Effective Date: September 2024
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.
This Notice is for participants and beneficiaries of the United Community Foundation and gives you advice required by law.
This Notice applies to all health care services provided by UCF, including:
We understand that your health information is personal. We are committed to protecting the confidentiality of your Protected Health Information (PHI). We create records of the health care and services you receive here. We need these records to provide quality care and comply with legal requirements.
This Notice explains:
We are required by law to:
Below is a summary of permitted uses and disclosures. Not every possible use or disclosure is listed. We will use or share your information only as permitted or required by applicable law.
| Purpose | Examples / Explanations |
|---|---|
| Treatment | To provide, coordinate, or manage your health care, including sharing PHI with other providers, laboratories, specialists, pharmacies, etc. |
| Payment | To bill and collect for services, verify insurance coverage or eligibility, determine medical necessity, and obtain prior authorizations. |
| Health Care Operations | For internal administrative, quality improvement, training, audit, accreditation, business management, and other similar functions. |
| Appointment Reminders / Health-Related Communications | To send you reminders (by mail, phone, text, or email) or inform you of alternative treatments, healthcare services, programs, or wellness initiatives. |
| Public Health & Safety | Reporting for public health activities (disease control, vital statistics, product recalls, abuse/neglect, exposure notifications), and preventing a serious threat to health or safety. |
| Health Oversight / Governmental Activities | For audits, investigations, inspections, licensure, or other regulatory actions. |
| Legal / Law Enforcement | In response to subpoenas, court orders, law enforcement requests, identifying suspects, reporting criminal conduct, etc., as permitted or required by law. |
| Research | With proper oversight (e.g. Institutional Review Board) and protections in place, for approved research projects. |
| Organ & Tissue Donation | Sharing PHI necessary for organ or tissue procurement and transplantation. |
| Workers’ Compensation / Disability / Similar Programs | To comply with legal requirements and benefit programs concerning work injuries or disability claims. |
| Business Associates | We may disclose PHI to vendors or agents (business associates) who assist us in operations, subject to written contracts requiring them to protect PHI. |
| Others Involved in Your Care | With your consent or as allowed by law, disclosure to family members or persons involved in your care or payment. |
If you authorize such a use, you can revoke that authorization in writing at any time (except to the extent we have already acted on the authorization).
Right to Inspect and Copy: You may request to view or obtain copies of PHI that we maintain in a designated record set (medical, billing, etc.). We may charge a reasonable, cost-based fee for copying, mailing, or electronic delivery.
Right to Amend: If you believe your PHI is incorrect or incomplete, you can request a written amendment. We may deny your request if we determine the record is accurate, or if it wasn’t created by us, among other reasons. If we deny, we will provide a written explanation and a right to submit a statement of disagreement.
Right to an Accounting of Disclosures: You may request a list (accounting) of certain disclosures of your PHI made by us (other than for treatment, payment, operations, or in certain other excluded categories). You may request the accounting for up to the past six years. The first accounting in a 12-month period is free; we may charge for additional accountings.
Right to Request Restrictions: You can ask us to limit how we use or disclose your PHI. We are not required to agree to all requests. However, if you pay out-of-pocket in full for a particular service, you can request that we not share PHI about that service with your health plan (for payment or healthcare operations). If we agree, we will abide by the restriction (unless needed in an emergency).
Right to Confidential Communications: You can request that we communicate with you by alternate means or at an alternate location (e.g., only at work, by mail). We will honor reasonable requests.
Right to a Paper Copy of This Notice: Even if you have accepted it electronically, you may request a paper version of this Notice at any time.
Right to Receive Notice of a Breach: If there is a breach of unsecured PHI, we will notify you as required by law, including describing the nature of the breach, steps to protect yourself, and what we are doing to investigate and mitigate the breach.
Right to Opt-Out of Fundraising Communications: If we engage in fundraising and use PHI for fundraising efforts (e.g., name, address, dates of service), you may opt out of receiving such communications. Contact the Privacy Officer to opt out.
We reserve the right to change the terms of this Notice at any time. A revised Notice may apply to all PHI we currently maintain and in the future. The revised Notice will be posted in our facilities, on our website, and you may request a copy at any time.
If we materially change this Notice, we will notify you of the change and the effective date.
If you believe your privacy rights have been violated, you may file a complaint with UCF privacy official at 832-884-9715 or by email at director@ucftexas.org.
You may also complaint with the U.S. Department of Health & Human Services, Office for Civil Rights by visiting their website.
All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.
You will be asked to sign an acknowledgment confirming that you have received this Notice of Privacy Practices. If you refuse to sign, we will note that you were offered the Notice and document your refusal.