictions 

You may request that we restrict or limit how your protected health information is used or disclosed for treatment, payment, or health care operations. We do NOT have to agree to this restriction, but if we do agree, we will comply with your request except under emergency circumstances. To request a restriction, submit the following in writing: 

(a) The information to be restricted, (b) what kind of restriction you are requesting (i.e. on the use of information, disclosure of information or both), and (c) to whom the limits apply. Please send the request to the address and person listed below. You may also request that we limit disclosure to family members, other relatives, or close personal friends that may or may not be involved in your care. 

Receiving Confidential Communications by Alternative Means 

You may request that we send communications of protected health information by alternative means or to an alternative location. This request must be made in writing to the person listed below. We are required to accommodate only reasonable requests. Please specify in your correspondence exactly how you want us to communicate with you and, if you are directing us to send it to a particular place, the contact/address information. 

Inspection and Copies of Protected Health Information 

You may inspect and/or copy health information that is within the designated record set, which is information that is issued to make decisions about your care. Texas law requires that requests for inspection of your health information also be made in writing.

Please send your request to the person listed below. 

We can refuse to provide some of the information you ask to inspect or ask to be copied of the information : 

• Includes psychotherapy notes 
• Includes the identity of a person who provided the information promise of confidentiality • Is subject to the Clinical Laboratory Improvements Amendments of 1988 • Has been compiled in anticipation of litigation 

We can refuse to provide access to or copies of some information for other reasons, provided that we provide a review of our decision on your request. Another licensed health care provider who was not involved in the prior decision to deny access will make any such review. Texas Law requires that we are ready to provide copies or a narrative within 15 days of your request. We will inform you of when the records are ready, or if we believe access should be limited. If we deny access, we will inform you in writing. HIPAA permits us to charge a reasonable cost based fee. The Texas State Board of Medical Examiners(TSBME) has set limits on fees for copies of medical records that under some circumstances may be lower than the charges permitted by HIPAA. In any event, the lower of the fee permitted by HIPAA or the fee permitted by the TSBME will be charged. 

Amendment of Medical Information 

You may request an amendment of your medical information in the designated record set. Any such request must be made in writing to the person listed below. We will respond within 60 days of your request. We may refuse to allow an amendment if the information: 

• Was not created by this practice or the physicians here in this practice 
• Is not part of the Designated Record Set 
• Is not available for inspection because of an appropriate denial 
• If the information is accurate and complete 

Even if we refuse to allow an amendment you are permitted to include a patient statement about the information at issue in your medical record. If we refuse to allow an amendment we will inform you in writing. lf we approve the amendment, we will inform you in writing, allow the amendment to be made and tell others that we know have the incorrect information. 

Accounting of Certain Disclosures 

The HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures that are other than for treatment, payment, health care operations, or made via an authorization signed by you or your representative. Please submit any request for an accounting of disclosure to the person listed below. Yourfirst accounting of disclosures (within a 12 month period) will be free. For additional requests within that period we are permitted to charge for the cost of providing the list. If there is a charge we will notify you and you may choose to withdraw or modify your request before any costs are incurred. 

Appointment Reminders, Treatment Alternatives, and Other Health-Related Benefits 

We may contact you by telephone, mail, or both to provide appointment reminders,information about treatment alternatives, or other health-related benefits and services that may be of interest to you. 

You may also opt-in for receiving SMS communications. SMS opt-in or phone numbers for the purpose of SMS will not be shared with anyone outside our office. 

Complaints 

lf you are concerned that your privacy rights have been violated, you may contact the person listed below. You may also send a written complaint to the United States 

Department of Health and Human Services. We will not retaliate against you for filing a complaint with the government or us. The contact information for the United States Department of Health and Human Services is: 

HIPAA Complaint 

7500 Security Blvd, C524-04 

Baltimore, MD 21244 

Questions and Contact Person for Requests 

If you have any questions or want to make a request pursuant to the rights described above, please contact: 

Adam Bruggeman, M.D. 

3619 Paesanos Pkwy #302

San Antonio, TX 78231 

This notice is effective on the following date: July 15, 2024. We may change our policies and this notice at any time and have those revised policies apply to all the protected health information we maintain. If or when we change our notice, we will post the new notice in the office where it can be seen.